Transcranial Magnetic Stimulation in Spino-Cerebellar Ataxia

Inclusion Criteria

• Outpatients with ataxia as diagnosed by a movement disorder specialist and confirmed by clinically obtained genetic testing of the patient and/or in a first-degree relative of the patient.
• Women of child-bearing potential must use a reliable method of contraception and must provide a negative pregnancy test at entry into the study
• Stable on doses of all medications for at least 30 days prior to study entry and for the duration of the study
• The ability to ambulate
• A score of three or higher (worse) on the 'gait' subsection of the Scale of the Assessment and Rating of Ataxia (SARA) rating scale.

Exclusion Criteria

• Any unstable illness or concomitant medical condition that, in the investigator's opinion, precludes participation in this study, including disorders that may affect gait or balance (i.e., stroke, arthritis, etc).
• The presence of clinically significant abnormalities on screening CBC, CMP or EKG.
• Pregnancy or lactation
• Concurrent participation in another clinical study
• A history of substance abuse
• The presence of psychosis, bipolar disorder, untreated depression (BDI greater than or equal to 21), or history of suicide attempt.
• Dementia or other psychiatric illness that prevents the patient from giving informed consent (Mini Mental Status Exam score less than 24).
• Legal incapacity or limited legal capacity.
• Ataxia derived from any cause other than genetically-confirmed SCA (including but not limited to alcoholism, head injury, Multiple Sclerosis, olivo-ponto-cerebellar atrophy or multiple system atrophy).
• No medication is an absolute exclusion from TMS. Medications will be reviewed by the responsible MD and a decision about inclusion will be made based on the following:
• The patient's past medical history, drug dose, history of recent medication changes or duration of treatment, and combination with other CNS active drugs.
• The published TMS guidelines review of medications to be considered with TMS.
• History of seizures, diagnosis of epilepsy, history of abnormal (epileptiform) EEG.
• TMS and MRI-Specific exclusion criteria including:
• Known metal in the head (such as a surgical aneurysm clip) or a history of prior neurosurgical procedures.
• Ferromagnetic bioimplants activated by any electronic, mechanical or magnetic means, such as cochlear implants, pacemakers, medication pumps, vagal stimulators, deep brain stimulators, neurostimulators, biostimulators, or ventriculo-peritoneal shunts.
• Subjects who have or might have bullet fragments or other shrapnel (veterans or workers exposed to metal in their work environment).
• Subjects with metallic paint (e.g. color contact lenses, tattoos, metallic eyeliner)
• Subjects expressing significant claustrophobia.