This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Disputes & Debates: Rapid online correspondence
- Author response: Cerebello-spinal tDCS in ataxia
- Reader response: Cerebello-spinal tDCS in ataxia
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.