Thank you Peggy and Gloria
Today was interesting and tiring. Being a double-blind study, Dr. Hu and I don't know if the treatment today was a sham or real. Dr. Hu said that Dr. Shukla knows. The day went pretty much as outlined in the clinical trial description. There were questions asked by Dr. Hu as to my ability to do certain things. Then I was videotaped while standing as long as possible, sit to rest, then up again as long as possible x3. Another was standing with arms crossed across my chest and my eyes closed, then turning around in a circle to the right, then to the left. Then standing on foam as long as possible with eyes closed and jumping with both feet....standing broad jump, thankfully with eyes open.
Then we moved to the hallway where I was videotaped doing the TUG Test, and other tests to measure my gait, speed, and balance. The worst for me was having to walk putting one foot in front of the other (Drunk driving test). I didn't care for the metronome test either where you have to walk while turning your head back and forth to the beat of a metronome for 10 meters. I imagine that I looked pretty silly doing that after looking drunk on the previous test
Then into the EMG room to record the tremors while sitting with one leg after another locked and extended. Then standing, then walking.
Then in the same room they did the TMS measure as described below. It was uncomfortable and slightly painful (mainly in my left eye and jaw/teeth) with the last of the third sessions almost biting my tongue each time as it caused my jaw to suddenly clench x 50 times. The first session was done 50 times, the middle 100 times, the last with 50 again.
TMS measure [ Time Frame: Baseline to 60 Minutes ]
Cerebellar inhibition (CBI) will be recorded which is a well-established TMS measure. A paired pulse protocol will be used with right cerebellar stimulation as the conditioning stimulus, (cerebellar conditioning stimulus or CCS) and left motor cortex stimulation (M1) as the test stimulus (TS). The investigator will determine the 'TS 0.5mV' which will indicate a stimulator setting (determined to the nearest 1% of the maximum stimulator output) that produces a peak-to-peak MEP amplitude of ≥0.5mV in at least five out of 10 trials. Interstimulus intervals (ISI) of 3 to 8 milliseconds at increment of 1 millisecond will be tested. Each run will consist of 10 trials of each of the paired stimuli (CCS-TS) and 10 trials of TS alone delivered in random order. Inhibition trial will be expressed as a ratio of mean conditioned to mean unconditioned MEP amplitude for each subject.
This was all repeated three times today. Once before the rTMS and twice afterward at 30 minutes post rTMS and 60 minutes rTMS. This took place between 10:30 and 3:30 with a 30 minute break for lunch before the treatment.
The treatment itself was in a different room with the new MagStim equipment. They did the left side first, 15 minutes. The sound is very loud, like having an MRI and does feel like being hit in the head with a ball peen hammer repeatedly. Then the right side was done for 15 minutes, which was better, having been given ear plugs for the second half of the treatment. Afterwards my neck hurt because of the position in which you have to hold your head (I have herniated and bulging disks in my neck.) I expected my head to feel bruised but it doesn't at all.
After the treatment we went through two more sessions of everything that had happened in the morning, including drawing the spirals and straight lines two more times, all the videoed hallway exercises and standing as long as I could x 3, etc. and the TMS measure.
It felt to me that I could stand longer after the treatment, but then in the last session of standing I was back to where I started. My hope is that today's treatment was the sham treatment and tomorrow's will be the real treatment in which I will see marked improvement. Dr. Hu said that tomorrow should only take from 10:00 to 1:00