Cervical Dystonia Treatment with Injections Supplemented by Transcranial Magnetic Stimulation: The D‐ TWIST Pilot Randomized Controlled Trial

Abstract Background For some patients with cervical dystonia (CD), botulinum toxin (BoNT) injections last less than 12 weeks. Objectives To determine if a novel, accelerated repetitive transcranial magnetic stimulation (rTMS) protocol is a safe and feasible adjunctive treatment with BoNT for CD. Methods Patients with CD reporting BoNT benefit lasting ≤9 weeks were enrolled in a randomized double‐blind, sham‐controlled, crossover study. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), mood, cognitive, and gait measures were collected before, after, and 2‐weeks following rTMS/SHAM. Results In a homogenous subset of patients (N = 4/5), TWSTRS scores were lower 2‐weeks following rTMS, but evidence of an effect was potentially limited by sample size. There was little evidence of rTMS effects on mood, cognition, or gait. Conclusions Accelerated rTMS for CD was safe, feasible, and well‐tolerated; larger randomized studies are needed to determine whether accelerated rTMS may be an effective treatment bridge for dystonia symptoms.