Personalising magnetic brain stimulation

This clinical trial aims to evaluate whether individualized targeted repetitive transcranial magnetic stimulation (rTMS) can improve motor and non-motor symptoms in patients with parkinsonian disorders. The main question it aims to answer is: * Does individualized targeted rTMS alleviate symptoms of parkinsonian disorders? * Which clinical manifestations of parkinsonian syndromes are responsive to individualized targeted rTMS, and to what degree? Procedures: * Preparation (Screening) Participants will undergo clinical assessments, MRI, and EEG before the treatment. * Treatment (2 Weeks) Participants will receive a 10-day TMS treatment (once daily, Monday-Friday). Each treatment day takes approximately 3-4 hours. Participants need to keep stable medications and rehabilitation routines during this time. * Follow-up (10 Weeks) Participants will undergo follow-up assessments at the end of treatment and 10 weeks after treatment. Assessments include clinical scales, MRI, and EEG.

Parkinsonian disorders, including Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy, are characterized by heterogeneous motor and non-motor manifestations that may respond incompletely to conventional pharmacological and rehabilitative treatments. Repetitive transcranial magnetic stimulation may provide a noninvasive approach to modulating dysfunctional brain networks. This study aims to evaluate the feasibility, safety, and potential clinical effects of individualized, network-guided repetitive transcranial magnetic stimulation in patients with parkinsonian disorders. This is an ongoing, single-center, single-group, open-label interventional study comprising disease-specific cohorts of participants with Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Individualized stimulation targets are identified using structural and functional magnetic resonance imaging, with particular attention to sites within the somato-cognitive action network. Participants receive intermittent theta burst stimulation according to the stimulation protocol specified in the intervention section of this record. Clinical, neuroimaging, and neurophysiological assessments are performed before treatment, immediately after completion of treatment, and at the prespecified follow-up visit. Clinical assessments evaluate motor function, mobility, balance, ataxia, non-motor symptoms, autonomic symptoms, orthostatic blood pressure regulation, and urinary function, as applicable to each disease cohort. Magnetic resonance imaging and electroencephalography are used to explore treatment-related changes in brain network function. Medications and rehabilitation regimens are maintained as stable as clinically feasible during the treatment period. An initial cohort of eight participants with multiple system atrophy was evaluated as an early, disease-specific pilot and exploratory analysis of the ongoing parent study. This analysis was conducted to assess treatment feasibility, safety, and preliminary clinical changes in the multiple system atrophy cohort. These participants form part of the overall study population and do not constitute a separate clinical trial. Recruitment and follow-up of the parent study are ongoing.