Cortico-cortical paired associative stimulation increases SMA-M1 facilitation in tremor-dominant Parkinson’s disease

Jane Tan; Brittany K. Rurak; Rick C. Helmich; Julian P. Rodrigues; Brian D. Power; Peter Drummond; Hakuei Fujiyama; Ann-Maree Vallence

doi:10.1016/j.clinph.2026.2111928

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Cortico-cortical paired associative stimulation increases SMA-M1 facilitation in tremor-dominant Parkinson’s disease

Journal article

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Cortico-cortical paired associative stimulation increases SMA-M1 facilitation in tremor-dominant Parkinson’s disease

Jane Tan, Brittany K. Rurak, Rick C. Helmich, Julian P. Rodrigues, Brian D. Power, Peter Drummond, Hakuei Fujiyama and Ann-Maree Vallence

Clinical neurophysiology, Vol.188, 2111928

2026

DOI: https://doi.org/10.1016/j.clinph.2026.2111928

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Abstract

Parkinson'sdisease

Transcranialmagneticstimulation

Tremor

Plasticity

Primary motor cortex

Supplementary motor area

Objective Tremor is a common motor symptom of Parkinson’s disease (PD) that reduces quality of life. Cortico-cortical paired associative stimulation (ccPAS) is a transcranial magnetic stimulation protocol that induces connective associative plasticity between cortical regions. This study investigated the effects of ccPAS over supplementary motor area (SMA) and primary motor cortex (M1) on SMA-M1 facilitation and tremor severity in individuals with tremor-dominant PD. Methods Fourteen individuals with tremor-dominant PD (mean age 66.5 ± 6.3 years; 5 females) received real and sham ccPAS in separate sessions. SMA-M1 activity and tremor severity were measured before and after ccPAS. Participants were tested OFF dopaminergic medication. Results SMA-M1 facilitation increased significantly after real but not sham ccPAS. There was no significant change in tremor severity after either real or sham ccPAS. Tremor severity was not associated with the change in SMA-M1 activity following ccPAS or with baseline SMA-M1 activity. Conclusions ccPAS can increase SMA-M1 facilitation in individuals with tremor-dominant PD. A single session of SMA-M1 ccPAS was insufficient in modulating tremor severity. Significance This study provides preliminary evidence of significant increases in SMA-M1 facilitation from ccPAS in tremor-dominant PD OFF dopamine medication. Future research should explore ccPAS effects ON dopamine medication, and the effects of multi-session ccPAS.

Details

Title: Cortico-cortical paired associative stimulation increases SMA-M1 facilitation in tremor-dominant Parkinson’s disease
Authors/Creators: Jane Tan - Murdoch University
Brittany K. Rurak - Murdoch University
Rick C. Helmich - Radboud University Nijmegen
Julian P. Rodrigues - Hollywood Orthopaedic Group
Brian D. Power - The University of Notre Dame Australia
Peter Drummond - Murdoch University
Hakuei Fujiyama - Murdoch University
Ann-Maree Vallence
Publication Details: Clinical neurophysiology, Vol.188, 2111928
Publisher: Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology.
Number of pages: 10
Identifiers: 991005883368007891
Murdoch Affiliation: School of Psychology; Centre for Healthy Ageing
Language: English
Resource Type: Journal article

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