| Study at a glance | |
|---|---|
| Published | Neurotherapeutics, April 2026 |
| Study type | Randomized controlled trial (STEP-PD) |
| Participants | 50 people with Parkinson’s disease |
| Treatment | Physical therapy plus motor cortex iTBS or sham, twice daily, 5 days a week, for 2 weeks |
| Main finding | Greater improvement in motor symptoms with active iTBS; no change in quality of life |
What the study is about
Parkinson’s disease affects movement: it can bring stiffness, slowness, tremor, and problems with balance and walking. Physical therapy (PT) is a cornerstone of care, helping people move more safely and confidently. But the gains from PT alone can be modest.
This study tested whether a type of TMS could help the brain get more out of each therapy session.
Why they did it
The idea is called cortical priming. Stimulating the primary motor cortex (M1), the brain region that plans and controls movement, may make it more receptive to learning. If the brain is “primed” right as therapy happens, PT might stick better.
The researchers used intermittent theta-burst stimulation (iTBS), a patterned form of TMS that delivers bursts of pulses in a few minutes rather than the longer sessions of traditional TMS. A version of iTBS, aimed at a different brain region, is already FDA-cleared for treating depression.
What they did
Fifty people with Parkinson’s disease were randomly assigned to receive PT combined with either:
- Active iTBS over the motor cortex on both sides of the brain, or
- Sham iTBS, which mimics treatment without active stimulation.
Sessions ran twice a day, five days a week, for two weeks. The main measure was the MDS-UPDRS Part III, a standard clinician-rated score of Parkinson’s motor symptoms where lower is better. It was measured in the “OFF” medication state, after medication has worn off, to capture underlying motor function rather than the effect of medication.
What it showed
- Better movement scores. The iTBS + PT group improved significantly more on OFF-medication motor scores than the sham group (a change of −4.6 points).
- No difference in quality of life. Self-reported quality-of-life scores did not differ between groups.
- Encouraging extras. Exploratory analyses found better walking stability, fewer falls, and reduced abnormal “beta-band” brain activity, a pattern of brain rhythms linked to Parkinson’s motor symptoms.
Why it matters
This study treats TMS not as a stand-alone therapy but as an amplifier for rehabilitation people are already doing. That’s a practical model: a few minutes of stimulation could make existing therapy more effective.
The early signs on balance and falls are especially worth following. Falls are one of the most serious risks for people living with Parkinson’s.
What to keep in mind
- The benefit is short-term so far. The study ran for two weeks, and the researchers note we don’t yet know how long improvements last.
- Quality of life didn’t change. Better motor scores didn’t translate into people feeling their daily life had improved, at least not within this window.
- Gait and falls were exploratory. Those findings are promising but need confirmation in studies designed to measure them.
- This is investigational. TMS is not FDA-cleared for Parkinson’s disease.
The bottom line
Pairing physical therapy with motor cortex theta-burst stimulation improved Parkinson’s motor symptoms more than physical therapy alone over two weeks. It’s a promising short-term approach, and the next step is finding out how long the benefits last.
At Junction Brain Health, we follow TMS research closely so our patients and referring providers know where the field is heading. Have questions about TMS? Contact our team.
Source: Zhang HY, Hou TT, Chen KK, et al. Intermittent theta-burst stimulation to enhance physical therapy in Parkinson’s disease: the STEP-PD randomized trial. Neurotherapeutics. 2026;23(3):e00897.
Link to Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC10273730/