Continuous theta-burst stimulation to a lesion network in cervical dystonia: a randomized, double-blind, sham-controlled, pilot trial
- 1Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Australia
Abstract
BackgroundThe mechanisms driving cervical dystonia remain unclear, limiting effective, non-invasive treatment development. Lesion network mapping previously localized a brain network derived from lesions causing cervical dystonia, with a network hub in the somatosensory cortex, a viable target for non-invasive brain stimulation.
ObjectivesWe conducted a randomized, sham-controlled, crossover trial administering continuous theta-burst stimulation (cTBS) to the S1 lesion network hub, testing whether modulating this network reduces CD symptoms.
MethodsThirteen idiopathic cervical dystonia patients (57.85 {+/-} 10.85 years) received two 10-session blocks of bilateral somatosensory cortex cTBS (active or sham; counterbalanced). The primary outcome was change in cervical dystonia symptoms, measured by the Toronto Western Spasmodic Torticollis Scale (TWSTRS). A wearable motion sensor objectively measured change in head and neck movement patterns. Motor evoked potentials and resting-state fMRI assessed cTBS-induced changes in corticospinal excitability and functional connectivity, respectively.
ResultsActive cTBS did not significantly reduce cervical dystonia symptoms compared to sham (condition x timepoint interaction: p = .149). Range of motion significantly increased with active, versus sham, cTBS (p = .015). Corticospinal excitability decreased following sham (p = .042), but not active, cTBS. No significant connectivity changes were seen from the somatosensory cortex stimulation site after active cTBS; however, significant changes emerged from the globus pallidus interna.
ConclusionThis study prospectively tested the effects of neuromodulation on a lesion network mapping-derived target. Active cTBS did not significantly improve TWSTRS scores relative to sham. The intervention was well tolerated by all patients, and future studies could consider higher-dose or alternative protocols to this target.
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BibTeX
@misc{morrisonham2026continuous,
title = {{Continuous theta-burst stimulation to a lesion network in cervical dystonia: a randomized, double-blind, sham-controlled, pilot trial}},
author = {J. Morrison-Ham and E. F. P. Younger and E. G. Ellis and N. Parsons and T. Hart and B. Speranza and L. Dipnall and M. Do and R. Perellon-Alfonso and P. M. Pecoraro and L. di Biase and K. L. Bertram and P. A. Aguis and F. Morgante and J. Joutsa and A. T. Hill and P. G. Enticott and D. T. Corp},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.10.26362783},
url = {https://www.medrxiv.org/content/10.64898/2026.09.10.26362783v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Continuous theta-burst stimulation to a lesion network in cervical dystonia: a randomized, double-blind, sham-controlled, pilot trial
AU - J. Morrison-Ham
AU - E. F. P. Younger
AU - E. G. Ellis
AU - N. Parsons
AU - T. Hart
AU - B. Speranza
AU - L. Dipnall
AU - M. Do
AU - R. Perellon-Alfonso
AU - P. M. Pecoraro
AU - L. di Biase
AU - K. L. Bertram
AU - P. A. Aguis
AU - F. Morgante
AU - J. Joutsa
AU - A. T. Hill
AU - P. G. Enticott
AU - D. T. Corp
PY - 2026
DA - 2026/09/10
PB - medRxiv
DO - 10.64898/2026.09.10.26362783
UR - https://www.medrxiv.org/content/10.64898/2026.09.10.26362783v1
AB - BackgroundThe mechanisms driving cervical dystonia remain unclear, limiting effective, non-invasive treatment development. Lesion network mapping previously localized a brain network derived from lesions causing cervical dystonia, with a network hub in the somatosensory cortex, a viable target for non-invasive brain stimulation. ObjectivesWe conducted a randomized, sham-controlled, crossover trial administering continuous theta-burst stimulation (cTBS) to the S1 lesion network hub, testing whether modulating this network reduces CD symptoms. MethodsThirteen idiopathic cervical dystonia patients (57.85 {+/-} 10.85 years) received two 10-session blocks of bilateral somatosensory cortex cTBS (active or sham; counterbalanced). The primary outcome was change in cervical dystonia symptoms, measured by the Toronto Western Spasmodic Torticollis Scale (TWSTRS). A wearable motion sensor objectively measured change in head and neck movement patterns. Motor evoked potentials and resting-state fMRI assessed cTBS-induced changes in corticospinal excitability and functional connectivity, respectively. ResultsActive cTBS did not significantly reduce cervical dystonia symptoms compared to sham (condition x timepoint interaction: p = .149). Range of motion significantly increased with active, versus sham, cTBS (p = .015). Corticospinal excitability decreased following sham (p = .042), but not active, cTBS. No significant connectivity changes were seen from the somatosensory cortex stimulation site after active cTBS; however, significant changes emerged from the globus pallidus interna. ConclusionThis study prospectively tested the effects of neuromodulation on a lesion network mapping-derived target. Active cTBS did not significantly improve TWSTRS scores relative to sham. The intervention was well tolerated by all patients, and future studies could consider higher-dose or alternative protocols to this target.
ER -