Effects of Transcranial Pulse Stimulation in Parkinson's Disease

Inclusion criteria

• Diagnosis of "probable" or "possible" PD, as defined by the current clinical criteria (52) or as confirmed by a co-investigator neurologist or confirmation via medical records or a letter from a patient's physician.
• Age from 40 to 90 years old.
• Disease stages 2 to 4 based on the UPDRS scale subdomain V (or Hoehn and Yahr scale).
• Taking stable medications for PD for at least 30 days.

Exclusion criteria

• Features suggestive of other causes of parkinsonism/Parkinson's-plus syndromes.
• History of deep brain stimulation, brain ablation surgeries, or malignant mass brain lesions.
• History of schizophrenia, bipolar illness, or alcohol/drug abuse within the past six months.
• Need for rapid clinical response due to conditions such as initiation, psychosis, or suicidality.
• Contraindications to transcranial brain stimulation (i.e., metal objects in the head, metal implanted brain medical devices, cortisone treatments within six weeks before the first stimulation session, CNS thrombosis, etc).
• Unstable medical conditions (e.g., uncontrolled diabetes, uncompensated cardiac issues, heart failure, uncompensated pulmonary disease, or chronic obstructive pulmonary disease).
• Contraindications to MRI according to MGB screening in the Martinos-Center (i.e., pacemaker, defibrillator or wires other than sternal wires, metallic foreign body in the eye, or drug infusion devices - if the models of these devices are not compatible with MRI).
• Pregnancy.
• Epilepsy or disorders that significantly increase the likelihood of seizures, including: (i) severe traumatic brain injury; (ii) congenital birth defects leading to seizures; (iii) brain tumor; (iv) metabolic disorders associated with seizures; (v) intracranial or subarachnoid hemorrhage; and (vi) non-lacunar strokes.
• Bed- or wheelchair-bound patients.