Background: Sleeping disorder is a debilitating condition of non-motor symptoms in patients with Parkinson’s disease (PD). Pramipexole could improve sleep disorders in PD patients, while repetitive transcranial magnetic stimulation (rTMS) also improves sleep in PD. However, there is no report on whether a combination therapy of Pramipexole with rTMS would produce a better therapeutic effect over administration of Pramipexole alone.

Objective: To evaluate the clinical effect of pramipexole combined with rTMS on sleep disorders in PD patients.

Methods: PD patients with sleep disorders were selected and divided into the control group and the treatment group using a random number table method. The control group was treated with pramipexole (0.25 mg tid), and the treatment group was treated with both pramipexole (0.25 mg tid) and rTMS. Baseline medications were continued in both groups. Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used quantitatively for sleep evaluation before and after treatment. The treatment course was 4 weeks.

Results: Sixty PD patients with sleep disorders were enrolled and divided into control (N = 30, age 68.0 ± 5.7-year-old) and treatment (N = 30, 67.6 ± 6.9-year-old) groups. The sleep scores were significantly decreased in both groups after treatment with Pramipexole (P < 0.01 and P < 0.01 in ESS and PQSI scores respectively) alone or combined with rTMS (P = 0.004 and P < 0.01). The effect size for ESS score was large (Cohen’s d = 0.91 and Cohen’s d = 1.01 respectively) and was even larger for PQSI score (Cohen’s d = 1.89 and Cohen’s d = 2.23 respectively) in the control and treatment groups. Additionally, combination of Pramipexole with rTMS had a better therapeutic effect (P = 0.028 and P = 0.001). The effect size for ESS score was medium (Cohen’s d = 0.58), while the effect size for PQSI score was larger (Table 1).

Conclusion: Combination therapy of Pramipexole with rTMS can further improve sleep quality in PD patients.

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