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September 18, 2018; 91 (12) Article

Cerebello-spinal tDCS in ataxia

A randomized, double-blind, sham-controlled, crossover trial

Alberto Benussi, Valentina Dell'Era, Valentina Cantoni, Elisa Bonetta, Roberto Grasso, Rosa Manenti, Maria Cotelli, Alessandro Padovani, Barbara Borroni
First published August 22, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006210
Alberto Benussi
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Valentina Dell'Era
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Valentina Cantoni
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Elisa Bonetta
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Roberto Grasso
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Rosa Manenti
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Maria Cotelli
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Alessandro Padovani
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Barbara Borroni
From the Neurology Unit (A.B., V.D., V.C., E.B., R.G., A.P., B.B.), Department of Clinical and Experimental Sciences, University of Brescia; Department of Neuroscience, Psychology, Drug Research and Child Health (V.C.), University of Florence; and Neuropsychology Unit (R.M., M.C.), IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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Citation
Cerebello-spinal tDCS in ataxia
A randomized, double-blind, sham-controlled, crossover trial
Alberto Benussi, Valentina Dell'Era, Valentina Cantoni, Elisa Bonetta, Roberto Grasso, Rosa Manenti, Maria Cotelli, Alessandro Padovani, Barbara Borroni
Neurology Sep 2018, 91 (12) e1090-e1101; DOI: 10.1212/WNL.0000000000006210

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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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Letters: Rapid online correspondence

  • Author response: Cerebello-spinal tDCS in ataxia
    • Alberto Benussi, Assistant Professor of Neurology, University of Brescia
    • Barbara Borroni, Associate Professor of Neurology, University of Brescia
    Submitted February 25, 2019
  • Reader response: Cerebello-spinal tDCS in ataxia
    • Akiyoshi Matsugi, Physiotherapist, Shijonawate Gakuen University
    Submitted August 31, 2018
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