Clinical Efficacy of Intermittent Theta Burst Transcranial Magnetic Stimulation With Different Modes on Parkinson's Disease

King's PD Pain Scale (KPPS) includes 14 items rating the severity and frequency of pain, each item scored by severity (0-3) multiplied by frequency (0-4), resulting in a subscore of 0 to 12, with a total possible score range from 0 to 168. Higher scores indicate greater symptom severities and more serious influence.

Modified King's PD Pain Scale (MKPPS)，the modified version which is more suitable for Chinese people, combined with Ford's pain subtypes basing on the original. It covers five main domains, including 16 items, each item scored by severity (0-3) multiplied by frequency (0-4), resulting in a total possible score range from 0 to 192. Higher scores indicate greater symptom severities and more serious influence.

VAS, a 0-10 numeric rating scale with 0= no pain and 10=maximal pain. Higher scores indicate greater symptom severities and more serious influence.

The participants will be evaluated in their "ON" medication states. The scales used to assess non-motor symptoms included parts I (ranging from 0 to 52) and II (ranging from 0 to 52) of the MDS-UPDRS, with higher scores indicating more severe symptoms

The participants will be evaluated in their "ON" medication states. The scales used to assess non-motor symptoms included parts I (ranging from 0 to 52) and II (ranging from 0 to 52) of the MDS-UPDRS, with higher scores indicating more severe symptoms.

The participants will be evaluated in their "ON" medication states. The scales used to assess motor symptoms included parts III (ranging from 0 to 132) and IV (ranging from 0 to 24) of the MDS-UPDRS, with higher scores indicating more severe symptoms.

The depression score (ranging from 0 to 76 with higher scores indicating more severe depression) from the 24 items Hamilton Depression Scale (HAMD).

The anxiety score (ranging from 0 to 60 with higher scores indicating more severe anxiety) from the 14 items Hamilton Anxiety Scale (HAMA).

The Scale for Outcomes in Parkinson's disease for Autonomic Symptoms (SCOUP-AUT, maximal score 67, with higher scores indicating higher autonomic nervous system dysfunction).

The sleep problem index (from 0 to 68 with higher scores indicating more severe sleep problem) from the PD Sleep Scale-2 (PDSS-2).

The daytime sleepiness will be assessed by the Epworth Sleeping Scale (ESS), maximal score 24, with higher scores indicating more severe symptoms.

We will also assess change in quality of life from the Parkinson's Disease Questionnaire-39 (PDQ-39), ranging from 0 to 156 with higher scores indicating more serious influence.

The EEG examination room should be suitably arranged, kept quiet, and free from unnecessary personnel moving around, especially near the patient. Patients are instructed to wash their hair before the examination, avoid fasting, understand the precautions, and remain relaxed. Patients are asked to keep their eyes closed, stay awake, breathe calmly, sit comfortably in a chair, and keep their head still without falling asleep. The EEG cap should be fitted with appropriate tightness, with scalp impedance maintained below 20 kΩ. Earplugs are worn to minimize external interference. EEG signals are recorded using a 128-channel EEG acquisition system (Neuracle, NSH0128, China) and a 64-channel EEG cap (Greentek, Wuhan, China), with a bandpass filter of 0.1-100 Hz and a sampling rate of 1 kHz. Continuous recording is performed for at least 15 minutes. EEG data are collected at time points T0 and T1 between approximately 8:00 AM and 11:00 AM to avoid deviations due to diurnal variations within

Functional magnetic resonance imaging (fMRI) of the brain was performed using a Philips Ingenia Elition 3.0T MRI scanner in the Department of Radiology, Suzhou Blue Cross Brain Hospital, Jiangsu Province, China. During the MRI scan, patients lay quietly in a supine position with eyes closed, without limb movement, and with both upper extremities fixed. A standard 8-channel phase-array head coil was used. Subjects were placed in a supine position and immobilized using a standard plastic face mask and soft padding to restrict motion. Conventional SE sequence T1WI was used to acquire anatomical images [repetition time (TR) = 500 ms, echo time (TE) = 16 ms, matrix = 256 × 256, slice thickness = 5 mm, interslice gap = 1 mm, number of slices = 24].

Fluid attenuated inversion recovery (FLAIR) T2WI was performed to exclude patients with intracranial lesions [TR = 8000 ms, TE = 125 ms, inversion time (TI) = 2000 ms, number of excitations (NEX) = 1.00, field of view (FOV) = 24 cm × 18 cm, matr