[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-433714-105":3,"detail-sidebar-cat-0-en-105":85,"doc-detail-433714-en":134},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":78,"head_meta":80,"extra_data":82,"updated_unix":84},105,"en","repetitive-transcranial-magnetic-stimulation-in-spinocerebellar-ataxia-a-promising-avenue-amidst-clinical-trial-challenges","Repetitive transcranial magnetic stimulation in spinocerebellar ataxia - A promising avenue amidst clinical trial challenges","","Spinocerebellar ataxia is a group of hereditary neurodegenerative disorders marked by progressive gait incoordination, impaired motor control, and additional neurological deficits. A systematic review and meta-analysis of eight randomized controlled trials evaluates repetitive transcranial magnetic stimulation (rTMS) in this setting. Compared with sham, rTMS improves motor function, reducing SARA scores and increasing ICARS scores. Subgroup protocol analyses support benefit for low-frequency rTMS and intermittent theta burst stimulation, with no significant adverse events, while future work should broaden outcomes to cognitive and affective domains and address ongoing trial challenges.",{"@graph":14,"@context":77},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/repetitive-transcranial-magnetic-stimulation-in-spinocerebellar-ataxia-a-promising-avenue-amidst-clinical-trial-challenges/433714/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/repetitive-transcranial-magnetic-stimulation-in-spinocerebellar-ataxia-a-promising-avenue-amidst-clinical-trial-challenges/433714.png","ImageObject",300,407,{"name":42,"@type":43},"Eliana","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-01","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69,73],{"name":60,"@type":61,"acceptedAnswer":62},"What is spinocerebellar ataxia and why is rTMS considered?","Question",{"text":63,"@type":64},"Spinocerebellar ataxia encompasses hereditary neurodegenerative disorders with progressive gait incoordination and impaired motor control. rTMS is highlighted as noninvasive, easy to apply, and with a favorable safety profile, making it a promising potential intervention given limited effective therapies.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does rTMS affect motor outcomes in SCA compared with sham stimulation?",{"text":68,"@type":64},"The analyzed randomized controlled trials show that rTMS significantly improves motor function versus sham. Reductions in SARA scores and improvements in ICARS scores are reported as statistically significant outcomes.",{"name":70,"@type":61,"acceptedAnswer":71},"Which rTMS protocols show evidence of improving SARA scores, and what about safety?",{"text":72,"@type":64},"Low-frequency rTMS and intermittent theta burst stimulation are both reported to significantly improve SARA scores in subgroup analyses. Consistent reporting of no significant adverse events across included trials supports a favorable safety profile when standard protocols are followed.",{"name":74,"@type":61,"acceptedAnswer":75},"What challenges and future research directions are emphasized for rTMS in SCA?",{"text":76,"@type":64},"Key challenges include limited numbers of RCTs, heterogeneity in stimulation parameters, and short follow-up durations, alongside genetic heterogeneity that drives clinical variability. Future directions include longer observation periods, refined outcome measures, imaging/fluid biomarkers, wearable-sensor data capture, and potential MRI-guided neuronavigation to support personalized stimulation.","https://schema.org",{"og:url":32,"og:type":79,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":81,"canonical":32},"index,follow",{"doc_id":83,"site_id":7},433714,1791038474,{"code":4,"msg":86,"data":87},"success",[88,92,96,100,105,110,114,118,123,126,130],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Exam",70,"exam",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},5,"Comic",60,"comic",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},6,"Technology",50,"technology",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},"Research & Report",30,"research-report",{"id":119,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},9,"Religion & Spirituality",20,"religion-spirituality",{"id":121,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":121,"slug":125},"World Cup","world-cup",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":127,"slug":129},10,"Lifestyle","lifestyle",{"id":131,"doc_module":4,"doc_module_name":25,"category_name":132,"show_sort_weight":101,"slug":133},19,"General","general",{"code":4,"msg":86,"data":135},{"doc_id":83,"user_id":136,"nickname":42,"user_avatar":137,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":143,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":12,"update_tm":147,"read_time":101,"preview_page_count":4},4398048949847,"https://ap-avatar.wpscdn.com/avatar/400002536579ef2da7f?_k=1778318612642679267","J Chin MedAssoc  \nEditorial  \nRepetitive transcranial magnetic stimulation inspinocerebellar ataxia: A promising avenue amidst clinical trial challenges  \nJong-Ling Fuha,b,c,*  \naDepartment of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cBrain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC  \nSpinocerebellar ataxia (SCA) encompasses a group of hereditary neurodegenerative disorders, manifesting primarily as progressive gait incoordination, impaired motor control, and a spectrum of neurological deficits.1 Beyond the cerebellum, other brain regions, particularly the brainstem, are often affected, contributing to substantial morbidity and mortality.1,2 Given the current scarcity of effective therapeutic options for SCA,3 repetitive transcranial magnetic stimulation (rTMS) has emerged as a compelling potential intervention, recognized for its noninvasive nature, ease of application, and favorable safety profile.4  \nA recent systematic review and meta-analysis by Lin et al5 provide a timely and methodologically robust contribution to the evolving landscape of neuromodulation therapies for hereditary SCA. This comprehensive synthesis of eight randomized controlled trials (RCTs), involving 237 subjects, offers clinically meaningful insights into the efficacy of rTMS. Their findings demonstrate that rTMS significantly improves motor function, with notable reductions in Scale for the Assessment and Rating of Ataxia (SARA) scores (average 1.56 points, 95% CI,−2.88 to −0.24; p = 0.02) and improvements in International Cooperative Ataxia Rating Scale (ICARS) scores (average 3.16 points, 95% CI, −3.93 to −2.39; p \u003C 0.001) compared with sham stimulation.  \nThe strength of Lin et al’s5 study lies in its detailed protocolspecific subgroup analysis. This analysis revealed that both lowfrequency (LF) rTMS (mean difference [MD], −1.60; 95% CI,−3.06 to −0.13; p = 0.03) and intermittent theta burst stimulation (iTBS) (MD, −1.68; 95% CI, −2.29 to −1.08; p \u003C 0.001) were effective in significantly improving SARA scores. While high-frequency rTMS also showed some reduction in SARA scores, it did not reach statistical significance, likely due to smaller sample sizes in that subgroup. These findings are particularly encouraging as the observed improvements in motor symptoms surpass the natural disease progression rates, underscoring the tangible therapeutic effect of rTMS. Furthermore,  \n*Address correspondence. Dr. Jong-Ling Fuh, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: stellafuh@gmail.com](ROC. E-mail address: stellafuh@gmail.com) (J.-L. Fuh) Conflicts of interest: Dr. Jong-Ling Fuh, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article.  \nJournal of Chinese Medical Association. (2025) 88: 733-734.  \nReceived June 13, 2025; accepted June 16, 2025. doi: 10. 1097/JCMA.0000000000001257  \nCopyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nthe consistent reporting of no significant adverse events across all included trials reinforces the safety profile of rTMS when standard protocols are followed. Similar evidence of both efficacy and tolerability has also been demonstrated beyond movement disorders, such as in insomnia patients under hypnotics treated with low-frequency rTMS.6  \nBeyond motor improvements, Lin et al5 thoughtfully highlight the often-overlooked cognitive and affective dimensions of cerebellar function. They advocate for the inclusion of nonmo","cbCaimv0wi2IN1Gi","https://ap.wps.com/l/cbCaimv0wi2IN1Gi","pdf",294478,"English","# Overview of SCA and rTMS rationale\n## Evidence from systematic review and meta-analysis\n## Protocol-specific findings and safety profile\n## Cognitive and affective outcome considerations\n## Clinical trial challenges and future directions","[{\"question\":\"What is spinocerebellar ataxia and why is rTMS considered?\",\"answer\":\"Spinocerebellar ataxia encompasses hereditary neurodegenerative disorders with progressive gait incoordination and impaired motor control. rTMS is highlighted as noninvasive, easy to apply, and with a favorable safety profile, making it a promising potential intervention given limited effective therapies.\"},{\"question\":\"How does rTMS affect motor outcomes in SCA compared with sham stimulation?\",\"answer\":\"The analyzed randomized controlled trials show that rTMS significantly improves motor function versus sham. Reductions in SARA scores and improvements in ICARS scores are reported as statistically significant outcomes.\"},{\"question\":\"Which rTMS protocols show evidence of improving SARA scores, and what about safety?\",\"answer\":\"Low-frequency rTMS and intermittent theta burst stimulation are both reported to significantly improve SARA scores in subgroup analyses. Consistent reporting of no significant adverse events across included trials supports a favorable safety profile when standard protocols are followed.\"},{\"question\":\"What challenges and future research directions are emphasized for rTMS in SCA?\",\"answer\":\"Key challenges include limited numbers of RCTs, heterogeneity in stimulation parameters, and short follow-up durations, alongside genetic heterogeneity that drives clinical variability. Future directions include longer observation periods, refined outcome measures, imaging/fluid biomarkers, wearable-sensor data capture, and potential MRI-guided neuronavigation to support personalized stimulation.\"}]","Repetitive transcranial magnetic stimulation in spinocerebellar ataxia - A promising avenue amidst clinical trial challenges | PDF",1790665241]