الفهرس 
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Abstract
Parkinson’s disease is aneuro-degenerative disorder that results from dopaminergic fibers degeneration in the substantia nigra and ventral mid-brain tegmentum, it is characterized by motor symptoms ( bradykinesia, tremors, rigidity and gait disorders) and non-motor symptoms (cognitive ,mood ,psychotic,……) these symptoms may affect the Quality Of Life (QOL) of PD patients.
In the past the available treatment was medical drug treatment and rehabilitation, in the past few years brain stimulation played an important role in treatment of PD patients and in raising their QOL.
Brain stimulation may be invasive e.g. Deep Brain Stimulation (DBS) or non-invasive like t-DCS or TMS, the DBS is invasive and need good choice and higher selectivity of patients.
After application r TMS the cortex may be repeatedly stimulated and modulate its activity, for PD patients high frequency r TMS were applied on the motor areas showed marked improvement as regard motor and gait symptoms (khedr, et al., 2006).
r TMS over the DLPF cortex improves depression , cognition and may motor function as well. While the number of studies investigating the role of the PFC in motor function in PD is limited, it is possible that stimulating the PFC increases endogenous dopamine production from the basal ganglia via corticostriatal pathways.
Our study aimed to assess the efficacy of motor (c3,c4) areas stimulation using high frequency r TMS in Improving the gait and motor symptoms In PD patients and its correlation to cognitive function.
Fifteen patients with PD were enrolled in this cross over study.
All patients were assessed clinically using UPDRS, GARS and 10 MW for gait, and WCST and ERP for cognitive functions.
Each patient received 6 sessions of SHAM TMS with wash-out period of 2 weeks then the same patient received 6 sessions of Active r-TMS. Patients were assessed using motor and cognitive scales before starting the sessions (T0) then after receiving 6 sessions (T1), and 2 weeks after the end of sessions (T2)
the current study found that High frequency r TMS over motor areas (C3, C4) has significantly improved the motor symptoms and gait in PD patients , it also had mild to moderate significant improvement on the results of WCST, but has no significant effect on the ERP, there is no correlation between gait improvement and cognitive improvement when the r TMS given of these motor areas, the improvement in the gait may be referred to the direct e effect of active r TMS on the motor cortex
favorable gait response to rTMS over motor areas could be attributed to improvement of other motor features, and to lesser extent to improvement of some cognitive features.