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Abstract
Objective To investigate whether a 2-week treatment with cerebellar anodal and spinal cathodal transcranial direct current stimulation (tDCS) could reduce symptoms in patients with neurodegenerative ataxia and could modulate cerebello-motor connectivity at the short and long terms.
Methods We performed a double-blind, randomized, sham-controlled, crossover trial with cerebello-spinal tDCS (5 d/wk for 2 weeks) in 20 patients with neurodegenerative ataxia. Each patient underwent a clinical evaluation before and after real tDCS or sham stimulation. A follow-up evaluation was performed at 1 and 3 months with a crossover washout period of 3 months. Cerebello-motor connectivity was evaluated with transcranial magnetic stimulation at baseline and at each follow-up.
Results Cerebello-spinal tDCS showed a significant improvement in all performance scores (Scale for the Assessment and Rating of Ataxia, International Cooperative Ataxia Rating Scale, 9-Hole Peg Test, 8-m walking time), in motor cortex excitability, and in cerebellar brain inhibition compared to sham stimulation.
Conclusions A 2-week treatment with cerebello-spinal tDCS reduces symptoms in patients with ataxia and restores motor cortex inhibition exerted by cerebellar structures. Cerebello-spinal tDCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia, still an orphan disorder of any pharmacologic intervention.
Clinical trial registration NCT03120013.
Classification of evidence This study provides Class II evidence that cerebello-spinal stimulation is effective and safe in cerebellar ataxia.
Glossary
- ANCOVA=
- analysis of covariance;
- BADL=
- basic activities of daily living;
- CBI=
- cerebellar brain inhibition;
- CS=
- conditioning stimuli;
- 8 MW=
- 8-m walking time;
- IADL=
- instrumental activities of daily living;
- ICARS=
- International Cooperative Ataxia Rating Scale;
- ISI=
- interstimulus interval;
- MSA-C=
- cerebellar variant of multiple system atrophy;
- MEP=
- motor evoked potential;
- 9HPT=
- 9-Hole Peg Test;
- rMT=
- resting motor threshold;
- SARA=
- Scale for the Assessment and Rating of Ataxia;
- SCA=
- spinocerebellar ataxia;
- SF-36=
- Short-Form Health Survey 36;
- tDCS=
- transcranial direct current stimulation;
- TMS=
- transcranial magnetic stimulation;
- TS=
- target stimuli
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial page 541
Class of Evidence: NPub.org/coe
Podcast: NPub.org/obi0b6
- Received February 5, 2018.
- Accepted in final form June 6, 2018.
- © 2018 American Academy of Neurology
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