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

The pilot found that accelerated rTMS could be delivered safely and was well tolerated. A four-person subset had lower cervical-dystonia scores two weeks after active stimulation, but the sample is far too small to show that the approach extends botulinum toxin benefit.

Frey J, Shukla AW, Lopes JL, Fanty L, Wajid M, Ramirez‐Zamora A, Malaty IA, Cagle J, de Hemptinne C, Scarisbrick DM, Worhunsky P, Yu J.
Movement Disorders Clinical Practice · Publication date: 2026-10-11
Added to site: 2026-10-12
DOI: 10.1002/mdc3.70862

Published online October 11, 2026. Added to Neurofeedback.com October 12, 2026 after abstract review.

Modalities

Accelerated repetitive transcranial magnetic stimulation, Botulinum toxin adjunct

Clinical focus

Cervical dystonia, Treatment-interval bridging

Population

People with cervical dystonia who reported botulinum toxin benefit lasting nine weeks or less

Sample

Five participants; the main two-week symptom observation was reported for a more homogeneous subset of four

Intervention / method

An accelerated rTMS protocol was administered as an adjunct to botulinum toxin treatment, with clinical, mood, cognitive and gait measures collected before, immediately after and two weeks after active or sham stimulation

Comparator

Sham stimulation in a crossover design

Clinician summary

TWSTRS scores were lower two weeks after active rTMS in a homogeneous subset of four of five participants. The abstract reports little evidence of effects on mood, cognition or gait. The result supports feasibility and a larger trial, not comparative efficacy.

How to interpret the findings

Only five people entered this crossover pilot, the favorable symptom observation was based on four, and the abstract does not provide exact effect sizes, confidence intervals, masking checks, carryover analysis or longer follow-up. Subset analysis and the absence of clear effects on mood, cognition or gait sharply limit interpretation.

Equipment and disclosures

An accelerated rTMS protocol was used. The checked abstract does not identify a device manufacturer, and this record does not attribute the system to BrainMaster.

The checked PubMed and Crossref records did not provide a conflict-of-interest statement or funding details. No correction, retraction or expression-of-concern relationship appeared in the retained records.

Related evidence

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