DISCUSSION
tremor, functional disability, dysfunction of the cerebellum
PATHOGENESIS, MOVEMENT DISORDERS
ET is one of the most common movement disorders, and multiple treatments are available (Sharma & Pandey, In our study, we found that when patients took propranolol orally at a dose of 30 or 60 mg for the first 10 days, there was no significant change in any of the FTM subscores or the total score. We observed that there was a significant reduction in tremor severity and significant improvement in functional disability (including writing/drawing/pouring of water) in patients when the dose was increased to 90 mg and administered for another 20 days. According to the evidence‐based ET treatment guidelines from the American Academy of Neurology, class I evidence supports the successful use of propranolol in ET treatment (Zesiewicz et al., Our research results also presented that there was no statistically significant difference in the therapeutic effect between rTMS and propranolol at any time point. In a recent single‐center, single‐blinded, randomized, sham‐controlled pilot study, all patients kept taking propranolol at their original dosage during all rTMS applications of the same protocol as our study, and they concluded that rTMS as an “add‐on” treatment had no obvious effect on ET patients who took propranolol (Shin et al., Previous studies have shown that dysfunction of the cerebellum is crucial in the pathogenesis of ET. Using a combination of electromyography and fMRI, researchers have found increased tremor‐related activity in multiple regions of the bilateral cerebellum of ET patients (Maas et al., When interpreting our results, some limitations of our study should be taken into account. First, since we did not design a sham stimulation control during rTMS treatment, we cannot completely rule out the placebo effect on ET patients. In a double‐blind, sham‐controlled, crossover, add‐on clinical trial, patients were divided into two groups to receive rTMS and sham stimulation treatments and crossed over after a 2‐month washout period. In this study, one patient who received sham stimulation had at least a 70% reduction in the severity of tremor on day 5 compared with the baseline total FTM scores. They also found that compared with sham stimulation on day 5, 12, or 30, the total FTM scores in rTMS did not significantly improve (Olfati et al., 