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Wilkins EW, Pantovic M, Noorda KJ, Premyanov MI, Boss R, Davidson R, Hagans TA, Riley ZA, Poston B. Motor Learning in a Complex Motor Task Is Unaffected by Three Consecutive Days of Transcranial Alternating Current Stimulation. Bioengineering (Basel) 2024; 11:744. [PMID: 39199702 PMCID: PMC11351210 DOI: 10.3390/bioengineering11080744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 09/01/2024] Open
Abstract
Transcranial alternating current stimulation (tACS) delivered to the primary motor cortex (M1) can increase cortical excitability, entrain neuronal firing patterns, and increase motor skill acquisition in simple motor tasks. The primary aim of this study was to assess the impact of tACS applied to M1 over three consecutive days of practice on the motor learning of a challenging overhand throwing task in young adults. The secondary aim was to examine the influence of tACS on M1 excitability. This study implemented a double-blind, randomized, SHAM-controlled, between-subjects experimental design. A total of 24 healthy young adults were divided into tACS and SHAM groups and performed three identical experimental sessions that comprised blocks of overhand throwing trials of the right dominant arm concurrent with application of tACS to the left M1. Performance in the overhand throwing task was quantified as the endpoint error. Motor evoked potentials (MEPs) were assessed in the right first dorsal interosseus (FDI) muscle with transcranial magnetic stimulation (TMS) to quantify changes in M1 excitability. Endpoint error was significantly decreased in the post-tests compared with the pre-tests when averaged over the three days of practice (p = 0.046), but this decrease was not statistically significant between the tACS and SHAM groups (p = 0.474). MEP amplitudes increased from the pre-tests to the post-tests (p = 0.003), but these increases were also not different between groups (p = 0.409). Overall, the main findings indicated that tACS applied to M1 over multiple days does not enhance motor learning in a complex task to a greater degree than practice alone (SHAM).
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Affiliation(s)
- Erik W. Wilkins
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
- Interdisciplinary Ph.D. Program in Neuroscience, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA
| | - Milan Pantovic
- Health and Human Performance Department, Utah Tech University, St. George, UT 84770, USA;
| | - Kevin J. Noorda
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.J.N.); (M.I.P.); (R.B.); (R.D.); (T.A.H.)
| | - Mario I. Premyanov
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.J.N.); (M.I.P.); (R.B.); (R.D.); (T.A.H.)
| | - Rhett Boss
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.J.N.); (M.I.P.); (R.B.); (R.D.); (T.A.H.)
| | - Ryder Davidson
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.J.N.); (M.I.P.); (R.B.); (R.D.); (T.A.H.)
| | - Taylor A. Hagans
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (K.J.N.); (M.I.P.); (R.B.); (R.D.); (T.A.H.)
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
- Interdisciplinary Ph.D. Program in Neuroscience, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA
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Bosch-Barceló P, Climent-Sanz C, Martínez-Navarro O, Masbernat-Almenara M, Pakarinen A, Ghosh PK, Fernández-Lago H. A treadmill training program in a gamified virtual reality environment combined with transcranial direct current stimulation in Parkinson's Disease: Study protocol for a randomized controlled trial. PLoS One 2024; 19:e0307304. [PMID: 39012877 PMCID: PMC11251630 DOI: 10.1371/journal.pone.0307304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Parkinson's Disease (PD) affects movement and cognition, and physiotherapy, particularly treadmill gait training, has potential in addressing movement dysfunctions in PD. However, treadmill training falls short in addressing cognitive aspects and adherence. Virtual reality (VR) and gamification can enhance motor and cognitive retraining and improve adherence. People with Parkinson's Disease (PWPD) have decreased motor skill learning efficiency, but tDCS can improve motor and cognitive learning. METHODS 78 participants with PD will be randomly allocated in a 1:1:1 ratio to one of three groups: (1) treadmill + Gamified Virtual Reality Environment (GVRE) + tDCS training group; (2) treadmill + GVRE training group or (3) treadmill training group. Participants will follow a 6-week, 12-session treadmill gait training plan, gradually increasing session duration from 20 to 45 minutes. Participants in (1) and (2) will undergo a GVRE training protocol, with (1) also receiving tDCS for the first 20 minutes of each session. Assessments will occur at baseline, post-intervention, and at a 6-week follow-up. The primary outcome measure will be gait speed during single and dual-task performance. Secondary measures will include additional gait parameters, executive tests for cognitive performance, and clinical outcomes for disease stage, cognitive status, and physical condition. DISCUSSION This randomized clinical trial presents an innovative neurorehabilitation protocol that aims to improve gait and cognition in PWPD. The study also examines how tDCS can enhance motor and cognitive training. Results could contribute to enhancing the motor and cognitive state of PWPD through a GVRE and tDCS-based neurorehabilitation protocol. TRIAL REGISTRATION NCT05243394. 28/02/2024 -v3.2.
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Affiliation(s)
- Pere Bosch-Barceló
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Lleida Institute for Biomedical Research Dr Pifarré Foundation, IRBLleida, Lleida, Spain
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Oriol Martínez-Navarro
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Maria Masbernat-Almenara
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Anni Pakarinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Pradip K. Ghosh
- Physical Therapy Program, Walker College of Health Profession, Maryville University, St Louis, MO, United States of America
| | - Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Lleida Institute for Biomedical Research Dr Pifarré Foundation, IRBLleida, Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
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de Souza Souto JJ, Edite Casé de Oliveira M, Silva GM, Nascimento de Sousa JM, Fernandes Franco CI, Dos Santos NA. Transcranial direct current stimulation and cognitive changes in Parkinson's disease, a systematic review with meta-analysis and meta-regression. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38967481 DOI: 10.1080/23279095.2024.2367108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Parkinson's disease is the second most common neurodegenerative disease, but therapeutic options such as neuromodulation continue to show variable effects, making clinical management of the disease difficult. This systematic review with meta-analysis and meta-regression aimed to analyze the isolated effect of cortical modulation with transcranial direct current stimulation (tDCS) compared to sham stimulation on cognitive changes in people with Parkinson's disease. The databases used were: Web of Science, Scopus, PsycINFO, PubMed, and Cochrane. The results showed that tDCS can influence the improvement of cognition in PD (Inverse Variance:0.24 [95% Confidence Interval: 0.09 to -0.40], p < 0.00). The meta-analysis showed that active tDCS can influence cognitive function by improving aspects related to memory (Inverse Variance:0.34 [95% Confidence Interval: 0.07 to 0.61], p < 0.01) and reducing reaction time in cognitive tasks (Inverse Variance:0.42 [95% Confidence Interval: 0.07 to 0.76], p < 0.02). Innovative meta-regression analyses showed that variables such as age (Q = 2.54, df = 1, p < 0.11), education level (Q = 2.62, df = 1, p < 0.10), disease duration (Q = 0.01, df = 1, p < 0.92), and Unified PD Rating Scale stage (Q = 0.01, df = 1, p < 0.92) did not influence the results. Thus, tDCS may be a therapeutic option for cognitive changes in people with PD, and we suggest further studies to identify protocols that can be replicated.
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Wang Y, Monai H. Transcranial direct current stimulation alters cerebrospinal fluid-interstitial fluid exchange in mouse brain. Brain Stimul 2024; 17:620-632. [PMID: 38688399 DOI: 10.1016/j.brs.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained prominence recently. Clinical studies have explored tDCS as an adjunct to neurologic disease rehabilitation, with evidence suggesting its potential in modulating brain clearance mechanisms. The glymphatic system, a proposed brain waste clearance system, posits that cerebrospinal fluid-interstitial fluid (CSF-ISF) exchange aids in efficient metabolic waste removal. While some studies have linked tDCS to astrocytic inositol trisphosphate (IP3)/Ca2+ signaling, the impact of tDCS on CSF-ISF exchange dynamics remains unclear. HYPOTHESIS tDCS influences the dynamics of CSF-ISF exchange through astrocytic IP3/Ca2+ signaling. METHODS In this study, we administered tDCS (0.1 mA for 10 min) to C57BL/6N mice anesthetized with ketamine-xylazine (KX). The anode was positioned on the cranial bone above the cortex, and the cathode was inserted into the neck. Following tDCS, we directly assessed brain fluid dynamics by injecting biotinylated dextran amine (BDA) as a CSF tracer into the cisterna magna (CM). The brain was then extracted after either 30 or 60 min and fixed. After 24 h, the sectioned brain slices were stained with Alexa 594-conjugated streptavidin (SA) to visualize BDA using immunohistochemistry. We conducted Electroencephalography (EEG) recordings and aquaporin 4 (AQP4)/CD31 immunostaining to investigate the underlying mechanisms of tDCS. Additionally, we monitored the efflux of Evans blue, injected into the cisterna magna, using cervical lymph node imaging. Some experiments were subsequently repeated with inositol trisphosphate receptor type 2 (IP3R2) knockout (KO) mice. RESULTS Post-tDCS, we observed an increased CSF tracer influx, indicating a modulation of CSF-ISF exchange by tDCS. Additionally, tDCS appeared to enhance the brain's metabolic waste efflux. EEG recordings showed an increase in delta wave post-tDCS. But no significant change in AQP4 expression was detected 30 min post-tDCS. Besides, we found no alteration in CSF-ISF exchange and delta wave activity in IP3R2 KO mice after tDCS. CONCLUSION Our findings suggest that tDCS augments the glymphatic system's influx and efflux. Through astrocytic IP3/Ca2+ signaling, tDCS was found to modify the delta wave, which correlates positively with brain clearance. This study underscores the potential of tDCS in modulating brain metabolic waste clearance.
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Affiliation(s)
- Yan Wang
- Graduate School of Humanities and Sciences, Ochanomizu University, Ohtsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hiromu Monai
- Graduate School of Humanities and Sciences, Ochanomizu University, Ohtsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
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Davidson B, Bhattacharya A, Sarica C, Darmani G, Raies N, Chen R, Lozano AM. Neuromodulation techniques - From non-invasive brain stimulation to deep brain stimulation. Neurotherapeutics 2024; 21:e00330. [PMID: 38340524 PMCID: PMC11103220 DOI: 10.1016/j.neurot.2024.e00330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past 30 years, the field of neuromodulation has witnessed remarkable advancements. These developments encompass a spectrum of techniques, both non-invasive and invasive, that possess the ability to both probe and influence the central nervous system. In many cases neuromodulation therapies have been adopted into standard care treatments. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS) are the most common non-invasive methods in use today. Deep brain stimulation (DBS), spinal cord stimulation (SCS), and vagus nerve stimulation (VNS), are leading surgical methods for neuromodulation. Ongoing active clinical trials using are uncovering novel applications and paradigms for these interventions.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nasem Raies
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
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Tamura R, Dezawa S, Kato J, Nakata M, Kunori N, Takashima I. Transcranial direct current stimulation improves motor function in rats with 6-hydroxydopamine-induced Parkinsonism. Behav Brain Res 2024; 460:114815. [PMID: 38122905 DOI: 10.1016/j.bbr.2023.114815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Transcranial direct current stimulation (tDCS) is increasingly being used for Parkinson's disease (PD); however, the evaluation of its clinical impact remains complex owing to the heterogeneity of patients and treatments. Therefore, we used a unilateral 6-hydroxydopamine-induced PD rat model to investigate whether anodal tDCS of the primary motor cortex (M1) alleviates PD motor deficits. Before tDCS treatment, unilateral PD rats preferentially used the forelimb ipsilateral to the lesion in the exploratory cylinder test and showed reduced locomotor activity in the open field test. In addition, PD-related clumsy forelimb movements during treadmill walking were detected using deep learning-based video analysis (DeepLabCut). When the 5-day tDCS treatment began, the forelimb-use asymmetry was ameliorated gradually, and locomotor activity increased to pre-lesion levels. tDCS treatment also normalized unnatural forelimb movement during walking and restored a balanced gait. However, these therapeutic effects were rapidly lost or gradually disappeared when the tDCS treatment was terminated. Histological analysis at the end of the experiment revealed that the animals had moderately advanced PD, with 40-50% of dopamine neurons and fibers preserved on the injured side compared with those on the intact side. Although it remains a challenge to elucidate the neural mechanisms of the transient improvement in motor function induced by tDCS, the results of this study provide evidence that tDCS of the M1 produces positive behavioral outcomes in PD animals and provides the basis for further clinical research examining the application of tDCS in patients with PD.
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Affiliation(s)
- Ryota Tamura
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shinnosuke Dezawa
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan; Faculty of Medical and Health Sciences, Tsukuba International University, Tsuchiura, Japan
| | - Junpei Kato
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Mariko Nakata
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan; Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Japan
| | - Nobuo Kunori
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Ichiro Takashima
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Department of Informatics and Electronics, Daiichi Institute of Technology, Tokyo, Japan.
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Firouzi M, Baetens K, Swinnen E, Baeken C, Van Overwalle F, Deroost N. Does transcranial direct current stimulation of the primary motor cortex improve implicit motor sequence learning in Parkinson's disease? J Neurosci Res 2024; 102:e25311. [PMID: 38400585 DOI: 10.1002/jnr.25311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Implicit motor sequence learning (IMSL) is a cognitive function that is known to be associated with impaired motor function in Parkinson's disease (PD). We previously reported positive effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) on IMSL in 11 individuals with PD with mild cognitive impairments (MCI), with the largest effects occurring during reacquisition. In the present study, we included 35 individuals with PD, with (n = 15) and without MCI (n = 20), and 35 age- and sex-matched controls without PD, with (n = 13) and without MCI (n = 22). We used mixed-effects models to analyze anodal M1 tDCS effects on acquisition (during tDCS), short-term (five minutes post-tDCS) and long-term reacquisition (one-week post-tDCS) of general and sequence-specific learning skills, as measured by the serial reaction time task. At long-term reacquisition, anodal tDCS resulted in smaller general learning effects compared to sham, only in the PD group, p = .018, possibly due to floor effects. Anodal tDCS facilitated the acquisition of sequence-specific learning (M = 54.26 ms) compared to sham (M = 38.98 ms), p = .003, regardless of group (PD/controls). Further analyses revealed that this positive effect was the largest in the PD-MCI group (anodal: M = 69.07 ms; sham: M = 24.33 ms), p < .001. Although the observed effect did not exceed the stimulation period, this single-session tDCS study confirms the potential of tDCS to enhance IMSL, with the largest effects observed in patients with lower cognitive status. These findings add to the body of evidence that anodal tDCS can beneficially modulate the abnormal basal ganglia network activity that occurs in PD.
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Affiliation(s)
- Mahyar Firouzi
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Jette, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Kris Baetens
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Jette, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Chris Baeken
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
- Department of Psychiatry and Medical Psychology, Ghent University, University Hospital Ghent (UZ Ghent), Ghent, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, University Hospital Brussel (UZ Brussel), Brussels, Belgium
| | - Frank Van Overwalle
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Natacha Deroost
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
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Mattioli F, Maglianella V, D'Antonio S, Trimarco E, Caligiore D. Non-invasive brain stimulation for patients and healthy subjects: Current challenges and future perspectives. J Neurol Sci 2024; 456:122825. [PMID: 38103417 DOI: 10.1016/j.jns.2023.122825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Non-invasive brain stimulation (NIBS) techniques have a rich historical background, yet their utilization has witnessed significant growth only recently. These techniques encompass transcranial electrical stimulation and transcranial magnetic stimulation, which were initially employed in neuroscience to explore the intricate relationship between the brain and behaviour. However, they are increasingly finding application in research contexts as a means to address various neurological, psychiatric, and neurodegenerative disorders. This article aims to fulfill two primary objectives. Firstly, it seeks to showcase the current state of the art in the clinical application of NIBS, highlighting how it can improve and complement existing treatments. Secondly, it provides a comprehensive overview of the utilization of NIBS in augmenting the brain function of healthy individuals, thereby enhancing their performance. Furthermore, the article delves into the points of convergence and divergence between these two techniques. It also addresses the existing challenges and future prospects associated with NIBS from ethical and research standpoints.
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Affiliation(s)
- Francesco Mattioli
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; School of Computing, Electronics and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom
| | - Valerio Maglianella
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Sara D'Antonio
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Emiliano Trimarco
- Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy
| | - Daniele Caligiore
- AI2Life s.r.l., Innovative Start-Up, ISTC-CNR Spin-Off, Via Sebino 32, 00199 Rome, Italy; Computational and Translational Neuroscience Laboratory, Institute of Cognitive Sciences and Technologies, National Research Council (CTNLab-ISTC-CNR), Via San Martino della Battaglia 44, 00185 Rome, Italy.
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Chen P, Cheng C, Yang X, Sha TT, Zou X, Zhang F, Jiang W, Xu Y, Cao X, You YM, Luo Z. Wireless Deep Brain Stimulation by Ultrasound-Responsive Molecular Piezoelectric Nanogenerators. ACS NANO 2023; 17:25625-25637. [PMID: 38096441 DOI: 10.1021/acsnano.3c10227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Implantable neural stimulation devices are becoming prevalent in bioelectronic medicine for the precise treatment of various clinical diseases. Nevertheless, the limited lifespan and buckling size of the implanted devices remain significant obstacles for chronic clinical application. In this study, we developed an ultrasound-driven battery-free neurostimulator based on a high-performance mini-sized nanogenerator and demonstrated its successful application for the deep-brain-stimulation (DBS) therapy of Parkinson's disease in a rat model. This soft piezoelectric-triboelectric hybrid nanogenerators (PTNG) are made of porous thin-films of molecular piezoelectric materials, which have great advantages of facile, scalable, low-temperature, and flexible processing. Without any bucky accessory control circuits, the subcutaneously implanted soft PTNG can function as a wirelessly powered neurostimulator, allowing for the adjustment of stimulation parameters through external programmable ultrasound pulses. This DBS electroceutical application of energy-harvesting thin-film devices based on molecular piezoelectric materials provides valuable insight into the development of a soft high-performance bioelectronic device.
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Affiliation(s)
- Ping Chen
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Chi Cheng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaomei Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tai-Ting Sha
- Ordered Matter Science Research Center, Southeast University, Nanjing, Jiangsu 211189, China
| | - Xianghui Zou
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Fuchi Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xuebing Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu-Meng You
- Ordered Matter Science Research Center, Southeast University, Nanjing, Jiangsu 211189, China
| | - Zhiqiang Luo
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
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Pantovic M, de Albuquerque LL, Mastrantonio S, Pomerantz AS, Wilkins EW, Riley ZA, Guadagnoli MA, Poston B. Transcranial Direct Current Stimulation of Primary Motor Cortex over Multiple Days Improves Motor Learning of a Complex Overhand Throwing Task. Brain Sci 2023; 13:1441. [PMID: 37891809 PMCID: PMC10604977 DOI: 10.3390/brainsci13101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) applied to the primary motor cortex (M1) improves motor learning in relatively simple motor tasks performed with the hand and arm. However, it is unknown if tDCS can improve motor learning in complex motor tasks involving whole-body coordination with significant endpoint accuracy requirements. The primary purpose was to determine the influence of tDCS on motor learning over multiple days in a complex over-hand throwing task. This study utilized a double-blind, randomized, SHAM-controlled, between-subjects experimental design. Forty-six young adults were allocated to either a tDCS group or a SHAM group and completed three experimental sessions on three consecutive days at the same time of day. Each experimental session was identical and consisted of overhand throwing trials to a target in a pre-test block, five practice blocks performed simultaneously with 20 min of tDCS, and a post-test block. Overhand throwing performance was quantified as the endpoint error. Transcranial magnetic stimulation was used to obtain motor-evoked potentials (MEPs) from the first dorsal interosseus muscle to quantify changes in M1 excitability due to tDCS. Endpoint error significantly decreased over the three days of practice in the tDCS group but not in the SHAM group. MEP amplitude significantly increased in the tDCS group, but the MEP increases were not associated with increases in motor learning. These findings indicate that tDCS applied over multiple days can improve motor learning in a complex motor tasks in healthy young adults.
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Affiliation(s)
- Milan Pantovic
- Health and Human Performance Department, Utah Tech University, St. George, UT 84770, USA;
| | - Lidio Lima de Albuquerque
- School of Health and Applied Human Sciences, University of North Carolina-Wilmington, Wilmington, NC 28403, USA;
| | - Sierra Mastrantonio
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (S.M.); (A.S.P.); (M.A.G.)
| | - Austin S. Pomerantz
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (S.M.); (A.S.P.); (M.A.G.)
| | - Erik W. Wilkins
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
| | - Zachary A. Riley
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Mark A. Guadagnoli
- School of Medicine, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA; (S.M.); (A.S.P.); (M.A.G.)
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV 89154, USA;
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11
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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12
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de Albuquerque LL, Pantovic M, Clingo M, Fischer K, Jalene S, Landers M, Mari Z, Poston B. A Single Application of Cerebellar Transcranial Direct Current Stimulation Fails to Enhance Motor Skill Acquisition in Parkinson's Disease: A Pilot Study. Biomedicines 2023; 11:2219. [PMID: 37626716 PMCID: PMC10452618 DOI: 10.3390/biomedicines11082219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder that leads to numerous impairments in motor function that compromise the ability to perform activities of daily living. Practical and effective adjunct therapies are needed to complement current treatment approaches in PD. Transcranial direct current stimulation applied to the cerebellum (c-tDCS) can increase motor skill in young and older adults. Because the cerebellum is involved in PD pathology, c-tDCS application during motor practice could potentially enhance motor skill in PD. The primary purpose was to examine the influence of c-tDCS on motor skill acquisition in a complex, visuomotor isometric precision grip task (PGT) in PD in the OFF-medication state. The secondary purpose was to determine the influence of c-tDCS on transfer of motor skill in PD. The study utilized a double-blind, SHAM-controlled, within-subjects design. A total of 16 participants completed a c-tDCS condition and a SHAM condition in two experimental sessions separated by a 7-day washout period. Each session involved practice of the PGT concurrent with either c-tDCS or SHAM. Additionally, motor transfer tasks were quantified before and after the practice and stimulation period. The force error in the PGT was not significantly different between the c-tDCS and SHAM conditions. Similarly, transfer task performance was not significantly different between the c-tDCS and SHAM conditions. These findings indicate that a single session of c-tDCS does not elicit acute improvements in motor skill acquisition or transfer in hand and arm tasks in PD while participants are off medications.
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Affiliation(s)
- Lidio Lima de Albuquerque
- School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC 28403, USA;
| | - Milan Pantovic
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; (M.P.); (K.F.); (S.J.)
| | - Mitchell Clingo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Katherine Fischer
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; (M.P.); (K.F.); (S.J.)
| | - Sharon Jalene
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; (M.P.); (K.F.); (S.J.)
| | - Merrill Landers
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Zoltan Mari
- Movement Disorders Program, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA;
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA; (M.P.); (K.F.); (S.J.)
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13
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Garcia Santa Cruz B, Husch A, Hertel F. Machine learning models for diagnosis and prognosis of Parkinson's disease using brain imaging: general overview, main challenges, and future directions. Front Aging Neurosci 2023; 15:1216163. [PMID: 37539346 PMCID: PMC10394631 DOI: 10.3389/fnagi.2023.1216163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Parkinson's disease (PD) is a progressive and complex neurodegenerative disorder associated with age that affects motor and cognitive functions. As there is currently no cure, early diagnosis and accurate prognosis are essential to increase the effectiveness of treatment and control its symptoms. Medical imaging, specifically magnetic resonance imaging (MRI), has emerged as a valuable tool for developing support systems to assist in diagnosis and prognosis. The current literature aims to improve understanding of the disease's structural and functional manifestations in the brain. By applying artificial intelligence to neuroimaging, such as deep learning (DL) and other machine learning (ML) techniques, previously unknown relationships and patterns can be revealed in this high-dimensional data. However, several issues must be addressed before these solutions can be safely integrated into clinical practice. This review provides a comprehensive overview of recent ML techniques analyzed for the automatic diagnosis and prognosis of PD in brain MRI. The main challenges in applying ML to medical diagnosis and its implications for PD are also addressed, including current limitations for safe translation into hospitals. These challenges are analyzed at three levels: disease-specific, task-specific, and technology-specific. Finally, potential future directions for each challenge and future perspectives are discussed.
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Affiliation(s)
| | - Andreas Husch
- Imaging AI Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Frank Hertel
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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14
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Jwa AS, Goodman JS, Glover GH. Inconsistencies in mapping current distribution in transcranial direct current stimulation. FRONTIERS IN NEUROIMAGING 2023; 1:1069500. [PMID: 37555148 PMCID: PMC10406311 DOI: 10.3389/fnimg.2022.1069500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION tDCS is a non-invasive neuromodulation technique that has been widely studied both as a therapy for neuropsychiatric diseases and for cognitive enhancement. However, recent meta-analyses have reported significant inconsistencies amongst tDCS studies. Enhancing empirical understanding of current flow in the brain may help elucidate some of these inconsistencies. METHODS We investigated tDCS-induced current distribution by injecting a low frequency current waveform in a phantom and in vivo. MR phase images were collected during the stimulation and a time-series analysis was used to reconstruct the magnetic field. A current distribution map was derived from the field map using Ampere's law. RESULTS The current distribution map in the phantom showed a clear path of current flow between the two electrodes, with more than 75% of the injected current accounted for. However, in brain, the results did evidence a current path between the two target electrodes but only some portion ( 25%) of injected current reached the cortex demonstrating that a significant fraction of the current is bypassing the brain and traveling from one electrode to the other external to the brain, probably due to conductivity differences in brain tissue types. Substantial inter-subject and intra-subject (across consecutive scans) variability in current distribution maps were also observed in human but not in phantom scans. DISCUSSIONS An in-vivo current mapping technique proposed in this study demonstrated that much of the injected current in tDCS was not accounted for in human brain and deviated to the edge of the brain. These findings would have ramifications in the use of tDCS as a neuromodulator and may help explain some of the inconsistencies reported in other studies.
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Affiliation(s)
- Anita S. Jwa
- Stanford University Law School, Stanford, CA, United States
| | - Jonathan S. Goodman
- Program in Biophysics, Stanford School of Medicine, Stanford, CA, United States
| | - Gary H. Glover
- Department of Radiology, Stanford University, Stanford, CA, United States
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15
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Schwell G, Kozol Z, Tarshansky D, Einat M, Frenkel-Toledo S. The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial. Front Hum Neurosci 2023; 17:1126510. [PMID: 36936614 PMCID: PMC10014919 DOI: 10.3389/fnhum.2023.1126510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Action observation (AO) can improve motor performance in humans, probably via the human mirror neuron system. In addition, there is some evidence that transcranial direct current stimulation (tDCS) can improve motor performance. However, it is yet to be determined whether AO combined with tDCS has an enhanced effect on motor performance. We investigated the effect of AO combined with high-definition tDCS (HD-tDCS) targeting the inferior parietal lobe (IPL) and inferior frontal gyrus (IFG), the main aggregates of the human mirror neuron system, on motor performance in healthy adults and compared the immediate vs. 24-h retention test effects (anodal electrodes were placed over these regions of interest). Sixty participants were randomly divided into three groups that received one of the following single-session interventions: (1) observation of a video clip that presented reaching movement sequences toward five lighted units + active HD-tDCS stimulation (AO + active HD-tDCS group); (2) observation of a video clip that presented the same reaching movement sequences + sham HD-tDCS stimulation (AO + sham HD-tDCS group); and (3) observation of a video clip that presented neutral movie while receiving sham stimulation (NM + sham HD-tDCS group). Subjects' reaching performance was tested before and immediately after each intervention and following 24 h. Subjects performed reaching movements toward units that were activated in the same order as the observed sequence during pretest, posttest, and retest. Occasionally, the sequence order was changed by beginning the sequence unexpectedly with a different activated unit. Outcome measures included mean Reaching Time and difference between the Reaching Time of the unexpected and expected reaching movements (Delta). In the posttest and retest, Reaching Time and Delta improved in the AO + sham HD-tDCS group compared to the NM + HD-sham tDCS group. In addition, at posttest, Delta improved in the AO + active HD-tDCS group compared to the NM + sham HD-tDCS group. It appears that combining a montage of active HD-tDCS, which targets the IPL and IFG, with AO interferes with the positive effects of AO alone on the performance of reaching movement sequences.
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Affiliation(s)
- Gidon Schwell
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - David Tarshansky
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Moshe Einat
- Department of Electrical and Electronic Engineering, Ariel University, Ariel, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana, Israel
- *Correspondence: Silvi Frenkel-Toledo,
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16
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Neuroprotection and Non-Invasive Brain Stimulation: Facts or Fiction? Int J Mol Sci 2022; 23:ijms232213775. [PMID: 36430251 PMCID: PMC9692544 DOI: 10.3390/ijms232213775] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
Non-Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and repetitive Magnetic Transcranial Stimulation (rTMS), are well-known non-pharmacological approaches to improve both motor and non-motor symptoms in patients with neurodegenerative disorders. Their use is of particular interest especially for the treatment of cognitive impairment in Alzheimer's Disease (AD), as well as axial disturbances in Parkinson's (PD), where conventional pharmacological therapies show very mild and short-lasting effects. However, their ability to interfere with disease progression over time is not well understood; recent evidence suggests that NIBS may have a neuroprotective effect, thus slowing disease progression and modulating the aggregation state of pathological proteins. In this narrative review, we gather current knowledge about neuroprotection and NIBS in neurodegenerative diseases (i.e., PD and AD), just mentioning the few results related to stroke. As further matter of debate, we discuss similarities and differences with Deep Brain Stimulation (DBS)-induced neuroprotective effects, and highlight possible future directions for ongoing clinical studies.
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17
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Beretta VS, Santos PCR, Orcioli-Silva D, Zampier VC, Vitório R, Gobbi LTB. Transcranial direct current stimulation for balance rehabilitation in neurological disorders: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101736. [PMID: 36116750 DOI: 10.1016/j.arr.2022.101736] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
Postural instability is common in neurological diseases. Although transcranial direct current stimulation (tDCS) seems to be a promising complementary therapy, emerging evidence indicates mixed results and protocols' characteristics. We conducted a systematic review and meta-analysis on PubMed, EMBASE, Scopus, and Web of Science to synthesize key findings of the effectiveness of single and multiple sessions of tDCS alone and combined with other interventions on balance in adults with neurological disorders. Thirty-seven studies were included in the systematic review and 33 in the meta-analysis. The reviewed studies did not personalize the stimulation protocol to individual needs/characteristics. A random-effects meta-analysis indicated that tDCS alone (SMD = -0.44; 95%CI = -0.69/-0.19; p < 0.001) and combined with another intervention (SMD = -0.31; 95%CI = -0.51/-0.11; p = 0.002) improved balance in adults with neurological disorders (small to moderate effect sizes). Balance improvements were evidenced regardless of the number of sessions and targeted area. In summary, tDCS is a promising therapy for balance rehabilitation in adults with neurological disorders. However, further clinical trials should identify factors that influence responsiveness to tDCS for a more tailored approach, which may optimize the clinical use of tDCS.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | | | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Vinicius Cavassano Zampier
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Rodrigo Vitório
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Swissa Y, Hacohen S, Friedman J, Frenkel-Toledo S. Sensorimotor performance after high-definition transcranial direct current stimulation over the primary somatosensory or motor cortices in men versus women. Sci Rep 2022; 12:11117. [PMID: 35778465 PMCID: PMC9249866 DOI: 10.1038/s41598-022-15226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
The primary somatosensory (S1) cortex is a central structure in motor performance. However, transcranial direct current stimulation (tDCS) research aimed at improving motor performance usually targets the primary motor cortex (M1). Recently, sex was found to mediate tDCS response. Thus, we investigated whether tDCS with an anodal electrode placed over S1 improves motor performance and sensation perception in men versus women. Forty-five participants randomly received 15-min high-definition tDCS (HD-tDCS) at 1 mA to S1, M1, or sham stimulation. Reaching performance was tested before and immediately following stimulation. Two-point orientation discrimination (TPOD) of fingers and proprioception of a reaching movement were also tested. Although motor performance did not differ between groups, reaching reaction time improved in the M1 group men. Reaching movement time and endpoint error improved in women and men, respectively. Correct trials percentage for TPOD task was higher in the S1 compared to the M1 group in the posttest and improved only in the S1 group. Reaching movement time for the proprioception task improved, overall, and endpoint error did not change. Despite the reciprocal connections between S1 and M1, effects of active tDCS over S1 and M1 may specifically influence sensation perception and motor performance, respectively. Also, sex may mediate effects of HD-tDCS on motor performance.
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Affiliation(s)
- Yochai Swissa
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Shlomi Hacohen
- Department of Mechanical Engineering, Ariel University, Ariel, Israel
| | - Jason Friedman
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel. .,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
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Transcranial Direct Current Stimulation Enhances Cognitive Function in Patients with Mild Cognitive Impairment and Early/Mid Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050562. [PMID: 35624949 PMCID: PMC9138792 DOI: 10.3390/brainsci12050562] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) i a non-invasive brain stimulation which is considered to have the potential to improve cognitive impairment in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). However, previous studies have been controversial on the therapeutic effect of tDCS. This meta-analysis aimed to evaluate the effects of tDCS on cognitive impairment in patients with MCI and mild-to-moderate AD. Five databases, namely PubMed, EMBASE, MEDLINE, Web of Science and The Cochrane Library, were searched with relative terms to extract the cognitive function changes measured by an objective cognitive scale in the included studies. The meta-analysis results showed that, compared with sham tDCS treatment, the overall cognitive function of patients with AD and MCI was significantly improved (weighted mean difference = 0.99; 95% confidence interval, 0.32 to 1.66; p = 0.004) after tDCS treatment, but the behavioral symptoms, recognition memory function, attention and executive function were not significantly improved. The subgroup analysis showed that the treatment would be more efficacious if the temporal-lobe-related brain areas were stimulated, the number of stimulations was greater than or equal to 10 and the current density was 2.5 mA/cm2. Among them, AD patients benefited more than MCI patients. No cognitive improvement was observed in patients with MCI or AD at different follow-up times after treatment. Our meta-analysis provided important evidence for the cognitive enhancement of tDCS in patients with MCI and mild-to-moderate AD and discussed its underlying mechanisms.
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20
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Mishra RK, Thrasher AT. Effect of concurrent transcranial direct current stimulation on instrumented timed up and go task performance in people with Parkinson's disease: A double-blind and cross-over study. J Clin Neurosci 2022; 100:184-191. [PMID: 35487026 DOI: 10.1016/j.jocn.2022.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 03/25/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) delivered to the dorsolateral prefrontal cortex (DLPFC) can improve mobility among people with Parkinson's disease (PD). Previous studies suggest that delivering tDCS during task performance might be beneficial. However, only a few studies explored the effect of combining tDCS with task. We investigated the effect of stimulating the DLPFC using anodal tDCS while performing a timed up and go (TUG) test and its sustained effects. In this sham-controlled, cross-over, and double-blind study, twenty participants with PD (age = 67.8 ± 8.3 years and 6 females) completed two sessions (anodal or sham tDCS), conducted in the randomized and counterbalanced manner, with at least a 1-week gap. Stimulation involved transferring 2 mA current through the DLPFC for 30 min. Single-trial of TUG test was performed under single- and dual-task conditions before, during, immediately after, 15 and 30 min after stimulation ceased. We estimated durations of completing different components of TUG. Phoneme verbal fluency task was given as the cognitive distractor during the dual-tasking. An improvement was observed in cognitive performance due to the tDCS condition (d = 0.7, p < 0.01) over time. However, we found no effect of tDCS condition on iTUG related outcomes under single- or dual-task conditions. In conclusion, DLPFC stimulation combined with task improved cognitive performance only, and the improvement was sustained after tDCS ceased. Future studies may investigate stimulating multiple brain regions to improve motor and cognitive performance.
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Affiliation(s)
- Ram Kinker Mishra
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, USA.
| | - Adam Timothy Thrasher
- Center for Neuromotor and Biomechanics Research, Department of Health and Human Performance, University of Houston, Houston, TX, USA.
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21
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Simpson MW, Mak M. Single session transcranial direct current stimulation to the primary motor cortex fails to enhance early motor sequence learning in Parkinson's disease. Behav Brain Res 2022; 418:113624. [PMID: 34634239 DOI: 10.1016/j.bbr.2021.113624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Explicit motor sequence learning is impaired in Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) applied over the motor cortex in healthy can improve explicit motor learning, but comparative effects in PD are unknown. This exploratory study aims to examine the effect of single session tDCS on explicit motor sequence learning in PD. METHODS Thirty-three people with mild to moderate PD learnt a short and long finger tapping sequence with their right hand. Participants received either anodal, cathodal, or sham tDCS applied over the left primary motor cortex during task practice. Single- and dual-task finger tapping performance was assessed before and after task practice and functional near-infrared spectroscopy used to measure task related changes of oxygenated haemoglobin. RESULTS Finger tapping performance of short and long sequences under single-task conditions significantly improved following practice (p = 0.010 and p < 0.001, respectively). A condition-by-time interaction trend was observed for the long finger tapping sequence (p = 0.069) driven by improved performance in the cathodal (p = 0.001) and sham (p < 0.001) tDCS conditions, but not anodal tDCS (p = 0.198). The primary and premotor cortex and supplementary motor area were active in all tasks. No interaction or main effects were observed for task related changes of oxygenated haemoglobin. CONCLUSIONS PD patients retain the capacity to learn an explicit sequence of movements. Motor cortex tDCS does not improve explicit motor learning in PD and anodal tDCS may even suppress the rate of learning.
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Affiliation(s)
- Michael William Simpson
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Margaret Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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22
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Cammisuli DM, Cignoni F, Ceravolo R, Bonuccelli U, Castelnuovo G. Transcranial Direct Current Stimulation (tDCS) as a Useful Rehabilitation Strategy to Improve Cognition in Patients With Alzheimer's Disease and Parkinson's Disease: An Updated Systematic Review of Randomized Controlled Trials. Front Neurol 2022; 12:798191. [PMID: 35185754 PMCID: PMC8847129 DOI: 10.3389/fneur.2021.798191] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022] Open
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are neurodegenerative disorders characterized by cognitive impairment and functional decline increasing with disease progression. Within non-pharmacological interventions, transcranial direct current stimulation (tDCS) might represent a cost-effective rehabilitation strategy to implement cognitive abilities with positive implications for functional autonomy and quality-of-life of patients. Our systematic review aimed at evaluating the effects of tDCS upon cognition in people suffering from AD and PD. We searched for randomized controlled trials (RCTs) into PubMed, Web of Science, and Cochrane Library. Three review authors extracted data of interest, with neuropsychological tests or experimental cognitive tasks scores as outcome measures. A total of 17 RCTs (10 trials for AD and 7 trials for PD) were included. Compared with sham stimulation, tDCS may improve global cognition and recognition memory in patients with AD and also some executive functions (i.e., divided attention, verbal fluency, and reduction of sensitivity to interference) in patients with PD. Criticism remains about benefits for the other investigated cognitive domains. Despite preliminary emerging evidences, larger RCTs with common neuropsychological measures and long-term follow-ups establishing longevity of the observed effects are necessary for future research in applied psychology field, alongside improved clinical guidelines on the neurodegenerative disorders pertaining electrodes montage, sessions number, duration and intensity of the stimulation, and cognitive battery to be used.
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Affiliation(s)
| | - Fabio Cignoni
- Neurological Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Pisa, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- *Correspondence: Gianluca Castelnuovo ;
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23
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Parkinson's disease: Alterations of motor plasticity and motor learning. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:135-151. [PMID: 35034730 DOI: 10.1016/b978-0-12-819410-2.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This chapter reviews the alterations in motor learning and motor cortical plasticity in Parkinson's disease (PD), the most common movement disorder. Impairments in motor learning, which is a hallmark of basal ganglia disorders, influence the performance of motor learning-related behavioral tasks and have clinical implications for the management of disturbance in gait and posture, and for rehabilitative management of PD. Although plasticity is classically induced and assessed in sliced preparation in animal models, in this review we have concentrated on the results from non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS) and transcranial direct current stimulation (tDCS) in patients with PD, in addition to a few animal electrophysiologic studies. The chapter summarizes the results from different cortical and subcortical plasticity investigations. Plasticity induction protocols reveal deficient plasticity in PD and these plasticity measures are modulated by medications and deep brain stimulation. There is considerable variability in these measures that are related to inter-individual variations, different disease characteristics and methodological considerations. Nevertheless, these pathophysiologic studies expand our knowledge of cortical excitability, plasticity and the effects of different treatments in PD. These tools of modulating plasticity and motor learning improve our understanding of PD pathophysiology and help to develop new treatments for this disabling condition.
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24
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Zhang M, He T, Wang Q. Effects of Non-invasive Brain Stimulation on Multiple System Atrophy: A Systematic Review. Front Neurosci 2021; 15:771090. [PMID: 34966257 PMCID: PMC8710715 DOI: 10.3389/fnins.2021.771090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background/Objective: Multiple system atrophy (MSA) refers to a progressive neurodegenerative disease characterized by autonomic dysfunction, parkinsonism, cerebellar ataxia, as well as cognitive deficits. Non-invasive brain stimulation (NIBS) has recently served as a therapeutic technique for MSA by personalized stimulation. The primary aim of this systematic review is to assess the effects of NIBS on two subtypes of MSA: parkinsonian-type MSA (MSA-P) and cerebellar-type MSA (MSA-C). Methods: A literature search for English articles was conducted from PubMed, Embase, Web of Science, Cochrane Library, CENTRAL, CINAHL, and PsycINFO up to August 2021. Original articles investigating the therapeutics application of NIBS in MSA were screened and analyzed by two independent reviewers. Moreover, a customized form was adopted to extract data, and the quality of articles was assessed based on the PEDro scale for clinical articles. Results: On the whole, nine articles were included, i.e., five for repetitive transcranial magnetic stimulation (rTMS), two for transcranial direct current stimulation (tDCS), one for paired associative stimulation, with 123 patients recruited. The mentioned articles comprised three randomized controlled trials, two controlled trials, two non-controlled trials, and two case reports which assessed NIBS effects on motor function, cognitive function, and brain modulatory effects. The majority of articles demonstrated significant motor symptoms improvement and increased cerebellar activation in the short term after active rTMS. Furthermore, short-term and long-term effects on improvement of motor performance were significant for tDCS. As opposed to the mentioned, no significant change of motor cortical excitability was reported after paired associative stimulation. Conclusion: NIBS can serve as a useful neurorehabilitation strategy to improve motor and cognitive function in MSA-P and MSA-C patients. However, further high-quality articles are required to examine the underlying mechanisms and standardized protocol of rTMS as well as its long-term effect. Furthermore, the effects of other NIBS subtypes on MSA still need further investigation.
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Affiliation(s)
- Mengjie Zhang
- Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, China
| | - Ting He
- Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, China
| | - Quan Wang
- Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, China
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25
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Nooristani M, Augereau T, Moïn-Darbari K, Bacon BA, Champoux F. Using Transcranial Electrical Stimulation in Audiological Practice: The Gaps to Be Filled. Front Hum Neurosci 2021; 15:735561. [PMID: 34887736 PMCID: PMC8650084 DOI: 10.3389/fnhum.2021.735561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
The effects of transcranial electrical stimulation (tES) approaches have been widely studied for many decades in the motor field, and are well known to have a significant and consistent impact on the rehabilitation of people with motor deficits. Consequently, it can be asked whether tES could also be an effective tool for targeting and modulating plasticity in the sensory field for therapeutic purposes. Specifically, could potentiating sensitivity at the central level with tES help to compensate for sensory loss? The present review examines evidence of the impact of tES on cortical auditory excitability and its corresponding influence on auditory processing, and in particular on hearing rehabilitation. Overall, data strongly suggest that tES approaches can be an effective tool for modulating auditory plasticity. However, its specific impact on auditory processing requires further investigation before it can be considered for therapeutic purposes. Indeed, while it is clear that electrical stimulation has an effect on cortical excitability and overall auditory abilities, the directionality of these effects is puzzling. The knowledge gaps that will need to be filled are discussed.
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Affiliation(s)
- Mujda Nooristani
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Thomas Augereau
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | - Karina Moïn-Darbari
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
| | | | - François Champoux
- École d'Orthophonie et d'Audiologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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26
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da Silva Machado CB, da Silva LM, Gonçalves AF, Andrade PRD, Mendes CKTT, de Assis TJCF, Godeiro Júnior CDO, Andrade SM. Multisite non-invasive brain stimulation in Parkinson's disease: A scoping review. NeuroRehabilitation 2021; 49:515-531. [PMID: 34776426 PMCID: PMC8764602 DOI: 10.3233/nre-210190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening.
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Affiliation(s)
| | | | | | | | | | | | - Clécio de Oliveira Godeiro Júnior
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, La Tronche, Grenoble, France.,Division of Neurology, Hospital Universitario Onofre Lopes, Federal University of Rio Grande do Norte, Natal, Brazil
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27
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Liu X, Liu H, Liu Z, Rao J, Wang J, Wang P, Gong X, Wen Y. Transcranial Direct Current Stimulation for Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:746797. [PMID: 34776931 PMCID: PMC8584149 DOI: 10.3389/fnagi.2021.746797] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Parkinson's disease is a common neurodegenerative disorder with motor and non-motor symptoms. Recently, as adjuvant therapy, transcranial direct current stimulation (tDCS) has been shown to improve the motor and non-motor function of patients with Parkinson's disease (PD). This systematic review aimed to evaluate the existing evidence for the efficacy of tDCS for PD. We included English databases (PubMed, the Cochrane Library, Embase, and Web of Science) and Chinese databases [Wanfang database, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and China Biology Medicine (CBM)] without restricting the year of publication. Twenty-one tDCS studies, with a total of 736 participants, were included in the analysis. Two independent researchers extracted the data and characteristics of each study. There was a significant pooled effect size (-1.29; 95% CI = -1.60, -0.98; p < 0.00001; I 2 = 0%) in the Unified PD Rating Scale (UPDRS) I and the Montreal cognitive assessment (SMD = 0.87, 95% CI = 0.50 to 1.24; p < 0.00001; I 2 = 0%). The poor effect size was observed in the UPDRS III scores (SMD = -0.13; 95% CI = -0.64, 0.38; p = 0.61; I 2 = 77%), and similar results were observed for the timed up and go (TUG) test, Berg balance scale, and gait assessment. The results of this meta-analysis showed that there was insufficient evidence that tDCS improves the motor function of patients with PD. However, tDCS seemed to improve their cognitive performance. Further multicenter research with a larger sample size is needed. In addition, future research should focus on determining the tDCS parameters that are most beneficial to the functional recovery of patients with PD.
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Affiliation(s)
- Xiang Liu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Zicai Liu
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Jinzhu Rao
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Jing Wang
- Department of Rehabilitation Medicine, Yuebei People's Hospital, Shaoguan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | | | - Youliang Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
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28
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Lee SA, Kim MK. The Effect of Transcranial Direct Current Stimulation Combined with Visual Cueing Training on Motor Function, Balance, and Gait Ability of Patients with Parkinson's Disease. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111146. [PMID: 34833364 PMCID: PMC8617912 DOI: 10.3390/medicina57111146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/10/2023]
Abstract
Background and Objectives: The purpose of this study was to investigate the effects of transcranial direct current stimulation (tDCS) on motor function, balance and gait ability in patients with Parkinson’s disease (PD). Materials and Methods: For the experiment, 30 patients with PD were randomly assigned to the experimental group (n = 15) and the control group (n = 15). Visual cueing training was commonly applied to both groups, the experimental group applied tDCS simultaneously with visual training, and the control group applied sham tDCS simultaneously with visual training. All subjects were pre-tested before the first intervention, post-tested after completing all 4 weeks of intervention, and followed-up tested 2 weeks after the completing intervention. The tests used the Unified Parkinson’s Disease Rating Scale (UPDRS) for motor function assessment, Functional Gait Assessment (FGA) for balance assessment, Freezing of Gait Questionnaire (FOG-Q) and the GAITRite system for gait ability assessment. Among the data obtained through the GAITRite system, gait velocity, cadence, step time, double support time, and stride length were analyzed. Results: The experimental group showed a significant decrease in UPDRS and a significant increase in FGA and cadence after the intervention. In addition, UPDRS and cadence showed a significant difference in the follow-up test compared to the pre-intervention test. Conclusions: This study suggests that the application of tDCS to the supplementary motor area of PD patients is useful as an adjuvant therapy for rehabilitation training of PD patients.
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Affiliation(s)
- Si-A Lee
- Department of Rehabilitation Sciences, Graduate School, Daegu University, Jillyang, Gyeongsan, Gyeongbuk 712-714, Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan, Gyeongbuk 712-714, Korea
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29
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Tu Y, Cao J, Guler S, Chai-Zhang T, Camprodon JA, Vangel M, Gollub RL, Dougherty DD, Kong J. Perturbing fMRI brain dynamics using transcranial direct current stimulation. Neuroimage 2021; 237:118100. [PMID: 33933595 PMCID: PMC8291729 DOI: 10.1016/j.neuroimage.2021.118100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/24/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
The dynamic nature of resting-state functional magnetic resonance imaging (fMRI) brain activity and connectivity has drawn great interest in the past decade. Specific temporal properties of fMRI brain dynamics, including metrics such as occurrence rate and transitions, have been associated with cognition and behaviors, indicating the existence of mechanism distruption in neuropsychiatric disorders. The development of new methods to manipulate fMRI brain dynamics will advance our understanding of these pathophysiological mechanisms from native observation to experimental mechanistic manipulation. In the present study, we applied repeated transcranial direct current stimulation (tDCS) to the right dorsolateral prefrontal cortex (rDLPFC) and the left orbitofrontal cortex (lOFC), during multiple simultaneous tDCS-fMRI sessions from 81 healthy participants to assess the modulatory effects of stimulating target brain regions on fMRI brain dynamics. Using the rDLPFC and the lOFC as seeds, respectively, we first identified two reoccurring co-activation patterns (CAPs) and calculated their temporal properties (e.g., occurrence rate and transitions) before administering tDCS. The spatial maps of CAPs were associated with different cognitive and disease domains using meta-analytical decoding analysis. We then investigated how active tDCS compared to sham tDCS in the modulation of the occurrence rates of these different CAPs and perturbations of transitions between CAPs. We found that by enhancing neuronal excitability of the rDLPFC and the lOFC, the occurrence rate of one CAP was significantly decreased while that of another CAP was significantly increased during the first 6 min of stimulation. Furthermore, these tDCS-associated changes persisted over subsequent testing sessions (both during and before/after tDCS) across three consecutive days. Active tDCS could perturb transitions between CAPs and a non-CAP state (when the rDLPFC and the lOFC were not activated), but not the transitions within CAPs. These results demonstrate the feasibility of modulating fMRI brain dynamics, and open new possibilities for discovering stimulation targets and dynamic connectivity patterns that can ensure the propagation of tDCS-induced neuronal excitability, which may facilitate the development of new treatments for disorders with altered dynamics.
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Affiliation(s)
- Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States
| | - Seyhmus Guler
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States
| | - Thalia Chai-Zhang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Mark Vangel
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Randy L Gollub
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States.
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30
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Long-Term Application of Cerebellar Transcranial Direct Current Stimulation Does Not Improve Motor Learning in Parkinson's Disease. THE CEREBELLUM 2021; 21:333-349. [PMID: 34232470 PMCID: PMC8260571 DOI: 10.1007/s12311-021-01297-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/19/2022]
Abstract
Cerebellar transcranial direct current stimulation (c-tDCS) enhances motor skill acquisition and motor learning in young and old adults. Since the cerebellum is involved in the pathophysiology of Parkinson’s disease (PD), c-tDCS may represent an intervention with potential to improve motor learning in PD. The primary purpose was to determine the influence of long-term application of c-tDCS on motor learning in PD. The secondary purpose was to examine the influence of long-term application of c-tDCS on transfer of motor learning in PD. The study was a randomized, double-blind, SHAM-controlled, between-subjects design. Twenty-one participants with PD were allocated to either a tDCS group or a SHAM stimulation group. Participants completed 9 practice sessions over a 2-week period that involved extensive practice of an isometric pinch grip task (PGT) and a rapid arm movement task (AMT). These practice tasks were performed over a 25-min period concurrent with either anodal c-tDCS or SHAM stimulation. A set of transfer tasks that included clinical rating scales, manual dexterity tests, and lower extremity assessments were quantified in Test sessions at Baseline, 1, 14, and 28 days after the end of practice (EOP). There were no significant differences between the c-tDCS and SHAM groups as indicated by performance changes in the practice and transfer tasks from Baseline to the 3 EOP Tests. The findings indicate that long-term application of c-tDCS does not improve motor learning or transfer of motor learning to a greater extent than practice alone in PD.
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31
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Pang MY. Physiotherapy management of Parkinson's disease. J Physiother 2021; 67:163-176. [PMID: 34154949 DOI: 10.1016/j.jphys.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Marco Yc Pang
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong.
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Nascimento LR, do Carmo WA, de Oliveira GP, Arêas FZDS, Dias FMV. Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review. J Physiother 2021; 67:190-196. [PMID: 34147400 DOI: 10.1016/j.jphys.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022] Open
Abstract
QUESTIONS Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION tDCS combined with walking training. OUTCOME MEASURES Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION PROSPERO CRD42020162908.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Willian Assis do Carmo
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Gabriela Pinto de Oliveira
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernando Zanela da Silva Arêas
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernanda Moura Vargas Dias
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
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Chen CH, Chen YC, Jiang RS, Lo LY, Wang IL, Chiu CH. Transcranial Direct Current Stimulation Decreases the Decline of Speed during Repeated Sprinting in Basketball Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136967. [PMID: 34209833 PMCID: PMC8297176 DOI: 10.3390/ijerph18136967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine whether transcranial direct current stimulation (tDCS) can improve countermovement jump performance, fatigue index and alleviate the speed decline during repeated shuttle sprints in trained basketball players. Thirteen trained basketball players were divided into the tDCS trial and sham trial by the random crossover design. The tDCS trial was stimulated with 2-mA current in the M1 area in the middle of the top of the head for 20 min. For the sham trial, the current was turned off after 5 s, stopping the electrical stimulation. After warming up, the players underwent countermovement jump test, weighted countermovement jump test and then performed 40 × 15-m sprints with with a 1:4 exercise: rest ratio. The jump height, sprinting time, fatigue index, heart rate and rating of perceived exertion (RPE) were analyzed by paired-sample t-test, when significance was discovered by two-way repeated measures analysis of variance. The study results revealed that the tDCS trial significantly increase the countermovement jump performance (p = 0.04), decrease the sprinting time (p = 0.016), and had improved fatigue index during the sprinting process (p = 0.009). However, the heart rate and RPE during sprinting were nonsignificantly different between the trials. This study has identified that tDCS can decrease the speed decline, fatigue index during sprinting and increase countermovement jump performance without affecting heart rate or the rating of perceived exertion.
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Affiliation(s)
- Che-Hsiu Chen
- Department of Sport Performance, National Taiwan University of Sport, Taichung 404, Taiwan;
| | - Yu-Chun Chen
- Department of Physical Education, National Taiwan University of Sport, Taichung 404, Taiwan; (Y.-C.C.); (R.-S.J.)
| | - Ren-Shiang Jiang
- Department of Physical Education, National Taiwan University of Sport, Taichung 404, Taiwan; (Y.-C.C.); (R.-S.J.)
| | - Lok-Yin Lo
- Graduate Program in Department of Exercise Health Science, National Taiwan University of Sport, Taichung 404, Taiwan;
| | - I-Lin Wang
- College of Physical Education, Hubei Normal University, Huangshi 435002, China;
| | - Chih-Hui Chiu
- Graduate Program in Department of Exercise Health Science, National Taiwan University of Sport, Taichung 404, Taiwan;
- Correspondence: ; Tel.: +886-4-2221-3108 (ext. 3486)
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Firouzi M, Baetens K, Swinnen E, Baeken C, Van Overwalle F, Deroost N. Registered report: Does transcranial direct current stimulation of the primary motor cortex improve implicit motor sequence learning in Parkinson's disease? J Neurosci Res 2021; 99:2406-2415. [PMID: 34181300 DOI: 10.1002/jnr.24908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/10/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
Implicit motor sequence learning (IMSL) is a cognitive function that is known to be directly associated with impaired motor function in Parkinson's disease (PD). Research on healthy young participants shows the potential for transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, over the primary motor cortex (M1) to enhance IMSL. tDCS has direct effects on the underlying cortex, but also induces distant (basal ganglia) network effects-hence its potential value in PD, a prime model of basal ganglia dysfunction. To date, only null effects have been reported in persons with PD. However, these studies did not determine the reacquisition effects, although previous studies in healthy young adults suggest that tDCS specifically exerts its beneficial effects on IMSL on reacquisition rather than acquisition. In the current study, we will therefore establish possible reacquisition effects, which are of a particular interest, as long-term effects are vital for the successful functional rehabilitation of persons with PD. Using a sham-controlled, counterbalanced design, we will investigate the potential of tDCS delivered over M1 to enhance IMSL, as measured by the serial reaction time task, in persons with PD and a neurologically healthy age- and sex-matched control (HC) group. Multilevel Mixed Models will be implemented to analyze the sequence-specific aspect of IMSL (primary outcome) and general learning (secondary outcome). We will determine not only the immediate effects that may occur concurrently with the application of tDCS but also the short-term (5 min post-tDCS) and long-term (1 week post-tDCS) reacquisition effects.
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Affiliation(s)
- Mahyar Firouzi
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Kris Baetens
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Eva Swinnen
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Chris Baeken
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium.,Department of Psychiatry and Medical Psychology, Ghent University, University Hospital Ghent (UZ Ghent), Ghent, Belgium.,Department of Psychiatry, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), University Hospital Brussel (UZ Brussel), Brussels, Belgium
| | - Frank Van Overwalle
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
| | - Natacha Deroost
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Elsene, Belgium
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Lerner O, Friedman J, Frenkel-Toledo S. The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:103. [PMID: 34174914 PMCID: PMC8236155 DOI: 10.1186/s12984-021-00899-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using–for the first time–a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects. Methods Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants’ reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h. Results In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint. Conclusions It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation. Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00899-z.
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Affiliation(s)
- Ohad Lerner
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Jason Friedman
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel. .,Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel.
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Zhou H, Meng L, Xia X, Lin Z, Zhou W, Pang N, Bian T, Yuan T, Niu L, Zheng H. Transcranial Ultrasound Stimulation Suppresses Neuroinflammation in a Chronic Mouse Model of Parkinson's Disease. IEEE Trans Biomed Eng 2021; 68:3375-3387. [PMID: 33830916 DOI: 10.1109/tbme.2021.3071807] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Neuroinflammation contributes to the development and progression of Parkinson's disease (PD). The aim of this study was to examine whether ultrasound (US) stimulation of the subthalamic nucleus (STN) could suppress the neuroinflammation in a chronic PD mouse model induced by 1-Methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP). METHODS A chronic PD mouse model was built by injections of 20mg/kg MPTP and 250 mg/kg probenecid at 3.5-day intervals for 5 weeks. Mice were randomized into control+sham, MPTP+sham and MPTP+STN+US group. For MPTP+STN+US group, ultrasound wave (3.8 MHz, 50% duty cycle, 1 kHz pulse repetition frequency, 30 min/day) was delivered to the STN the day after MPTP and probenecid injection (the early stage of PD progression). The rotarod test and pole test were performed to evaluate the behavioral changes after ultrasound treatment. Then, the activity of microglia and astrocyte were measured to evaluate the inflammation level in the brain. RESULTS Ultrasound stimulation improved the latency to falls in the rotarod test (p = 0.033) and decreased the climbing time in the pole test (p = 0.016) compared with MPTP+sham group. Moreover, ultrasound stimulation reduced the chronic inflammation response as shown in microglia (p = 0.007) and astrocyte (p = 0.032) activation. In addition, HE, Nissl and Tunel staining showed that no brain tissue injury was induced by US. CONCLUSION These findings demonstrated that ultrasound stimulation could suppress neuroinflammation in PD mice. SIGNIFICANCE Transcranial ultrasound neuromodulation offers a novel approach for Parkinson's disease intervention, potentially through its anti-neuroinflammation functions.
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Wang B, Xiao S, Yu C, Zhou J, Fu W. Effects of Transcranial Direct Current Stimulation Combined With Physical Training on the Excitability of the Motor Cortex, Physical Performance, and Motor Learning: A Systematic Review. Front Neurosci 2021; 15:648354. [PMID: 33897361 PMCID: PMC8062775 DOI: 10.3389/fnins.2021.648354] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/08/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose: This systematic review aims to examine the efficacy of transcranial direct current stimulation (tDCS) combined with physical training on the excitability of the motor cortex, physical performance, and motor learning. Methods: A systematic search was performed on PubMed, Web of Science, and EBSCO databases for relevant research published from inception to August 2020. Eligible studies included those that used a randomized controlled design and reported the effects of tDCS combined with physical training to improve motor-evoked potential (MEP), dynamic posture stability index (DPSI), reaction time, and error rate on participants without nervous system diseases. The risk of bias was assessed by the Cochrane risk of bias assessment tool. Results: Twenty-four of an initial yield of 768 studies met the eligibility criteria. The risk of bias was considered low. Results showed that anodal tDCS combined with physical training can significantly increase MEP amplitude, decrease DPSI, increase muscle strength, and decrease reaction time and error rate in motor learning tasks. Moreover, the gain effect is significantly greater than sham tDCS combined with physical training. Conclusion: tDCS combined with physical training can effectively improve the excitability of the motor cortex, physical performance, and motor learning. The reported results encourage further research to understand further the synergistic effects of tDCS combined with physical training.
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Affiliation(s)
- Baofeng Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Songlin Xiao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Changxiao Yu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Junhong Zhou
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Weijie Fu
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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Suarez-García DMA, Grisales-Cárdenas JS, Zimerman M, Cardona JF. Transcranial Direct Current Stimulation to Enhance Cognitive Impairment in Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:597955. [PMID: 33329353 PMCID: PMC7734248 DOI: 10.3389/fneur.2020.597955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/09/2020] [Indexed: 01/29/2023] Open
Abstract
Cognitive deficits are increasingly being recognized as a common trait in Parkinson's disease (PD). Recently, transcranial direct current stimulation (tDCS) has been shown to exert positive effects as an adjunctive therapy on motor and non-motor symptoms in PD. This systematic review and meta-analysis aims to provide an overview of reported evidence on the efficacy of tDCS interventions in the treatment of cognitive impairments in PD. A systematic literature review was conducted to examine articles that were published in the past 10 years and that study the effects of tDCS on cognitive deficits in PD patients. The PubMed, Scopus and Scielo databases were searched. Eight tDCS studies involving 168 participants were included for the analysis. Our meta-analysis results showed that anodal tDCS (atDCS) had various levels or no evidence of effectiveness. In the pre-post stimulation analysis, a strong effect was reported for executive functions (pre-post: g = 1.51, Z = 2.41, p = 0.016); non-significant effects were reported for visuospatial skills (pre-post: g = 0.27, Z = 0.69, p = 0.490); attention (pre-post: g = 0.02, Z = 0.08, p = 0.934), memory (pre-post: g = 0.01, Z = 0.03, p = 0.972) and language (pre-post: g = 0.07, Z = 0.21, p = 0.832). However, in the pre-follow-up stimulation analysis, the duration of the effect was not clear. This study highlights the potential effectiveness of atDCS to improve cognitive performance in PD patients but failed to establish a cause-effect relationship between tDCS intervention and cognitive improvement in PD. Future directions and recommendations for methodological improvements are outlined.
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Affiliation(s)
| | | | - Máximo Zimerman
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Juan F Cardona
- Instituto de Psicología, Universidad del Valle, Santiago de Cali, Colombia
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Firouzi M, Van Herk K, Kerckhofs E, Swinnen E, Baeken C, Van Overwalle F, Deroost N. Transcranial direct‐current stimulation enhances implicit motor sequence learning in persons with Parkinson's disease with mild cognitive impairment. J Neuropsychol 2020; 15:363-378. [DOI: 10.1111/jnp.12231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/07/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Mahyar Firouzi
- Brain, Body and Cognition Department of Psychology and Educational Sciences Vrije Universiteit Brussel Belgium
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
| | - Karlijn Van Herk
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Vrije Universiteit Brussel Belgium
| | - Eric Kerckhofs
- Brain, Body and Cognition Department of Psychology and Educational Sciences Vrije Universiteit Brussel Belgium
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
| | - Eva Swinnen
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
| | - Chris Baeken
- Brain, Body and Cognition Department of Psychology and Educational Sciences Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
- Department of Psychiatry and Medical Psychology Ghent University University Hospital Ghent Belgium
- Department of Psychiatry Faculty of Medicine and Pharmacy Vrije Universiteit Brussel University Hospital Brussel Belgium
| | - Frank Van Overwalle
- Brain, Body and Cognition Department of Psychology and Educational Sciences Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
| | - Natacha Deroost
- Brain, Body and Cognition Department of Psychology and Educational Sciences Vrije Universiteit Brussel Belgium
- Rehabilitation Research Department of Physiotherapy Human Physiology and Anatomy Vrije Universiteit Brussel Belgium
- Center for Neurosciences (C4N) Vrije Universiteit Brussel Belgium
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Khatri DK, Choudhary M, Sood A, Singh SB. Anxiety: An ignored aspect of Parkinson’s disease lacking attention. Biomed Pharmacother 2020; 131:110776. [DOI: 10.1016/j.biopha.2020.110776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
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An Acute Application of Cerebellar Transcranial Direct Current Stimulation Does Not Improve Motor Performance in Parkinson's Disease. Brain Sci 2020; 10:brainsci10100735. [PMID: 33066348 PMCID: PMC7602166 DOI: 10.3390/brainsci10100735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Transcranial direct current stimulation of the cerebellum (c-tDCS) improves motor performance in young and old adults. Based on the cerebellar involvement in Parkinson’s disease (PD), c-tDCS could have potential to improve motor function in PD. The purpose was to determine the effects of c-tDCS on motor performance in PD while participants were on medications. The study was a randomized, double-blind, SHAM-controlled, between-subjects design. Twenty-two participants with PD were allocated to either a c-tDCS group or a SHAM group. All participants completed one experimental session and performed two motor tasks with their most affected hand in a Baseline condition (no stimulation) and an Experimental condition. The motor tasks were a visuomotor isometric precision grip task (PGT) and a rapid arm movement task (AMT). The primary dependent variables were force error and endpoint error in the PGT and AMT, respectively. There were no significant differences in force error or endpoint error in the Experimental condition between the c-tDCS and SHAM groups. These results indicate that an acute application of c-tDCS does not enhance motor performance in hand and arm tasks in PD. Longer-term c-tDCS application over multiple days may be needed to enhance motor function in PD.
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Bornheim S, Croisier J, Leclercq V, Baude C, Kaux J. Les effets de la stimulation transcrânienne à courant continu (STCC) sur les performances physiques : une revue systématique de la littérature. Sci Sports 2020. [DOI: 10.1016/j.scispo.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Guo Z, Bao D, Manor B, Zhou J. The Effects of Transcranial Direct Current Stimulation (tDCS) on Balance Control in Older Adults: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2020; 12:275. [PMID: 33024431 PMCID: PMC7516302 DOI: 10.3389/fnagi.2020.00275] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Recently, considerable research has been conducted to study the effects of transcranial direct current stimulation (tDCS) on balance control in older adults. We completed a comprehensive systematic review and meta-analysis to assess the efficacy of tDCS on balance control in this population. Methods: A search strategy based on the PICOS principle was used to find the literatures in the databases of PubMed, EMBASE, EBSCO, Web of Science. The quality and risk of bias in the studies were independently assessed by two researchers. Results: Ten studies were included in the systematic review. A meta-analysis was completed on six of these ten, with a total of 280 participants. As compared to sham (i.e., control), tDCS induced significant improvement with low heterogeneity in balance control in older adults. Specifically, tDCS induced large effects on the performance of the timed-up-and-go test, the Berg balance scale, and standing postural sway (e.g., sway area) and gait (e.g., walking speed) in dual task conditions (standardized mean differences (SMDs) = -0.99~3.41 95% confidence limits (CL): -1.52~4.50, p < 0.006, I 2 < 52%). Moderate-to-large effects of tDCS were also observed in the standing posture on a static or movable platform (SMDs = 0.37~1.12 95%CL: -0.09~1.62, p < 0.03, I 2 < 62%). Conclusion: Our analysis indicates that tDCS holds promise to promote balance in older adults. These results warrant future studies of larger sample size and rigorous study design and results report, as well as specific research to establish the relationship between the parameter of tDCS and the extent of tDCS-induced improvement in balance control in older adults.
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Affiliation(s)
- Zhenxiang Guo
- Sports Coaching College, Beijing Sport University, Bejing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Bejing, China
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
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Individually customized transcranial temporal interference stimulation for focused modulation of deep brain structures: a simulation study with different head models. Sci Rep 2020; 10:11730. [PMID: 32678264 PMCID: PMC7366675 DOI: 10.1038/s41598-020-68660-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 06/22/2020] [Indexed: 01/25/2023] Open
Abstract
Temporal interference (TI) stimulation was recently proposed that allows for the stimulation of deep brain structures with neocortical regions being minimally stimulated. For human brain modulation, TI current patterns are known to be considerably affected by the complex structures of the human head, and thus, it is hard to deliver TI current to a specific deep brain region. In this study, we optimized scalp electrode configurations and injection currents that can deliver maximum TI stimulation currents to a specific deep brain region, the head of the right hippocampus in this study, considering the real anatomical head structures of each individual. Three realistic finite element (FE) head models were employed for the optimization of TI stimulation. To generate TI current patterns, two pairs of scalp electrodes were selected, which carry two sinusoidally alternating currents with a small frequency difference. For every possible combination of electrode pairs, optimal injection currents delivering the maximal TI currents to the head of the right hippocampus were determined. The distribution of the optimized TI currents was then compared with that of the unoptimized TI currents and the conventional single frequency alternating current stimulation. Optimization of TI stimulation parameters allows for the delivery of the desired amount of TI current to the target region while effectively reducing the TI currents delivered to cortical regions compared to the other stimulation approaches. Inconsistency of the optimal stimulation conditions suggest that customized stimulation, considering the individual anatomical differences, is necessary for more effective transcranial TI stimulation. Customized transcranial TI stimulation based on the numerical field analysis is expected to enhance the overall effectiveness of noninvasive stimulation of the human deep brain structures.
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Beretta VS, Conceição NR, Nóbrega-Sousa P, Orcioli-Silva D, Dantas LKBF, Gobbi LTB, Vitório R. Transcranial direct current stimulation combined with physical or cognitive training in people with Parkinson's disease: a systematic review. J Neuroeng Rehabil 2020; 17:74. [PMID: 32539819 PMCID: PMC7296764 DOI: 10.1186/s12984-020-00701-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pharmacologic therapy is the primary treatment used to manage Parkinson's disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. AIMS This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. METHODS The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. RESULTS Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. CONCLUSION The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.
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Affiliation(s)
- Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Núbia Ribeiro Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Luana Karla Braz Fonseca Dantas
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil.
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil.
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
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Yuan Y, Zhao Z, Wang Z, Wang X, Yan J, Li X. The Effect of Low-Intensity Transcranial Ultrasound Stimulation on Behavior in a Mouse Model of Parkinson's Disease Induced by MPTP. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1017-1021. [PMID: 32149644 DOI: 10.1109/tnsre.2020.2978865] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the effects of low-intensity transcranial ultrasound stimulation (TUS) on behavior in a mouse model of Parkinson's disease (PD) induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). The PD mouse model was induced by consecutive injecting the mice with MPTP for 7 days. When the animal model is completed, we performed behavioral tests including the wire hanging test, open field test and forced swimming test on day 1, 2, 3, 4, 7, 14 during 2 weeks. Simultaneously, the ultrasound was used to stimulate the brain tissue of the mice daily for these 2 weeks. The data were analyzed to examine treatment effects. When the PD+TUS and PD+Sham groups were compared, the behavior of the PD+TUS mice was better on the fourth day after TUS (*p<0.05) and had further improved on the fourteenth day of TUS (**p<0.01). These results demonstrate that TUS can improve behavior in mice with MPTP-induced PD. The treatment effect gradually improved as the TUS duration increased.
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Feng XJ, Huang YT, Huang YZ, Kuo CW, Peng CW, Rotenberg A, Juan CH, Pei YC, Chen YH, Chen KY, Chiang YH, Liu HH, Wu JX, Hsieh TH. Early transcranial direct current stimulation treatment exerts neuroprotective effects on 6-OHDA-induced Parkinsonism in rats. Brain Stimul 2020; 13:655-663. [PMID: 32289694 DOI: 10.1016/j.brs.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has been proven to be able to modulate motor cortical plasticity might have potential as an alternative, adjunctive therapy for Parkinson's disease (PD). However, the efficacy of tDCS in PD is still uncertain. A disease animal model may be useful to clarify the existence of a treatment effect and to explore an effective therapeutic strategy using tDCS protocols. OBJECTIVE The current study was designed to identify the comprehensive therapeutic effects of tDCS in 6-hydroxydopamine (6-OHDA)-lesioned PD rats. METHODS Following early and long-term tDCS application (starting 24 h after PD lesion, 300 μA anodal tDCS, 20 min/day, 5 days/week) in awake PD animals for a total of 4 weeks, the effects of tDCS on motor and non-motor behaviors as well as dopaminergic neuron degeneration levels, were identified. RESULTS We found that the 4-week tDCS intervention significantly alleviated 6-OHDA-induced motor deficits in locomotor activity, akinesia, gait pattern and anxiety-like behavior, but not in apomorphine-induced rotations, recognition memory and depression-like behavior. Immunohistochemically, tyrosine hydroxylase (TH)-positive neurons in the substantia nigra were significantly preserved in the tDCS intervention group. CONCLUSIONS These results suggest that early and long-term tDCS could exert neuroprotective effects and reduce the aggravation of motor dysfunctions in a 6-OHDA-induced PD rat model. Furthermore, this preclinical model may enhance the promising possibility of the potential use of tDCS and serve as a translational platform to further identify the therapeutic mechanism of tDCS for PD or other neurological disorders.
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Affiliation(s)
- Xiao-Jun Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University and The Second Clinical Institute of Anhui Medical University, Hefei, China
| | - Yu-Ting Huang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Zu Huang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Wei Kuo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan; Department of Life Science, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan; Brain Research Center, National Central University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Yun Chen
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Hua Liu
- Department of Rehabilitation Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Xian Wu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University and The Second Clinical Institute of Anhui Medical University, Hefei, China.
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
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Broeder S, Nackaerts E, Cuypers K, Meesen R, Verheyden G, Nieuwboer A. tDCS-Enhanced Consolidation of Writing Skills and Its Associations With Cortical Excitability in Parkinson Disease: A Pilot Study. Neurorehabil Neural Repair 2019; 33:1050-1060. [DOI: 10.1177/1545968319887684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background. Learning processes of writing skills involve the re-engagement of previously established motor programs affected by Parkinson disease (PD). To counteract the known problems with consolidation in PD, transcranial direct current stimulation (tDCS) could be imperative to achieve a lasting regeneration of habitual motor skills. Objective. To examine tDCS-enhanced learning of writing and explore alterations in cortical excitability after stimulation in PD compared with healthy controls (HCs). Methods. Ten patients and 10 HCs received 2 training sessions combined with 20 minutes of 1-mA anodal tDCS or sham on the left primary motor cortex in a randomized crossover design. Writing skills on a tablet and paper were assessed at baseline, after training, and after 1 week of follow-up. Before and immediately after the intervention, cortical excitability and inhibition were measured during rest and activity. Results. Writing amplitude and velocity improved when practice was tDCS supplemented compared with sham in PD. Benefits were sustained at retention for trained and untrained tasks on the tablet as well as for writing on paper. No improvements were found for HCs. Reduced resting motor thresholds after tDCS indicated tDCS-enhanced cortical excitability. Additionally, increments in motor-evoked potential amplitudes correlated with improved writing in PD, whereas HCs showed the opposite pattern. Conclusion. Our results endorse the usefulness of tDCS-boosted learning in PD, at least when applied to improving writing capacity. Although further confirmatory studies are needed, these novel findings are striking because tDCS-mediated consolidation was found for learning a motor task directly affected by PD.
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Affiliation(s)
| | | | - Koen Cuypers
- KU Leuven, Leuven, Belgium
- Hasselt University, Diepenbeek, Belgium
| | - Raf Meesen
- KU Leuven, Leuven, Belgium
- Hasselt University, Diepenbeek, Belgium
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Carrarini C, Russo M, Dono F, Di Pietro M, Rispoli MG, Di Stefano V, Ferri L, Barbone F, Vitale M, Thomas A, Sensi SL, Onofrj M, Bonanni L. A Stage-Based Approach to Therapy in Parkinson's Disease. Biomolecules 2019; 9:biom9080388. [PMID: 31434341 PMCID: PMC6723065 DOI: 10.3390/biom9080388] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder that features progressive, disabling motor symptoms, such as bradykinesia, rigidity, and resting tremor. Nevertheless, some non-motor symptoms, including depression, REM sleep behavior disorder, and olfactive impairment, are even earlier features of PD. At later stages, apathy, impulse control disorder, neuropsychiatric disturbances, and cognitive impairment can present, and they often become a heavy burden for both patients and caregivers. Indeed, PD increasingly compromises activities of daily life, even though a high variability in clinical presentation can be observed among people affected. Nowadays, symptomatic drugs and non-pharmaceutical treatments represent the best therapeutic options to improve quality of life in PD patients. The aim of the present review is to provide a practical, stage-based guide to pharmacological management of both motor and non-motor symptoms of PD. Furthermore, warning about drug side effects, contraindications, as well as dosage and methods of administration, are highlighted here, to help the physician in yielding the best therapeutic strategies for each symptom and condition in patients with PD.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Marianna G Rispoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Vincenzo Di Stefano
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Filomena Barbone
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Michela Vitale
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Stefano Luca Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, 66100 Chieti, Italy.
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50
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Lau CI, Liu MN, Chang KC, Chang A, Bai CH, Tseng CS, Walsh V, Wang HC. Effect of single-session transcranial direct current stimulation on cognition in Parkinson's disease. CNS Neurosci Ther 2019; 25:1237-1243. [PMID: 31424182 PMCID: PMC6834682 DOI: 10.1111/cns.13210] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/11/2019] [Accepted: 07/30/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS Nonmotor symptoms (NMS) such as cognitive impairment and impulse-control disorders in Parkinson's disease (PD) remain a therapeutic challenge. Transcranial direct current stimulation (tDCS) has emerged as a promising alternative, although its immediate effects on NMS have been less well defined. In this randomized, sham-controlled, crossover study, we aimed to explore the single-session tDCS effects on cognitive performance in PD. METHODS Ten nondemented patients with PD completed two sessions in counterbalanced order, receiving 20 minutes of either 2 mA anodal or sham tDCS over the left dorsolateral prefrontal cortex (DLPFC). During stimulation, they performed the visual working memory and go/no-go tasks. Performance of the tasks was compared between the two conditions. RESULTS Single-session anodal tDCS over the left DLPFC did not significantly improve cognitive tasks in PD compared with sham (P > .05). CONCLUSION Single-session tDCS is ineffective in improving visual working memory and inhibitory control in PD. Further research may worth exploring alternative tDCS parameters, ideally with repeated sessions and concomitant training.
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Affiliation(s)
- Chi-Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK.,College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Mu-N Liu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurology, Memory and Aging Centre, University of California, San Francisco, San Francisco, CA, USA
| | - Kae-Chwen Chang
- Department of Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Endeavor Rehabilitation Clinic, Taipei, Taiwan
| | - Anna Chang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Shiang Tseng
- Department of Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Endeavor Rehabilitation Clinic, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
| | - Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,College of Medicine, Taipei Medical University, Taipei, Taiwan
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