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van Dun K, Manto M. Non-invasive Cerebellar Stimulation: Moving Towards Clinical Applications for Cerebellar and Extra-Cerebellar Disorders. THE CEREBELLUM 2019; 17:259-263. [PMID: 29282616 DOI: 10.1007/s12311-017-0908-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The field of non-invasive stimulation of the cerebellum is quickly expanding. The anatomical structure of the cerebellum with a high density of neurons in the superficial layer, its electrical properties, and its participation in numerous closed-loop circuits involved in motor, cognitive, and affective operations both in children and in adults make of the cerebellum a target with very high potential for neuromodulation of both cerebellar and extra-cerebellar disorders, in neurology, psychiatry, and neurosurgery. A common research effort is required to extract the optimal parameters of stimulation and to identify how non-invasive stimulation of the cerebellum modifies cerebellar plasticity and functional connectivity in remote cortical and subcortical areas. A patient stratification should be considered.
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Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Mario Manto
- FNRS, ULB-Erasme, Brussels, Belgium
- Service des Neurosciences, Université de Mons, Mons, Belgium
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Maas RPPWM, Toni I, Doorduin J, Klockgether T, Schutter DJLG, van de Warrenburg BPC. Cerebellar transcranial direct current stimulation in spinocerebellar ataxia type 3 (SCA3-tDCS): rationale and protocol of a randomized, double-blind, sham-controlled study. BMC Neurol 2019; 19:149. [PMID: 31272408 PMCID: PMC6610834 DOI: 10.1186/s12883-019-1379-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Spinocerebellar ataxia type 3 (SCA3) is the most common subtype among the autosomal dominant cerebellar ataxias, a group of neurodegenerative disorders for which currently no disease-specific therapy is available. Evidence-based options for symptomatic treatment of ataxia are also limited. Recent investigations in a heterogeneous group of hereditary and acquired ataxias showed promising, prolonged effects of a two-week course with daily sessions of cerebellar anodal transcranial direct current stimulation (tDCS) on ataxia severity, gait speed, and upper limb dexterity. The aim of the SCA3-tDCS study is to further examine whether tDCS improves ataxia severity and various (cerebellar) non-motor symptoms in a homogeneous cohort of SCA3 patients and to explore the time course of these effects. METHODS/DESIGN An investigator-initiated, double-blind, randomized, sham-controlled, single-center trial will be conducted. Twenty mildly to moderately affected SCA3 patients (Scale for the Assessment and Rating of Ataxia score between 3 and 20) will be included and randomly assigned in a 1:1 ratio to either cerebellar anodal tDCS or sham cerebellar tDCS. Patients, investigators, and outcome assessors are unaware of treatment allocation. Cerebellar tDCS (20 min, 2 mA, ramp-up and down periods of 30 s each) will be delivered over ten sessions, distributed in two groups of five consecutive days with a two-day break in between. Outcomes are assessed after a single session of tDCS, after the tenth stimulation (T1), and after three, six, and twelve months. The primary outcome measure is the absolute change of the SARA score between baseline and T1. In addition, effects on a variety of other motor and neuropsychological functions in which the cerebellum is known to be involved will be evaluated using quantitative motor tests, static posturography, neurophysiological measurements, cognitive assessment, and questionnaires. DISCUSSION The results of this study will inform us whether repeated sessions of cerebellar anodal tDCS benefit SCA3 patients and whether this form of non-invasive stimulation might be a novel therapeutic approach to consider in a neurorehabilitation setting. Combined with two earlier controlled trials, a positive effect of the SCA3-tDCS study will encourage implementation of this intervention and stimulate further research in other SCAs and heredodegenerative ataxias. TRIAL REGISTRATION NL7321 , registered October 8, 2018.
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Affiliation(s)
- Roderick P. P. W. M. Maas
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Thomas Klockgether
- Department of Neurology, University of Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Dennis J. L. G. Schutter
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Bart P. C. van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
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Van Overwalle F, Manto M, Leggio M, Delgado-García JM. The sequencing process generated by the cerebellum crucially contributes to social interactions. Med Hypotheses 2019; 128:33-42. [PMID: 31203906 DOI: 10.1016/j.mehy.2019.05.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 11/25/2022]
Abstract
The capacity to understand another person's emotions, intentions, beliefs and personality traits, based on observed or communicated behaviors, is termed social cognition. During the last decade, social neuroscience has made great progress in understanding the neural correlates of social cognition. However, because the cerebellum is traditionally viewed as only involved in motor processing, the contribution of this major part of the brain in social processing has been largely ignored and its specific role in social cognition remains unclear. Nevertheless, recent meta-analyses have made its crucial contribution to social cognition evident. This raises the question: What is the exact function of the cerebellum in social cognition? We hypothesize that the cerebellum builds internal action models of our social inter-actions to predict how other people's actions will be executed, what our most likely responses are to these actions, so that we can automatize our interactions and instantly detect disruptions in these action sequences. This mechanism likely allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand behaviors and to detect violations. This hypothesis has major implications in neurological disorders affecting the cerebellum such as autism, with detrimental effects on social functionality, especially on more complex and abstract social cognitive processes. Because the fundamental anatomical organization of the cerebellum is identical in many species (cerebellar microcomplexes), this hypothesis could have major impacts to elucidate social interactions in social animals.
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Affiliation(s)
| | - Mario Manto
- Service de Neurologie, CHU-Charleroi, Belgium & Service des Neurosciences, Université de Mons, Belgium.
| | - Maria Leggio
- Department of Psychology, University of Rome 'Sapienza', Rome, Italy; Ataxia Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.
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Batsikadze G, Rezaee Z, Chang DI, Gerwig M, Herlitze S, Dutta A, Nitsche MA, Timmann D. Effects of cerebellar transcranial direct current stimulation on cerebellar-brain inhibition in humans: A systematic evaluation. Brain Stimul 2019; 12:1177-1186. [PMID: 31040077 DOI: 10.1016/j.brs.2019.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cerebellar transcranial direct current stimulation (ctDCS) is increasingly used to modulate cerebellar excitability and plasticity in healthy subjects and various patient populations. ctDCS parameters are poorly standardized, and its physiology remains little understood. Our aim was to compare the physiological effects of three different non-target electrode positions (buccinator muscle, supraorbital region, deltoid muscle). METHODS In the first experiment, physiological after-effects of ctDCS were compared based on cerebellar-brain inhibition (CBI) in a group of 15 healthy right-handed participants. In the second experiment, CBI after-effects of ctDCS were assessed using different transcranial magnetic stimulation (TMS) intensities in 14 participants (CBI recruitment curve). The electric field distribution was calculated for each of the electrode montages based on a single anatomically accurate head model. RESULTS Anodal and cathodal ctDCS polarities significantly decreased cerebellar-brain inhibition (CBI) with no substantial differences between the montages. Lower cerebellar TMS intensities resulted in decreased CBI following cathodal and increased CBI after anodal ctDCS. Computational modeling revealed minor differences in the electric field distribution between non-target electrode positions based on the effect size. CONCLUSION Our results show that the non-target electrode position has no significant impact on modeling results and physiological ctDCS after-effects. The recruitment of the cerebellar-M1 connection, however, varied depending on ctDCS polarity and cerebellar transcranial magnetic stimulation intensity, possibly due to diverse effects on different cell populations in the cerebellar cortex. This may be one of the reasons why ctDCS effects on functional measures are difficult to predict.
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Affiliation(s)
- Giorgi Batsikadze
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Zeynab Rezaee
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, 14260, USA
| | - Dae-In Chang
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany; Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Virchowstrasse 174, 45147, Essen, Germany
| | - Marcus Gerwig
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Stefan Herlitze
- Department of General Zoology and Neurobiology, Ruhr-University Bochum, Universitätsstraße 150, 44780, Bochum, Germany
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, 14260, USA
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Ardeystraße 67, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
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Rezaee Z, Dutta A. Cerebellar Lobules Optimal Stimulation (CLOS): A Computational Pipeline to Optimize Cerebellar Lobule-Specific Electric Field Distribution. Front Neurosci 2019; 13:266. [PMID: 31031578 PMCID: PMC6473058 DOI: 10.3389/fnins.2019.00266] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Cerebellar transcranial direct current stimulation (ctDCS) is challenging due to the complexity of the cerebellar structure which is reflected by the well-known variability in ctDCS effects. Therefore, our objective is to present a freely available computational modeling pipeline for cerebellar lobules' optimal stimulation (CLOS). METHODS CLOS can optimize lobule-specific electric field distribution following finite element analysis (FEA) using freely available computational modeling pipelines. We modeled published ctDCS montages with 5 cm × 5 cm anode placed 3 cm lateral to inion, and the same sized cathode was placed on the: (1) contralateral supra-orbital area (called Manto montage), and (2) buccinators muscle (called Celnik montage). Also, a published (3) 4×1 HD-ctDCS electrode montage was modeled. We also investigated the effects of the subject-specific head model versus Colin 27 average head model on lobule-specific electric field distribution. Three-way analysis of variance (ANOVA) was used to determine the effects of lobules, montage, and head model on the electric field distribution. The differences in lobule-specific electric field distribution across different freely available computational pipelines were also evaluated using subject-specific head model. We also presented an application of our computational pipeline to optimize a ctDCS electrode montage to deliver peak electric field at the cerebellar lobules VII-IX related to ankle function. RESULTS Eta-squared effect size after three-way ANOVA for electric field strength was 0.05 for lobule, 0.00 for montage, 0.04 for the head model, 0.01 for lobule∗montage interaction, 0.01 for lobule∗ head model interaction, and 0.00 for montage∗head model interaction. The electric field strength of both the Celnik and the Manto montages affected the lobules Crus I/II, VIIb, VIII, and IX of the targeted cerebellar hemisphere where Manto montage had a spillover to the contralateral cerebellar hemisphere. The 4×1 HD-ctDCS montage primarily affected the lobules Crus I/II of the targeted cerebellar hemisphere. All three published ctDCS montages were found to be not optimal for ankle function (lobules VII-IX), so we presented a novel HD-ctDCS electrode montage. DISCUSSION Our freely available CLOS pipeline can be leveraged to optimize electromagnetic stimulation to target cerebellar lobules related to different cognitive and motor functions.
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Affiliation(s)
- Zeynab Rezaee
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
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Mamlins A, Hulst T, Donchin O, Timmann D, Claassen J. No effects of cerebellar transcranial direct current stimulation on force field and visuomotor reach adaptation in young and healthy subjects. J Neurophysiol 2019; 121:2112-2125. [PMID: 30943093 DOI: 10.1152/jn.00352.2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Previous studies have shown that cerebellar transcranial direct current stimulation (tDCS) leads to faster adaptation of arm reaching movements to visuomotor rotation and force field perturbations in healthy subjects. The first aim of the present study was to confirm a stimulation-dependent effect on motor adaptation. Second, we investigated whether tDCS effects differ depending on onset, that is, before or at the beginning of the adaptation phase. A total of 120 healthy and right-handed subjects (60 women, mean age 23.2 ± SD 2.7 yr, range 18-31 yr) were tested. Subjects moved a cursor with a manipulandum to one of eight targets presented on a vertically orientated screen. Three baseline blocks were followed by one adaptation block and three washout blocks. Sixty subjects did a force field adaptation task (FF), and 60 subjects did a visuomotor adaptation task (VM). Equal numbers of subjects received anodal, cathodal, or sham cerebellar tDCS beginning either in the third baseline block or at the start of the adaptation block. In FF and VM, tDCS and the onset of tDCS did not show a significant effect on motor adaptation (all P values >0.05). We were unable to support previous findings of modulatory cerebellar tDCS effects in reaching adaptation tasks in healthy subjects. Prior to possible application in patients with cerebellar disease, future experiments are needed to determine which tDCS and task parameters lead to robust tDCS effects. NEW & NOTEWORTHY Transcranial direct current stimulation (tDCS) is a promising tool to improve motor learning. We investigated whether cerebellar tDCS improves motor learning in force field and visuomotor tasks in healthy subjects and what influence the onset of stimulation has. We did not find stimulation effects of tDCS or an effect of onset of stimulation. A reevaluation of cerebellar tDCS in healthy subjects and at the end of the clinical potential in cerebellar patients is demanded.
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Affiliation(s)
- A Mamlins
- Department of Neurology, University Hospital Essen, University of Duisburg - Essen , Germany
| | - T Hulst
- Department of Neurology, University Hospital Essen, University of Duisburg - Essen , Germany.,Department of Neuroscience, Erasmus MC, Rotterdam , The Netherlands ; Erasmus University College, Rotterdam , The Netherlands
| | - O Donchin
- Ben-Gurion University of the Negev, Department of Biomedical Engineering and Zlotowski Center for Neuroscience , Beer Sheva , Israel
| | - D Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg - Essen , Germany
| | - J Claassen
- Department of Neurology, University Hospital Essen, University of Duisburg - Essen , Germany
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van Dun K, Mitoma H, Manto M. Cerebellar Cortex as a Therapeutic Target for Neurostimulation. THE CEREBELLUM 2018; 17:777-787. [PMID: 30276522 DOI: 10.1007/s12311-018-0976-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.
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Affiliation(s)
- Kim van Dun
- Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussels, Pleinlaan 2, 1050, Brussels, Belgium.
| | - Hiroshi Mitoma
- Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, UMons, Mons, Belgium
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Bi-cephalic parietal and cerebellar direct current stimulation interferes with early error correction in prism adaptation: Toward a complex view of the neural mechanisms underlying visuomotor control. Cortex 2018; 109:226-233. [DOI: 10.1016/j.cortex.2018.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/19/2018] [Accepted: 09/17/2018] [Indexed: 11/23/2022]
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Fujioka S, Tsuboi Y, Friedman JH. A novel promising therapeutic approach for patients with ataxic disorders? Neurology 2018; 91:541-542. [PMID: 30135252 DOI: 10.1212/wnl.0000000000006190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shinsuke Fujioka
- From the Department of Neurology (S.F., Y.T.), Fukuoka University, Japan; and Butler Hospital and Department of Neurology (J.H.F.), Warren Alpert Medical School of Brown University, Providence, RI.
| | - Yoshio Tsuboi
- From the Department of Neurology (S.F., Y.T.), Fukuoka University, Japan; and Butler Hospital and Department of Neurology (J.H.F.), Warren Alpert Medical School of Brown University, Providence, RI
| | - Joseph H Friedman
- From the Department of Neurology (S.F., Y.T.), Fukuoka University, Japan; and Butler Hospital and Department of Neurology (J.H.F.), Warren Alpert Medical School of Brown University, Providence, RI
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Benussi A, Dell'Era V, Cantoni V, Bonetta E, Grasso R, Manenti R, Cotelli M, Padovani A, Borroni B. Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial. Neurology 2018; 91:e1090-e1101. [PMID: 30135258 DOI: 10.1212/wnl.0000000000006210] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
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.
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Affiliation(s)
- 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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
| | - 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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van der Vliet R, Jonker ZD, Louwen SC, Heuvelman M, de Vreede L, Ribbers GM, De Zeeuw CI, Donchin O, Selles RW, van der Geest JN, Frens MA. Cerebellar transcranial direct current stimulation interacts with BDNF Val66Met in motor learning. Brain Stimul 2018; 11:759-771. [DOI: 10.1016/j.brs.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/04/2018] [Accepted: 04/09/2018] [Indexed: 11/16/2022] Open
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Petti M, Astolfi L, Masciullo M, Clausi S, Pichiorri F, Cincotti F, Mattia D, Molinari M. Transcranial cerebellar direct current stimulation: Effects on brain resting state oscillatory and network activity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:4359-4362. [PMID: 29060862 DOI: 10.1109/embc.2017.8037821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transcranial cerebellar direct current stimulation (tcDCS) can offer new insights into the cerebellar function and disorders, by modulating noninvasively the activity of cerebellar networks. Taking into account the functional interplay between the cerebellum and the cerebral cortex, we addressed the effects of unilateral tcDCS (active electrode positioned over the right cerebellar hemisphere) on the electroencephalographic (EEG) oscillatory activity and on the cortical network organization at resting state. Effects on spectral (de)synchronizations and functional connectivity after anodal and cathodal stimulation were assessed with respect to a sham condition. A lateralized synchronization over the sensorimotor area in gamma band, as well as an increase of the network segregation in sensory-motor rhythms and a higher communication between hemispheres in gamma band, were detected after anodal stimulation. The same measures after cathodal tcDCS returned responses similar to the sham condition.
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Bocci T, Ferrucci R, Barloscio D, Parenti L, Cortese F, Priori A, Sartucci F. Cerebellar direct current stimulation modulates hand blink reflex: implications for defensive behavior in humans. Physiol Rep 2018; 6:e13471. [PMID: 29845771 PMCID: PMC5974722 DOI: 10.14814/phy2.13471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022] Open
Abstract
The cerebellum is involved in a wide number of integrative functions. We evaluated the role of cerebellum in peripersonal defensive behavior, as assessed by the so-called hand blink reflex (HBR), modulating cerebellar activity with transcranial direct current stimulation (tDCS). Healthy subjects underwent cerebellar (sham, anodal, and cathodal tcDCS) and motor cortex tDCS (anodal or cathodal; 20', 2 mA). For the recording of HBR, electrical stimuli were delivered using a surface bipolar electrode placed on the median nerve at the wrist and EMG activity recorded from the orbicularis oculi muscle bilaterally. Depending on the hand position respective to the face, HBR was assessed in four different conditions: "hand-far," "hand-near" (eyes open), "side hand," and "hand-patched" (eyes closed). While sham and cathodal cerebellar stimulation had no significant effect, anodal tcDCS dramatically dampened the magnitude of the HBR, as measured by the area under the curve (AUC), in the "hand-patched" and "side hand" conditions only, for ipsilateral (F(4,171) = 15.08, P < 0.0001; F(4,171) = 8.95, P < 0.0001) as well as contralateral recordings (F(4,171) = 17.96, P < 0.0001); F4,171) = 5.35, P = 0.0004). Cerebellar polarization did not modify AUC in the "hand-far" and "hand-near" sessions. tDCS applied over the motor area did not affect HBR. These results seem to support a role of the cerebellum in the defensive responses within the peripersonal space surrounding the face, thus suggesting a possible cerebellar involvement in visual-independent defensive behavior.
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Affiliation(s)
- Tommaso Bocci
- Department of Clinical and Experimental MedicineCisanello Neurology UnitPisa University Medical SchoolPisaItaly
- Department of Medical‐Surgical Pathophysiology and TransplantsUniversity of MilanMilanItaly
- Clinical Center for NeurotechnologyNeurostimulation and Movement DisordersFondazione IRCCS “Ca' Granda” Ospedale Maggiore di MilanoMilanItaly
| | - Roberta Ferrucci
- Department of Medical‐Surgical Pathophysiology and TransplantsUniversity of MilanMilanItaly
- Clinical Center for NeurotechnologyNeurostimulation and Movement DisordersFondazione IRCCS “Ca' Granda” Ospedale Maggiore di MilanoMilanItaly
- Department of Neurological SciencesUniversity of MilanFondazione IRCCS Ospedale Maggiore PoliclinicoMilanItaly
| | - Davide Barloscio
- Department of Clinical and Experimental MedicineCisanello Neurology UnitPisa University Medical SchoolPisaItaly
| | - Laura Parenti
- Department of Clinical and Experimental MedicineCisanello Neurology UnitPisa University Medical SchoolPisaItaly
| | - Francesca Cortese
- Department of Medical‐Surgical Pathophysiology and TransplantsUniversity of MilanMilanItaly
- Clinical Center for NeurotechnologyNeurostimulation and Movement DisordersFondazione IRCCS “Ca' Granda” Ospedale Maggiore di MilanoMilanItaly
- Department of Medical‐Surgical Sciences and BiotechonologiesSapienza University of RomeRomeItaly
| | - Alberto Priori
- Department of Medical‐Surgical Pathophysiology and TransplantsUniversity of MilanMilanItaly
- Clinical Center for NeurotechnologyNeurostimulation and Movement DisordersFondazione IRCCS “Ca' Granda” Ospedale Maggiore di MilanoMilanItaly
- Department of Neurological SciencesUniversity of MilanFondazione IRCCS Ospedale Maggiore PoliclinicoMilanItaly
| | - Ferdinando Sartucci
- Department of Clinical and Experimental MedicineCisanello Neurology UnitPisa University Medical SchoolPisaItaly
- Neuroscience InstituteNational Research CouncilPisaItaly
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64
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Summers RLS, Chen M, Hatch A, Kimberley TJ. Cerebellar Transcranial Direct Current Stimulation Modulates Corticospinal Excitability During Motor Training. Front Hum Neurosci 2018; 12:118. [PMID: 29686609 PMCID: PMC5900002 DOI: 10.3389/fnhum.2018.00118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Cerebellar activity can be modulated using cerebellar transcranial direct current stimulation (ctDCS) and, when applied concurrently with task training, has been shown to facilitate cognitive and motor performance. However, how ctDCS facilitates motor performance is not fully understood. Objective/Hypothesis: To assess the electrophysiological and motor performance effects of ctDCS applied during motor training. Methods: Fourteen healthy adults (age 28.8 ± 10.5 years) were randomly assigned to complete one session of finger tracking training with either simultaneous bilateral anodal or sham ctDCS. Training was completed in two 15 min epochs with a 5-min break (total 30 min stimulation, 2 mA). Tracking accuracy and corticospinal and intracortical excitability were measured immediately before and after the training period. Motor cortical excitability measures included resting motor threshold (RMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP) and short interval intracortical inhibition (SICI). Results: There was a significant interaction of Group * Time for MEP amplitude and CSP duration (p < 0.01). Post hoc analysis revealed MEP amplitude was increased in the sham group (p < 0.01), indicating increased corticospinal excitability from baseline while the anodal group displayed a decrease in MEP amplitude (p = 0.023) and prolongation of CSP duration (p < 0.01). SICI and RMT remained unchanged following ctDCS and training. Task accuracy was improved in both groups at post-test with a significant effect of Time (p < 0.01); however, there was no effect of Group (p = 0.45) or interaction of Group * Time (p = 0.83). During training, there was a significant effect of Block (p < 0.01) but no significant effect of Group or interaction effect (p > 0.06). Conclusions: ctDCS applied during task training is capable of modulating or interfering with practice-related changes in corticospinal excitability without disrupting performance improvement.
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Affiliation(s)
- Rebekah L S Summers
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Mo Chen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States.,Non-invasive Neuromodulation Laboratory, MnDRIVE Initiative, University of Minnesota, Minneapolis, MN, United States
| | - Andrea Hatch
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Teresa J Kimberley
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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65
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Panico F, Sagliano L, Nozzolillo C, Trojano L, Rossetti Y. Cerebellar contribution to spatial realignment: A tDCS study during multiple-step prism adaptation. Neuropsychologia 2018. [DOI: 10.1016/j.neuropsychologia.2018.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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66
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Oldrati V, Schutter DJLG. Targeting the Human Cerebellum with Transcranial Direct Current Stimulation to Modulate Behavior: a Meta-Analysis. CEREBELLUM (LONDON, ENGLAND) 2018; 17:228-236. [PMID: 28786014 PMCID: PMC5849643 DOI: 10.1007/s12311-017-0877-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Transcranial direct current stimulation (tDCS) is increasingly used to study motor- and non-motor-related functions of the cerebellum. The aim of the present study was to quantitatively review available studies to estimate the efficacy of cerebellar tDCS in altering motor- and cognitive-related behavioral performance in healthy volunteers. The present meta-analysis included 32 sham-controlled studies. Results from random effects modeling of the cumulative effect size demonstrated that anodal and cathodal tDCS to the cerebellum were effective in changing performance. No evidence for polarity-dependent effects of cerebellar tDCS was found. Current findings establish the feasibility to target motor and non-motor-related cerebellar functions with tDCS, but arguably due to anatomical differences between the cerebellum and cerebral cortex, the polarity of tDCS is not predictive of the direction of the behavioral changes in healthy volunteers.
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Affiliation(s)
- Viola Oldrati
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza A. Botta 6, 27100, Pavia, Italy
| | - Dennis J L G Schutter
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, The Netherlands.
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67
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Abstract
Transcranial magnetic and electric stimulation of the brain are novel and highly promising techniques currently employed in both research and clinical practice. Improving or rehabilitating brain functions by modulating excitability with these noninvasive tools is an exciting new area in neuroscience. Since the cerebellum is closely connected with the cerebral regions subserving motor, associative, and affective functions, the cerebello-thalamo-cortical pathways are an interesting target for these new techniques. Targeting the cerebellum represents a novel way to modulate the excitability of remote cortical regions and their functions. This review brings together the studies that have applied cerebellar stimulation, magnetic and electric, and presents an overview of the current knowledge and unsolved issues. Some recommendations for future research are implemented as well.
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68
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Non-invasive Cerebellar Stimulation: a Promising Approach for Stroke Recovery? THE CEREBELLUM 2017; 17:359-371. [DOI: 10.1007/s12311-017-0906-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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69
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Fernandez L, Major BP, Teo WP, Byrne LK, Enticott PG. Assessing cerebellar brain inhibition (CBI) via transcranial magnetic stimulation (TMS): A systematic review. Neurosci Biobehav Rev 2017; 86:176-206. [PMID: 29208533 DOI: 10.1016/j.neubiorev.2017.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/10/2017] [Accepted: 11/25/2017] [Indexed: 12/24/2022]
Abstract
The inhibitory tone that the cerebellum exerts on the primary motor cortex (M1) is known as cerebellar brain inhibition (CBI). Studies show CBI to be relevant to several motor functions, including adaptive motor learning and muscle control. CBI can be assessed noninvasively via transcranial magnetic stimulation (TMS) using a double-coil protocol. Variability in parameter choice and controversy surrounding the protocol's ability to isolate the cerebellothalamocortical pathway casts doubt over its validity in neuroscience research. This justifies a systematic review of both the protocol, and its application. The following review examines studies using the double-coil protocol to assess CBI in healthy adults. Parameters and CBI in relation to task-based studies, other non-invasive protocols, over different muscles, and in clinical samples are reviewed. Of the 1398 studies identified, 24 met selection criteria. It was found that methodological design and selection of parameters in several studies may have reduced the validity of outcomes. Further systematic testing of CBI protocols is warranted, both from a parameter and task-based perspective.
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Affiliation(s)
- Lara Fernandez
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia.
| | - Brendan P Major
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Wei-Peng Teo
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, 3220, Australia
| | - Linda K Byrne
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia; Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
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70
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Effects of Transcranial Direct Current Stimulation of Rat Cerebral Structures on Pentylenetetrazole-Induced Seizures. NEUROPHYSIOLOGY+ 2017. [DOI: 10.1007/s11062-017-9681-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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71
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Marangolo P, Fiori V, Caltagirone C, Pisano F, Priori A. Transcranial Cerebellar Direct Current Stimulation Enhances Verb Generation but Not Verb Naming in Poststroke Aphasia. J Cogn Neurosci 2017; 30:188-199. [PMID: 29064340 DOI: 10.1162/jocn_a_01201] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although the role of the cerebellum in motor function is well recognized, its involvement in the lexical domain remains to be further elucidated. Indeed, it has not yet been clarified whether the cerebellum is a language structure per se or whether it contributes to language processing when other cognitive components (e.g., cognitive effort, working memory) are required by the language task. Neuromodulation studies on healthy participants have suggested that cerebellar transcranial direct current stimulation (tDCS) is a valuable tool to modulate cognitive functions. However, so far, only a single case study has investigated whether cerebellar stimulation enhances language recovery in aphasic individuals. In a randomized, crossover, double-blind design, we explored the effect of cerebellar tDCS coupled with language treatment for verb improvement in 12 aphasic individuals. Each participant received cerebellar tDCS (20 min, 2 mA) in four experimental conditions: (1) right cathodal and (2) sham stimulation during a verb generation task and (3) right cathodal and (4) sham stimulation during a verb naming task. Each experimental condition was run in five consecutive daily sessions over 4 weeks. At the end of treatment, a significant improvement was found after cathodal stimulation only in the verb generation task. No significant differences were present for verb naming among the two conditions. We hypothesize that cerebellar tDCS is a viable tool for recovery from aphasia but only when the language task, such as verb generation, also demands the activation of nonlinguistic strategies.
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Affiliation(s)
- Paola Marangolo
- Università Federico II, Naples, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | | | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Università degli Studi di Roma Tor Vergata, Rome, Italy
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72
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Cerebellar transcranial direct current stimulation improves adaptive postural control. Clin Neurophysiol 2017; 129:33-41. [PMID: 29136550 DOI: 10.1016/j.clinph.2017.09.118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Rehabilitation interventions contribute to recovery of impaired postural control, but it remains a priority to optimize their effectiveness. A promising strategy may involve transcranial direct current stimulation (tDCS) of brain areas involved in fine-tuning of motor adaptation. This study explored the effects of cerebellar tDCS (ctDCS) on postural recovery from disturbance by Achilles tendon vibration. METHODS Twenty-eight healthy volunteers participated in this sham-ctDCS controlled study. Standing blindfolded on a force platform, four trials were completed: 60 s quiet standing followed by 20 min active (anodal-tDCS, 1 mA, 20 min, N = 14) or sham-ctDCS (40 s, N = 14) tDCS; three quiet standing trials with 15 s of Achilles tendon vibration and 25 s of postural recovery. Postural steadiness was quantified as displacement, standard deviation and path derived from the center of pressure (COP). RESULTS Baseline demographics and quiet standing postural steadiness, and backwards displacement during vibration were comparable between groups. However, active-tDCS significantly improved postural steadiness during vibration and reduced forward displacement and variability in COP derivatives during recovery. CONCLUSIONS We demonstrate that ctDCS results in short-term improvement of postural adaptation in healthy individuals. SIGNIFICANCE Future studies need to investigate if multisession ctDCS combined with training or rehabilitation interventions can induce prolonged improvement of postural balance.
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73
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John L, Küper M, Hulst T, Timmann D, Hermsdörfer J. Effects of transcranial direct current stimulation on grip force control in patients with cerebellar degeneration. CEREBELLUM & ATAXIAS 2017; 4:15. [PMID: 28932407 PMCID: PMC5603042 DOI: 10.1186/s40673-017-0072-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The control of grip forces when moving a hand held object is impaired in patients with cerebellar degeneration. We asked the question whether after-effects of anodal transcranial direct current stimulation (tDCS) applied to the lateral cerebellum or M1 improved grip force control in cerebellar patients. METHODS Grip force control while holding an object during cyclic arm movements was assessed in patients with pure cerebellar degeneration (n = 14, mean age 50.2 years ± SD 8.8 years) and age- and sex-matched control participants (n = 14, mean age 50.7 years ± SD 9.8 years). All subjects were tested before and after application of tDCS (2 mA, 22 min) in a within-subject design. Each subject received anodal tDCS applied to the cerebellum, anodal tDCS applied to M1 or sham-stimulation with a break of 1 week between the three experimental sessions. RESULTS There were no clear after-effects of tDCS on grip force control neither in control participants nor in cerebellar patients. Cerebellar patients showed typical impairments with higher grip forces, a higher variability of movements. CONCLUSION In the present study, deficits in grip force control were neither improved by tDCS applied over the cerebellum nor M1 in cerebellar degeneration.
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Affiliation(s)
- Liane John
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Küper
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Hulst
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Erasmus University College, Rotterdam, The Netherlands
| | - Dagmar Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Institute of Movement Science, Technical University of Munich, Munich, Germany
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74
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Angulo-Sherman IN, Rodríguez-Ugarte M, Sciacca N, Iáñez E, Azorín JM. Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power. J Neuroeng Rehabil 2017; 14:31. [PMID: 28420382 PMCID: PMC5395900 DOI: 10.1186/s12984-017-0242-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/08/2017] [Indexed: 12/12/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a technique for brain modulation that has potential to be used in motor neurorehabilitation. Considering that the cerebellum and motor cortex exert influence on the motor network, their stimulation could enhance motor functions, such as motor imagery, and be utilized for brain-computer interfaces (BCIs) during motor neurorehabilitation. Methods A new tDCS montage that influences cerebellum and either right-hand or feet motor area is proposed and validated with a simulation of electric field. The effect of current density (0, 0.02, 0.04 or 0.06 mA/cm2) on electroencephalographic (EEG) classification into rest or right-hand/feet motor imagery was evaluated on 5 healthy volunteers for different stimulation modalities: 1) 10-minutes anodal tDCS before EEG acquisition over right-hand or 2) feet motor cortical area, and 3) 4-seconds anodal tDCS during EEG acquisition either on right-hand or feet cortical areas before each time right-hand or feet motor imagery is performed. For each subject and tDCS modality, analysis of variance and Tukey-Kramer multiple comparisons tests (p <0.001) are used to detect significant differences between classification accuracies that are obtained with different current densities. For tDCS modalities that improved accuracy, t-tests (p <0.05) are used to compare μ and β band power when a specific current density is provided against the case of supplying no stimulation. Results The proposed montage improved the classification of right-hand motor imagery for 4 out of 5 subjects when the highest current was applied for 10 minutes over the right-hand motor area. Although EEG band power changes could not be related directly to classification improvement, tDCS appears to affect variably different motor areas on μ and/or β band. Conclusions The proposed montage seems capable of enhancing right-hand motor imagery detection when the right-hand motor area is stimulated. Future research should be focused on applying higher currents over the feet motor cortex, which is deeper in the brain compared to the hand motor cortex, since it may allow observation of effects due to tDCS. Also, strategies for improving analysis of EEG respect to accuracy changes should be implemented.
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Affiliation(s)
- Irma N Angulo-Sherman
- Center for Research and Advanced Studies (Cinvestav), Parque de Investigación e Innovación Tecnológica km 9.5 de la Autopista Nueva al Aeropuerto, 201, Monterrey, 66600, NL, Mexico
| | - Marisol Rodríguez-Ugarte
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
| | - Nadia Sciacca
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
| | - Eduardo Iáñez
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain.
| | - José M Azorín
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
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75
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Bodranghien F, Oulad Ben Taib N, Van Maldergem L, Manto M. A Postural Tremor Highly Responsive to Transcranial Cerebello-Cerebral DCS in ARCA3. Front Neurol 2017; 8:71. [PMID: 28316589 PMCID: PMC5334604 DOI: 10.3389/fneur.2017.00071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Cerebellar ataxias are disabling disorders that impact the quality of life of patients. In many cases, an effective treatment is missing. Despite the increasing knowledge on the pathogenesis of cerebellar disorders including genetic aspects, there is currently a gap in the therapeutical management of cerebellar deficits. Cerebellar ataxia associated with ANO10 mutation (ARCA3) presents a disabling cerebellar syndrome. The aim of this study is to report a patient with a marked postural tremor responding to transcranial cerebello-cerebral direct current stimulation (tCCDCS). Methods We applied tCCDCS using anodal stimulation over the cerebellum with a return electrode on the contralateral motor cortex. We performed a clinical rating, accelerometry studies, and recordings of voluntary movements at baseline, after sham, and after active tCCDCS. Results A dramatic response of postural tremor was observed after tCCDCS, with a major drop of the power spectral density to 26.12% of basal values. Discussion The postural tremor of cerebellar ataxia associated with ANO10 mutation was highly responsive to tCCDCS in our patient. This case illustrates that tCCDCS is a novel therapeutic option in the treatment of cerebellar deficits and might represent a promising tool to reduce tremor in ARCA3.
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Affiliation(s)
| | - Nordeyn Oulad Ben Taib
- Service de Neurochirurgie, ULB-Erasme, Bruxelles, Belgium; Service de Neurochirurgie, CHU-StPierre, Bruxelles, Belgium
| | - Lionel Van Maldergem
- Centre de génétique humaine, Université de Franche-Comté, Besançon, France; Metabolic Unit, Université de Liège, Liège, Belgium
| | - Mario Manto
- Unité d'Etude du Mouvement-GRIM, FNRS, ULB-Erasme, Bruxelles, Belgium; Service des Neurosciences, UMons, Mons, Belgium
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76
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Benussi A, Dell'Era V, Cotelli MS, Turla M, Casali C, Padovani A, Borroni B. Long term clinical and neurophysiological effects of cerebellar transcranial direct current stimulation in patients with neurodegenerative ataxia. Brain Stimul 2016; 10:242-250. [PMID: 27838276 DOI: 10.1016/j.brs.2016.11.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neurodegenerative cerebellar ataxias represent a group of disabling disorders for which we currently lack effective therapies. Cerebellar transcranial direct current stimulation (tDCS) is a non-invasive technique, which has been demonstrated to modulate cerebellar excitability and improve symptoms in patients with cerebellar ataxias. OBJECTIVE The present study investigated whether a two-weeks' treatment with cerebellar anodal tDCS could improve symptoms in patients with neurodegenerative cerebellar ataxia and could modulate cerebello-motor connectivity, at short and long term. METHODS We performed a double-blind, randomized, sham controlled trial with cerebellar tDCS (5 days/week for 2 weeks) in twenty patients with ataxia. Each patient underwent a clinical evaluation pre- and post-anodal tDCS or sham stimulation. A follow-up evaluation was performed at one and three months. Cerebello-motor connectivity was evaluated using transcranial magnetic stimulation (TMS) at baseline and at follow-up. RESULTS Patients who underwent anodal 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) and in cerebellar brain inhibition compared to patients who underwent sham stimulation. CONCLUSIONS A two-weeks' treatment with anodal cerebellar tDCS improves symptoms in patients with ataxia and restores physiological cerebellar brain inhibition pathways. Cerebellar tDCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia.
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Affiliation(s)
- Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valentina Dell'Era
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Marinella Turla
- Neurology Unit, Valle Camonica Hospital, Esine, Brescia, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University "La Sapienza", Rome, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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