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Lapenta OM, Rêgo GG, Boggio PS. Transcranial electrical stimulation for procedural learning and rehabilitation. Neurobiol Learn Mem 2024; 213:107958. [PMID: 38971460 DOI: 10.1016/j.nlm.2024.107958] [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: 01/16/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Procedural learning is the acquisition of motor and non-motor skills through a gradual process that increases with practice. Impairments in procedural learning have been consistently demonstrated in neurodevelopmental, neurodegenerative, and neuropsychiatric disorders. Considering that noninvasive brain stimulation modulates brain activity and boosts neuroplastic mechanisms, we reviewed the effects of coupling transcranial direct current stimulation (tDCS) with training methods for motor and non-motor procedural learning to explore tDCS potential use as a tool for enhancing implicit learning in healthy and clinical populations. The review covers tDCS effects over i. motor procedural learning, from basic to complex activities; ii. non-motor procedural learning; iii. procedural rehabilitation in several clinical populations. We conclude that targeting the primary motor cortex and prefrontal areas seems the most promising for motor and non-motor procedural learning, respectively. For procedural rehabilitation, the use of tDCS is yet at an early stage but some effectiveness has been reported for implicit motor and memory learning. Still, systematic comparisons of stimulation parameters and target areas are recommended for maximising the effectiveness of tDCS and its robustness for procedural rehabilitation.
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Affiliation(s)
- Olivia Morgan Lapenta
- Psychological Neuroscience Laboratory, Psychology Research Center, School of Psychology, University of Minho - Rua da Universidade, 4710-057 Braga, Portugal.
| | - Gabriel Gaudencio Rêgo
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
| | - Paulo Sérgio Boggio
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
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2
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Spiroiu FI, Minuzzi L, Duarte D, McCabe RE, Soreni N. Neurocognitive effects of transcranial direct current stimulation in obsessive-compulsive disorder: a systematic review. Int J Neurosci 2024:1-14. [PMID: 38913323 DOI: 10.1080/00207454.2024.2371303] [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: 11/16/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
Transcranial direct current stimulation (tDCS) has been used with increasing frequency as a therapeutic tool to alleviate clinical symptoms of obsessive compulsive-disorder (OCD). However, little is known about the effects of tDCS on neurocognitive functioning among OCD patients. The aim of this review was to provide a comprehensive overview of the literature examining the effects of tDCS on specific neurocognitive functions in OCD. A literature search following PRISMA guidelines was conducted on the following databases: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. The search yielded 4 results: one randomized, sham-controlled study (20 patients), one randomized, controlled, partial crossover trial (12 patients), one open-label study (5 patients), and one randomized, double-blind, sham-controlled, parallel-group trial (37 patients). A total of 51 patients received active tDCS with some diversity in electrode montages targeting the dorsolateral prefrontal cortex, the pre-supplementary motor area, or the orbitofrontal cortex. tDCS was associated with improved decision-making in study 1, enhanced attentional monitoring and response inhibition in study 2, improved executive and inhibitory control in study 3, and reduced attentional bias and improved response inhibition and working memory in study 4. Limitations of this review include its small sample, the absence of a sham group in half of the studies, and the heterogeneity in tDCS parameters. These preliminary results highlight the need for future testing in randomized, sham-controlled trials to examine whether and how tDCS induces relevant cognitive benefits in OCD.
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Affiliation(s)
- Flavia I Spiroiu
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Luciano Minuzzi
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Dante Duarte
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Pediatric OCD Consultation Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Moraca GAG, Orcioli-Silva D, Legutke BR, Gutierrez PP, Sirico TM, Zampier VC, Beretta VS, Gobbi LTB, Barbieri FA. Aerobic exercise on the treadmill combined with transcranial direct current stimulation on the gait of people with Parkinson's disease: A protocol for a randomized clinical trial. PLoS One 2024; 19:e0300243. [PMID: 38662740 PMCID: PMC11045059 DOI: 10.1371/journal.pone.0300243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024] Open
Abstract
Gait impairments negatively affect the quality of life of people with Parkinson's disease (PwPD). Aerobic exercise (AE) is an alternative to alleviate these impairments and its combination with transcranial direct current stimulation (tDCS) has demonstrated synergistic effects. However, the effect of multitarget tDCS application (i.e., motor, and prefrontal cortices simultaneously) combined with physical exercise on gait impairments is still little known. Thus, the proposed randomized clinical trial will verify the acute effects of AE combined with tDCS applied on motor and prefrontal cortices separately and simultaneously on gait (spatial-temporal and cortical activity parameters) in PwPD. Twenty-four PwPD in Hoehn & Yahr stages I-III will be recruited for this crossover study. PwPD will practice AE on treadmill simultaneously with the application of anodal tDCS during four intervention sessions on different days (∼ one week of interval). Active tDCS will be applied to the primary motor cortex, prefrontal cortex, and both areas simultaneously (multitarget), with an intensity of 2 mA for 20 min. For sham, the stimulation will remain at 2 mA for 10 s. The AE will last a total of 30 min, consisting of warm-up, main part (20 min with application of tDCS), and recovery. Exercise intensity will be controlled by heart rate. Spatial-temporal and cortical activity parameters will be acquired before and after each session during overground walking, walking with obstacle avoidance, and walking with a cognitive dual task at self-preferred velocity. An accelerometer will be positioned on the fifth lumbar vertebra to obtain the spatial-temporal parameters (i.e., step length, duration, velocity, and swing phase duration). Prefrontal cortex activity will be recorded from a portable functional near-infrared spectroscopy system and oxygenated and deoxygenated hemoglobin concentrations will be analyzed. Two-way ANOVAs with repeated measures for stimulation and moment will be performed. The findings of the study may contribute to improving gait in PwPD. Trial registration: Brazilian Clinical Trials Registry (RBR-738zkp7).
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Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Diego Orcioli-Silva
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Beatriz Regina Legutke
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Pedro Paulo Gutierrez
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Thiago Martins Sirico
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Vinicius Cavassano Zampier
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Victor Spiandor Beretta
- School of Technology and Sciences, Department of Physical Education, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
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Nguyen TXD, Mai PT, Chang YJ, Hsieh TH. Effects of transcranial direct current stimulation alone and in combination with rehabilitation therapies on gait and balance among individuals with Parkinson's disease: a systematic review and meta-analysis. J Neuroeng Rehabil 2024; 21:27. [PMID: 38373966 PMCID: PMC10875882 DOI: 10.1186/s12984-024-01311-2] [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: 04/01/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurogenerative disorder implicated in dysfunctions of motor functions, particularly gait and balance. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation offered as a potential adjuvant therapy for PD. This systematic review and meta-analysis were conducted to identify whether tDCS alone and combined with additional rehabilitation therapies improve gait and balance among individuals with PD. METHODS We searched PubMed, Embase, Web of Science, and relevant databases for eligible studies from inception to December 2022. Studies with a comparative design investigating the effects of tDCS on motor functions, including gait and balance among individuals with PD, were included. A meta-analysis was performed for each outcome using a random effects model for subgroup analysis and pooling of overall effect sizes. RESULTS A total of 23 studies were included in the meta-analysis. The pooled results revealed that tDCS has moderate overall effects on gait, measured by gait speed (standardized mean deviation [SMD] = 0.238; 95% confidence interval [CI] - 0.026 to 0.502); stride length (SMD = 0.318; 95% CI - 0.015 to 0.652); cadence (SMD = - 0.632; 95% CI - 0.932 to - 0.333); freezing of gait questionnaire scores (SMD = - 0.360; 95% CI - 0.692 to - 0.027); step length (SMD = 0.459; 95% CI - 0.031 to 0.949); walking time (SMD = - 0.253; 95% CI - 0.758 to 0.252); stride time (SMD = - 0.785; 95% CI: - 1.680 to 0.111); double support time (SMD = 1.139; 95% CI - 0.244 to 0.523); and balance, measured by timed up and go (TUG) test (SMD = - 0.294; 95% CI - 0.516 to - 0.073), Berg balance scale (BBS) scores (SMD = 0.406; 95% CI - 0.059 to 0.87), and dynamic gait index (SMD = 0.275; 95% CI - 0.349 to 0.898). For the subgroup analysis, gait and balance demonstrated moderate effect sizes. However, only cadence, stride time, and TUG indicated a significant difference between real and sham tDCS (P = 0.027, P = 0.002, and P = 0.023, respectively), whereas cadence and BBS (P < 0.01 and P = 0.045, respectively) significantly differed after real tDCS plus other therapies rather than after sham tDCS plus other therapies. CONCLUSIONS Our results indicated that tDCS is significantly associated with gait and balance improvements among individuals with PD. The findings of this study provide more proof supporting the effectiveness of tDCS, encouraging tDCS to be utilized alone or in combination with other therapies in clinical practice for PD rehabilitation.
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Affiliation(s)
- Thi Xuan Dieu Nguyen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Phuc Thi Mai
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan.
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Neuroscience Research Center, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan.
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Marcos-Frutos D, López-Alonso V, Mera-González I, Sánchez-Molina JA, Colomer-Poveda D, Márquez G. Chronic Functional Adaptations Induced by the Application of Transcranial Direct Current Stimulation Combined with Exercise Programs: A Systematic Review of Randomized Controlled Trials. J Clin Med 2023; 12:6724. [PMID: 37959190 PMCID: PMC10649950 DOI: 10.3390/jcm12216724] [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: 09/25/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
The present systematic review aimed to determine the chronic effects of the combination of transcranial direct current stimulation (tDCS) and exercise on motor function and performance outcomes. We performed a systematic literature review in the databases MEDLINE and Web of Science. Only randomized control trials that measured the chronic effect of combining exercise (comprising gross motor tasks) with tDCS during at least five sessions and measured any type of motor function or performance outcome were included. A total of 22 interventions met the inclusion criteria. Only outcomes related to motor function or performance were collected. Studies were divided into three groups: (a) healthy population (n = 4), (b) neurological disorder population (n = 14), and (c) musculoskeletal disorder population (n = 4). The studies exhibited considerable variability in terms of tDCS protocols, exercise programs, and outcome measures. Chronic use of tDCS in combination with strength training does not enhance motor function in healthy adults. In neurological disorders, the results suggest no additive effect if the exercise program includes the movements pretending to be improved (i.e., tested). However, although evidence is scarce, tDCS may enhance exercise-induced adaptations in musculoskeletal conditions characterized by pain as a limiting factor of motor function.
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Affiliation(s)
| | | | | | | | - David Colomer-Poveda
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, 15179 A Coruña, Spain; (D.M.-F.); (V.L.-A.); (I.M.-G.); (J.A.S.-M.)
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, 15179 A Coruña, Spain; (D.M.-F.); (V.L.-A.); (I.M.-G.); (J.A.S.-M.)
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6
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Liu X, Li L, Liu Y. Comparative motor effectiveness of non-invasive brain stimulation techniques in patients with Parkinson's disease: A network meta-analysis. Medicine (Baltimore) 2023; 102:e34960. [PMID: 37773851 PMCID: PMC10545289 DOI: 10.1097/md.0000000000034960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/04/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although noninvasive brain stimulation (NIBS) techniques are an effective alternative treatment option, their relative effects in patients with Parkinson's disease (PD) remain undefined. Here, we aimed to compare motor efficacy of the NIBS techniques in PD. METHODS We carried out an electronic search in PubMed, Embase, Cochrane Library, CINAHL, PEDro and PsycINFO (accessed via Ovid) for articles published until August 2022. The treatment efficacy of motor function was quantified by the Unified Parkinson's disease rating scale part III. RESULTS 28 randomized controlled trials with parallel group were included in the analysis, enrolling 1057 patients. In the "on" state, high-frequency repetitive transcranial magnetic stimulation (HFrTMS) conferred better short-term and long-term efficacy compared to transcranial direct current stimulation. Surface under the cumulative ranking curve rank showed that HFrTMS combined with transcranial direct current stimulation and low-frequency TMS ranked first among PD in improving motor function. In the "off" state, there were no significant differences in most of the treatments, but surface under the cumulative ranking curve rank showed that continuous theta burst stimulation and low-frequency TMS had the highest short- and long-term effect in improving motor function. CONCLUSION HFrTMS is an effective intervention in improving motor function. Besides, its combination with another NIBS technique produces better therapeutic effects in the "on" state.
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Affiliation(s)
- Xuan Liu
- Beijing Sport University, Beijing, China
| | - Lei Li
- Beijing Chunlizhengda Medical Instruments Co., Ltd, Beijing, China
| | - Ye Liu
- Beijing Sport University, Beijing, China
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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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Vitório R, Lirani-Silva E, Orcioli-Silva D, Beretta VS, Oliveira AS, Gobbi LTB. Electrocortical Dynamics of Usual Walking and the Planning to Step over Obstacles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4866. [PMID: 37430780 DOI: 10.3390/s23104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023]
Abstract
The neural correlates of locomotion impairments observed in people with Parkinson's disease (PD) are not fully understood. We investigated whether people with PD present distinct brain electrocortical activity during usual walking and the approach phase of obstacle avoidance when compared to healthy individuals. Fifteen people with PD and fourteen older adults walked overground in two conditions: usual walking and obstacle crossing. Scalp electroencephalography (EEG) was recorded using a mobile 64-channel EEG system. Independent components were clustered using a k-means clustering algorithm. Outcome measures included absolute power in several frequency bands and alpha/beta ratio. During the usual walk, people with PD presented a greater alpha/beta ratio in the left sensorimotor cortex than healthy individuals. While approaching obstacles, both groups reduced alpha and beta power in the premotor and right sensorimotor cortices (balance demand) and increased gamma power in the primary visual cortex (visual demand). Only people with PD reduced alpha power and alpha/beta ratio in the left sensorimotor cortex when approaching obstacles. These findings suggest that PD affects the cortical control of usual walking, leading to a greater proportion of low-frequency (alpha) neuronal firing in the sensorimotor cortex. Moreover, the planning for obstacle avoidance changes the electrocortical dynamics associated with increased balance and visual demands. People with PD rely on increased sensorimotor integration to modulate locomotion.
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Affiliation(s)
- Rodrigo Vitório
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Ellen Lirani-Silva
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Diego Orcioli-Silva
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- School of Technology and Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | | | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
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Present and Emerging Ethical Issues with tDCS use: A Summary and Review. NEUROETHICS-NETH 2023. [DOI: 10.1007/s12152-022-09508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Gaugain G, Quéguiner L, Bikson M, Sauleau R, Zhadobov M, Modolo J, Nikolayev D. Quasi-static approximation error of electric field analysis for transcranial current stimulation. J Neural Eng 2023; 20. [PMID: 36621858 DOI: 10.1088/1741-2552/acb14d] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
Objective.Numerical modeling of electric fields induced by transcranial alternating current stimulation (tACS) is currently a part of the standard procedure to predict and understand neural response. Quasi-static approximation (QSA) for electric field calculations is generally applied to reduce the computational cost. Here, we aimed to analyze and quantify the validity of the approximation over a broad frequency range.Approach.We performed electromagnetic modeling studies using an anatomical head model and considered approximations assuming either a purely ohmic medium (i.e. static formulation) or a lossy dielectric medium (QS formulation). The results were compared with the solution of Maxwell's equations in the cases of harmonic and pulsed signals. Finally, we analyzed the effect of electrode positioning on these errors.Main results.Our findings demonstrate that the QSA is valid and produces a relative error below 1% up to 1.43 MHz. The largest error is introduced in the static case, where the error is over 1% across the entire considered spectrum and as high as 20% in the brain at 10 Hz. We also highlight the special importance of considering the capacitive effect of tissues for pulsed waveforms, which prevents signal distortion induced by the purely ohmic approximation. At the neuron level, the results point a difference of sense electric field as high as 22% at focusing point, impacting pyramidal cells firing times.Significance.QSA remains valid in the frequency range currently used for tACS. However, neglecting permittivity (static formulation) introduces significant error for both harmonic and non-harmonic signals. It points out that reliable low frequency dielectric data are needed for accurate transcranial current stimulation numerical modeling.
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Affiliation(s)
- Gabriel Gaugain
- Univ Rennes, CNRS, IETR (Institut d'électronique et des technologies du numérique) - UMR 6164, 35000 Rennes, France
| | - Lorette Quéguiner
- Univ Rennes, CNRS, IETR (Institut d'électronique et des technologies du numérique) - UMR 6164, 35000 Rennes, France
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, United States of America
| | - Ronan Sauleau
- Univ Rennes, CNRS, IETR (Institut d'électronique et des technologies du numérique) - UMR 6164, 35000 Rennes, France
| | - Maxim Zhadobov
- Univ Rennes, CNRS, IETR (Institut d'électronique et des technologies du numérique) - UMR 6164, 35000 Rennes, France
| | - Julien Modolo
- Univ Rennes, INSERM, LTSI (Laboratoire traitement du signal et de l'image) - U1099, 35000 Rennes, France
| | - Denys Nikolayev
- Univ Rennes, CNRS, IETR (Institut d'électronique et des technologies du numérique) - UMR 6164, 35000 Rennes, France
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Zhang X, Jing F, Liu Y, Tang J, Hua X, Zhu J, Tuo H, Lin Q, Gao P, Liu W. Effects of non-invasive brain stimulation on walking and balance ability in Parkinson's patients: A systematic review and meta-analysis. Front Aging Neurosci 2023; 14:1065126. [PMID: 36704502 PMCID: PMC9871558 DOI: 10.3389/fnagi.2022.1065126] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To investigate and contrast the effects of non-invasive brain stimulation (NIBS), including repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), on walking and balance ability in patients with Parkinson's disease (PD). Methods The PubMed, Embase, Medline, Cochrane, CNKI, and Chinese WanFang databases were searched up to June 2022. Quality assessment was performed using the Cochrane Collaboration's risk-of-bias guidelines, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were calculated. Results Among 32 eligible studies, including 1,586 participants were analyzed in this meta-analysis. The results of the meta-analysis showed that NIBS was effective in improving UPDRS-III scores (MD = -2.07; 95% CI, -2.62 to -1.53; P < 0.00001; I 2 = 6%) and variables associated with the ability of walk such as step width (SMD = 0.35; 95% CI, 0.16-0.55; P = 0.0005; I 2 = 38%), cadence (SMD = 0.3; 95% CI, 0.05 to 0.55; P = 0.02; I 2 = 25%), and 6MWT (MD = 62.86; 95% CI, 39.43-86.29; P < 0.00001; I 2 = 0%). In subgroup analyses across intervention types, UPDRS-III scores (rTMS: MD = -2.54; 95% CI, -3.16 to -1.92; P < 0.00001; I 2 = 0%; tDCS: MD = -1.20; 95% CI, -1.99 to -0.40; P = 0.003; I 2 = 0%) and TUGT time (rTMS: MD = -4.11; 95% CI, -4.74 to -3.47; P < 0.00001; I 2 = 0%; tDCS: MD = -0.84; 95% CI, -1.48 to -0.21; P = 0.009; I 2 = 0%) significantly improved. Moreover, our results also showed that compared to tDCS, rTMS was more significant in improving UPDRS-III scores and TUGT time (p < 0.05). Conclusion NIBS benefits some walking ability variables but not balance ability in 36 patients with PD. The rTMS significantly improved UPDRS-III scores and TUGT time compared to tDCS. Further studies are needed to determine the optimal protocol and to illuminate effects based on the ideal target brain regions, stimulation intensity, timing, and type of intervention. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350782.
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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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Maudrich T, Ragert P, Perrey S, Kenville R. Single-session anodal transcranial direct current stimulation to enhance sport-specific performance in athletes: A systematic review and meta-analysis. Brain Stimul 2022; 15:1517-1529. [PMID: 36442774 DOI: 10.1016/j.brs.2022.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has emerged as a promising and feasible method to improve motor performance in healthy and clinical populations. However, the potential of tDCS to enhance sport-specific motor performance in athletes remains elusive. OBJECTIVE We aimed at analyzing the acute effects of a single anodal tDCS session on sport-specific motor performance changes in athletes compared to sham. METHODS A systematic review and meta-analysis was conducted in the electronic databases PubMed, Web of Science, and SPORTDiscus. The meta-analysis was performed using an inverse variance method and a random-effects model. Additionally, two subgroup analyses were conducted (1) depending on the stimulated brain areas (primary motor cortex (M1), temporal cortex (TC), prefrontal cortex (PFC), cerebellum (CB)), and (2) studies clustered in subgroups according to different sports performance domains (endurance, strength, visuomotor skill). RESULTS A total number of 19 studies enrolling a sample size of 258 athletes were deemed eligible for inclusion. Across all included studies, a significant moderate standardized mean difference (SMD) favoring anodal tDCS to enhance sport-specific motor performance could be observed. Subgroup analysis depending on cortical target areas of tDCS indicated a significant moderate SMD in favor of anodal tDCS compared to sham for M1 stimulation. CONCLUSION A single anodal tDCS session can lead to performance enhancement in athletes in sport-specific motor tasks. Although no definitive conclusions can be drawn regarding the modes of action as a function of performance domain or stimulation site, these results imply intriguing possibilities concerning sports performance enhancement through anodal M1 stimulation.
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Affiliation(s)
- Tom Maudrich
- Department of Movement Neuroscience, Faculty of Sport Science, Leipzig University, Leipzig, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Patrick Ragert
- Department of Movement Neuroscience, Faculty of Sport Science, Leipzig University, Leipzig, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Stéphane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Rouven Kenville
- Department of Movement Neuroscience, Faculty of Sport Science, Leipzig University, Leipzig, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Wu C, Yang L, Feng S, Zhu L, Yang L, Liu TCY, Duan R. Therapeutic non-invasive brain treatments in Alzheimer's disease: recent advances and challenges. Inflamm Regen 2022; 42:31. [PMID: 36184623 PMCID: PMC9527145 DOI: 10.1186/s41232-022-00216-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Alzheimer's disease (AD) is one of the major neurodegenerative diseases and the most common form of dementia. Characterized by the loss of learning, memory, problem-solving, language, and other thinking abilities, AD exerts a detrimental effect on both patients' and families' quality of life. Although there have been significant advances in understanding the mechanism underlying the pathogenesis and progression of AD, there is no cure for AD. The failure of numerous molecular targeted pharmacologic clinical trials leads to an emerging research shift toward non-invasive therapies, especially multiple targeted non-invasive treatments. In this paper, we reviewed the advances of the most widely studied non-invasive therapies, including photobiomodulation (PBM), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and exercise therapy. Firstly, we reviewed the pathological changes of AD and the challenges for AD studies. We then introduced these non-invasive therapies and discussed the factors that may affect the effects of these therapies. Additionally, we review the effects of these therapies and the possible mechanisms underlying these effects. Finally, we summarized the challenges of the non-invasive treatments in future AD studies and clinical applications. We concluded that it would be critical to understand the exact underlying mechanisms and find the optimal treatment parameters to improve the translational value of these non-invasive therapies. Moreover, the combined use of non-invasive treatments is also a promising research direction for future studies and sheds light on the future treatment or prevention of AD.
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Affiliation(s)
- Chongyun Wu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Luoman Yang
- Department of Anesthesiology, Peking University Third Hospital (PUTH), Beijing, 100083, China
| | - Shu Feng
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Ling Zhu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Luodan Yang
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA. .,Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Timon Cheng-Yi Liu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China.
| | - Rui Duan
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China.
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15
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Brown GL, Brown MT. Transcranial electrical stimulation in neurological disease. Neural Regen Res 2022; 17:2221-2222. [PMID: 35259838 PMCID: PMC9083147 DOI: 10.4103/1673-5374.335796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
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Siew-Pin Leuk J, Yow KE, Zi-Xin Tan C, Hendy AM, Kar-Wing Tan M, Hock-Beng Ng T, Teo WP. A meta-analytical review of transcranial direct current stimulation parameters on upper limb motor learning in healthy older adults and people with Parkinson's disease. Rev Neurosci 2022; 34:325-348. [PMID: 36138560 DOI: 10.1515/revneuro-2022-0073] [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: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022]
Abstract
Current literature lacks consolidated evidence for the impact of stimulation parameters on the effects of transcranial direct current stimulation (tDCS) in enhancing upper limb motor learning. Hence, we aim to synthesise available methodologies and results to guide future research on the usage of tDCS on upper limb motor learning, specifically in older adults and Parkinson's disease (PD). Thirty-two studies (Healthy older adults, N = 526, M = 67.25, SD = 4.30 years; PD, N = 216, M = 66.62, SD = 6.25 years) were included in the meta-analysis. All included studies consisted of active and sham protocols. Random effect meta-analyses were conducted for (i) subjects (healthy older adults and PD); (ii) intensity (1.0, 1.5, 2 mA); (iii) electrode montage (unilateral anodal, bilateral anodal, unilateral cathodal); (iv) stimulation site (cerebellum, frontal, motor, premotor, SMA, somatosensory); (v) protocol (online, offline). Significant tDCS effect on motor learning was reported for both populations, intensity 1.0 and 2.0 mA, unilateral anodal and cathodal stimulation, stimulation site of the motor and premotor cortex, and both online and offline protocols. Regression showed no significant relationship between tDCS effects and density. The efficacy of tDCS is also not affected by the number of sessions. However, studies that reported only single session tDCS found significant negative association between duration with motor learning outcomes. Our findings suggest that different stimulation parameters enhanced upper limb motor learning in older adults and PD. Future research should combine tDCS with neuroimaging techniques to help with optimisation of the stimulation parameters, considering the type of task and population.
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Affiliation(s)
- Jessie Siew-Pin Leuk
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Kai-En Yow
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Clenyce Zi-Xin Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Ashlee M Hendy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Mika Kar-Wing Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Tommy Hock-Beng Ng
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
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Sadler CM, Kami AT, Nantel J, Lommen J, Carlsen AN. Transcranial Direct Current Stimulation Over Motor Areas Improves Reaction Time in Parkinson's Disease. Front Neurol 2022; 13:913517. [PMID: 35775046 PMCID: PMC9237404 DOI: 10.3389/fneur.2022.913517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) has been shown to modulate cortical motor excitability and improve bradykinesia symptoms in Parkinson's disease. It is unclear how targeting different cortical motor areas with tDCS may differentially influence upper limb function for individuals diagnosed with PD. Objective This study investigated whether anodal tDCS applied separately to the primary motor cortex and the supplementary motor area would improve upper limb function for individuals with Parkinson's disease. In addition, a startling acoustic stimulus was used to differentiate between the effect of stimulation on motor preparatory and initiation processes associated with upper limb movements. Methods Eleven participants with idiopathic Parkinson's disease performed two upper limb simple reaction time tasks, involving elbow extension or a button press before and after either anodal tDCS or sham tDCS was applied over the primary motor cortex or supplementary motor area. A loud, startling stimulus was presented on a selection of trials to involuntarily trigger the prepared action. Results Anodal tDCS led to improved premotor reaction time in both tasks, but this was moderated by reaction time in pre-tDCS testing, such that individuals with slower pre-tDCS reaction time showed the greatest reaction time improvements. Startle-trial reaction time was not modified following tDCS, suggesting that the stimulation primarily modulated response initiation processes. Conclusion Anodal tDCS improved response initiation speed, but only in slower reacting individuals with PD. However, no differences attributable to tDCS were observed in clinical measures of bradykinesia or kinematic variables, suggesting that reaction time may represent a more sensitive measure of some components of bradykinesia.
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Affiliation(s)
| | - Aline Tiemi Kami
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Lommen
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Anthony N. Carlsen
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- *Correspondence: Anthony N. Carlsen ; ; orcid.org/0000-0001-6015-8991
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Kalloch B, Weise K, Lampe L, Bazin PL, Villringer A, Hlawitschka M, Sehm B. The influence of white matter lesions on the electric field in transcranial electric stimulation. Neuroimage Clin 2022; 35:103071. [PMID: 35671557 PMCID: PMC9168230 DOI: 10.1016/j.nicl.2022.103071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022]
Abstract
Sensitivity analysis allows the simulation of tDCS with uncertain conductivities. White matter lesions (WML) have no global influence on the electric field in tDCS. In subjects with a high lesion load, a local influence can be observed. In low to medium lesion load subjects, explicit modeling of WML is not required.
Background Transcranial direct current stimulation (tDCS) is a promising tool to enhance therapeutic efforts, for instance, after a stroke. The achieved stimulation effects exhibit high inter-subject variability, primarily driven by perturbations of the induced electric field (EF). Differences are further elevated in the aging brain due to anatomical changes such as atrophy or lesions. Informing tDCS protocols by computer-based, individualized EF simulations is a suggested measure to mitigate this variability. Objective While brain anatomy in general and specifically atrophy as well as stroke lesions are deemed influential on the EF in simulation studies, the influence of the uncertainty in the change of the electrical properties of the white matter due to white matter lesions (WMLs) has not been quantified yet. Methods A group simulation study with 88 subjects assigned into four groups of increasing lesion load was conducted. Due to the lack of information about the electrical conductivity of WMLs, an uncertainty analysis was employed to quantify the variability in the simulation when choosing an arbitrary conductivity value for the lesioned tissue. Results The contribution of WMLs to the EF variance was on average only one tenth to one thousandth of the contribution of the other modeled tissues. While the contribution of the WMLs significantly increased (p≪.01) in subjects exhibiting a high lesion load compared to low lesion load subjects, typically by a factor of 10 and above, the total variance of the EF didnot change with the lesion load. Conclusion Our results suggest that WMLs do not perturb the EF globally and can thus be omitted when modeling subjects with low to medium lesion load. However, for high lesion load subjects, the omission of WMLs may yield less robust local EF estimations in the vicinity of the lesioned tissue. Our results contribute to the efforts of accurate modeling of tDCS for treatment planning.
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Affiliation(s)
- Benjamin Kalloch
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany; Leipzig University of Applied Science, Faculty of Computer Science and Media, Leipzig, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Methods and Development Group "Brain Networks", Leipzig, Germany; Technische Universität Ilmenau, Instiute of Biomedical Engineering and Informatics, Ilmenau, Germany.
| | - Konstantin Weise
- Max Planck Institute for Human Cognitive and Brain Sciences, Methods and Development Group "Brain Networks", Leipzig, Germany; Technische Universität Ilmenau, Advanced Electromagnetics Group, Ilmenau, Germany
| | - Leonie Lampe
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
| | - Pierre-Louis Bazin
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany; University of Amsterdam, Faculty of Social and Behavioural Sciences, Amsterdam, The Netherlands
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany
| | - Mario Hlawitschka
- Leipzig University of Applied Science, Faculty of Computer Science and Media, Leipzig, Germany
| | - Bernhard Sehm
- Max Planck Institute for Human Cognitive and Brain Sciences, Department of Neurology, Leipzig, Germany; Department of Neurology, Martin Luther University of Halle-Wittenberg, Germany
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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Oh E, Park J, Youn J, Jang W. Anodal Transcranial Direct Current Stimulation Could Modulate Cortical Excitability and the Central Cholinergic System in Akinetic Rigid-Type Parkinson's Disease: Pilot Study. Front Neurol 2022; 13:830976. [PMID: 35401397 PMCID: PMC8987019 DOI: 10.3389/fneur.2022.830976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive technique that has been widely studied as an alternative treatment for Parkinson's disease (PD). However, its clinical benefit remains unclear. In this study, we aimed to investigate the effect of tDCS on the central cholinergic system and cortical excitability in mainly akinetic rigid-type patients with PD. Methods In total, 18 patients with PD were prospectively enrolled and underwent 5 sessions of anodal tDCS on the M1 area, which is on the contralateral side of the dominant hand. We excluded patients with PD who had evident resting tremor of the hand to reduce the artifact of electrophysiologic findings. We compared clinical scales reflecting motor, cognitive, and mood symptoms between pre- and post-tDCS. Additionally, we investigated the changes in electrophysiologic parameters, such as short latency afferent inhibition (SAI) (%), which reflects the central cholinergic system. Results The United Parkinson's Disease Rating Scale Part 3 (UPDRS-III), the Korean-Montreal Cognitive Assessment (MoCA-K), and Beck Depression Inventory (BDI) scores were significantly improved after anodal tDCS (p < 0.01, p < 0.01, and p < 0.01). Moreover, motor evoked potential amplitude ratio (MEPAR) (%) and integrated SAI showed significant improvement after tDCS (p < 0.01 and p < 0.01). The mean values of the change in integrated SAI (%) were significantly correlated with the changes in UPDRS-III scores; however, the MoCA-K and BDI scores did not show differences. Conclusions Anodal tDCS could influence the central cholinergic system, such as frontal cortical excitability and depression in PD. This mechanism could underlie the clinical benefit of tDCS in patients with PD.
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Affiliation(s)
- Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, South Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Wooyoung Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
- *Correspondence: Wooyoung Jang
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de Oliveira PCA, de Araújo TAB, Machado DGDS, Rodrigues AC, Bikson M, Andrade SM, Okano AH, Simplicio H, Pegado R, Morya E. Transcranial Direct Current Stimulation on Parkinson's Disease: Systematic Review and Meta-Analysis. Front Neurol 2022; 12:794784. [PMID: 35082749 PMCID: PMC8785799 DOI: 10.3389/fneur.2021.794784] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Clinical impact of transcranial direct current stimulation (tDCS) alone for Parkinson's disease (PD) is still a challenge. Thus, there is a need to synthesize available results, analyze methodologically and statistically, and provide evidence to guide tDCS in PD. Objective: Investigate isolated tDCS effect in different brain areas and number of stimulated targets on PD motor symptoms. Methods: A systematic review was carried out up to February 2021, in databases: Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, and Web of science. Full text articles evaluating effect of active tDCS (anodic or cathodic) vs. sham or control on motor symptoms of PD were included. Results: Ten studies (n = 236) were included in meta-analysis and 25 studies (n = 405) in qualitative synthesis. The most frequently stimulated targets were dorsolateral prefrontal cortex and primary motor cortex. No significant effect was found among single targets on motor outcomes: Unified Parkinson's Disease Rating Scale (UPDRS) III – motor aspects (MD = −0.98%, 95% CI = −10.03 to 8.07, p = 0.83, I2 = 0%), UPDRS IV – dyskinesias (MD = −0.89%, CI 95% = −3.82 to 2.03, p = 0.55, I2 = 0%) and motor fluctuations (MD = −0.67%, CI 95% = −2.45 to 1.11, p = 0.46, I2 = 0%), timed up and go – gait (MD = 0.14%, CI 95% = −0.72 to 0.99, p = 0.75, I2 = 0%), Berg Balance Scale – balance (MD = 0.73%, CI 95% = −1.01 to 2.47, p = 0.41, I2 = 0%). There was no significant effect of single vs. multiple targets in: UPDRS III – motor aspects (MD = 2.05%, CI 95% = −1.96 to 6.06, p = 0.32, I2 = 0%) and gait (SMD = −0.05%, 95% CI = −0.28 to 0.17, p = 0.64, I2 = 0%). Simple univariate meta-regression analysis between treatment dosage and effect size revealed that number of sessions (estimate = −1.7, SE = 1.51, z-score = −1.18, p = 0.2, IC = −4.75 to 1.17) and cumulative time (estimate = −0.07, SE = 0.07, z-score = −0.99, p = 0.31, IC = −0.21 to 0.07) had no significant association. Conclusion: There was no significant tDCS alone short-term effect on motor function, balance, gait, dyskinesias or motor fluctuations in Parkinson's disease, regardless of brain area or targets stimulated.
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Affiliation(s)
- Paloma Cristina Alves de Oliveira
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Thiago Anderson Brito de Araújo
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | | | - Abner Cardoso Rodrigues
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | | | - Alexandre Hideki Okano
- Center for Mathematics, Computing and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Hougelle Simplicio
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil.,Rehabilitation Center, Anita Garibaldi Center for Education and Health, Santos Dumont Institute, Macaíba, Brazil.,Department of Biomedical Sciences, State University of Rio Grande do Norte, Mossoró, Brazil.,Neuron-Care Unit in Neurosurgery, Hospital Rio Grande, Natal, Brazil
| | - Rodrigo Pegado
- Program in Rehabilitation Science, Program in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Edgard Morya
- Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil
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22
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Cosentino G, Todisco M, Blandini F. Noninvasive neuromodulation in Parkinson's disease: Neuroplasticity implication and therapeutic perspectives. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:185-198. [PMID: 35034733 DOI: 10.1016/b978-0-12-819410-2.00010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Noninvasive brain stimulation techniques can be used to study in vivo the changes of cortical activity and plasticity in subjects with Parkinson's disease (PD). Also, an increasing number of studies have suggested a potential therapeutic effect of these techniques. High-frequency repetitive transcranial magnetic stimulation (rTMS) and anodal transcranial direct current stimulation (tDCS) represent the most used stimulation paradigms to treat motor and nonmotor symptoms of PD. Both techniques can enhance cortical activity, compensating for its reduction related to subcortical dysfunction in PD. However, the use of suboptimal stimulation parameters can lead to therapeutic failure. Clinical studies are warranted to clarify in PD the additional effects of these stimulation techniques on pharmacologic and neurorehabilitation treatments.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Fabio Blandini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy
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23
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Camacho‐Conde JA, Gonzalez‐Bermudez MDR, Carretero‐Rey M, Khan ZU. Brain stimulation: a therapeutic approach for the treatment of neurological disorders. CNS Neurosci Ther 2022; 28:5-18. [PMID: 34859593 PMCID: PMC8673710 DOI: 10.1111/cns.13769] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023] Open
Abstract
Brain stimulation has become one of the most acceptable therapeutic approaches in recent years and a powerful tool in the remedy against neurological diseases. Brain stimulation is achieved through the application of electric currents using non-invasive as well as invasive techniques. Recent technological advancements have evolved into the development of precise devices with capacity to produce well-controlled and effective brain stimulation. Currently, most used non-invasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In last decade, application of these brain stimulation techniques has not only exploded but also expanded to wide variety of neurological disorders. Therefore, in the current review, we will provide an overview of the potential of both non-invasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques in the treatment of such brain diseases.
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Affiliation(s)
- Jose Antonio Camacho‐Conde
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | | | - Marta Carretero‐Rey
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | - Zafar U. Khan
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
- CIBERNEDInstitute of Health Carlos IIIMadridSpain
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24
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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: 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: 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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25
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Manor B, Dagan M, Herman T, Gouskova NA, Vanderhorst VG, Giladi N, Travison TG, Pascual-Leone A, Lipsitz LA, Hausdorff JM. Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial. Mov Disord 2021; 36:2693-2698. [PMID: 34406695 DOI: 10.1002/mds.28759] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatments of freezing of gait (FOG) in Parkinson's disease are suboptimal. OBJECTIVE The aim of this study was to evaluate the effects of multiple sessions of transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex and primary motor cortex (M1) on FOG. METHODS Seventy-seven individuals with Parkinson's disease and FOG were enrolled in a double-blinded randomized trial. tDCS and sham interventions comprised 10 sessions over 2 weeks followed by five once-weekly sessions. FOG-provoking test performance (primary outcome), functional outcomes, and self-reported FOG severity were assessed. RESULTS Primary analyses demonstrated no advantage for tDCS in the FOG-provoking test. In secondary analyses, tDCS, compared with sham, decreased self-reported FOG severity and increased daily living step counts. Among individuals with mild-to-moderate FOG severity, tDCS improved FOG-provoking test time and self-report of FOG. CONCLUSIONS Multisession tDCS targeting the left dorsolateral prefrontal cortex and M1 did not improve laboratory-based FOG-provoking test performance. Improvements observed in participants with mild-to-moderate FOG severity warrant further investigation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Moria Dagan
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Natalia A Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Veronique G Vanderhorst
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nir Giladi
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Tel Aviv University, Tel Aviv, Israel
| | - Thomas G Travison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Guttman Brain Health Institute, Institut Guttmann de Neurorehabilitació, Barcelona, Spain.,Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Roslindale, MA, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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26
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Sun W, Dong X, Yu G, Shuai L, Yuan Y, Ma C. Transcranial direct current stimulation in patients after decompressive craniectomy: a finite element model to investigate factors affecting the cortical electric field. J Int Med Res 2021; 49:300060520942112. [PMID: 33788619 PMCID: PMC8020252 DOI: 10.1177/0300060520942112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To simulate the process of transcranial direct current stimulation (tDCS) on
patients after decompressive craniectomy (DC), and to model cortical
electric field distributions under different electrode montages, we
constructed a finite element model that represented the human head at high
resolution. Methods Using computed tomography images, we constructed a human head model with high
geometrical similarity. The removed bone flap was simplified to be circular
with a diameter of 12 cm. We then constructed finite element models
according to bioelectrical parameters. Finally, we simulated tDCS on the
finite element models under different electrode montages. Results Inward current had a linear relationship with peak electric field value, but
almost no effect on electric field distribution. If the anode was not over
the skull hole (configuration 2), there was almost no difference in electric
field magnitude and focality between the circular and square electrodes.
However, if the anode was right over the hole (configuration 1), the
circular electrodes led to higher peak electric field values and worse
focality. In addition, configuration 1 significantly decreased focality
compared with configuration 2. Conclusion Our results might serve as guidelines for selecting current and electrode
montage settings when performing tDCS on patients after DC.
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Affiliation(s)
- Weiming Sun
- Institute of Life Science, Nanchang University, Nanchang,
Jiangxi Province, China
- School of Life Science, Nanchang University, Nanchang, Jiangxi
Province, China
- Department of Rehabilitation Medicine, The First Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi Province, China
- Yefeng Yuan, Department of Psychosomatic
Medicine, The First Affiliated Hospital of Nanchang University, No.17,
yongwaizheng street, Donghu District, Nanchang , Jiangxi Province 330006, China.
Chaolin Ma, Institute of Life Science,
Nanchang University, No. 999, xuefu road, Honggutan District, Nanchang, Jiangxi
Province 33003, China.
| | - Xiangli Dong
- Department of Psychosomatic Medicine, The Second Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Guohua Yu
- Department of Rehabilitation Medicine, The First Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Lang Shuai
- Department of Rehabilitation Medicine, The First Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Yefeng Yuan
- Department of Psychosomatic Medicine, The First Affiliated
Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Chaolin Ma
- Institute of Life Science, Nanchang University, Nanchang,
Jiangxi Province, China
- School of Life Science, Nanchang University, Nanchang, Jiangxi
Province, China
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27
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 238] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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28
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Beheshti I, Ko JH. Modulating brain networks associated with cognitive deficits in Parkinson's disease. Mol Med 2021; 27:24. [PMID: 33691622 PMCID: PMC7945662 DOI: 10.1186/s10020-021-00284-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is a relatively well characterised neurological disorder that primarily affects motor and cognitive functions. This paper reviews on how transcranial direct current stimulation (tDCS) can be used to modulate brain networks associated with cognitive deficits in PD. We first provide an overview of brain network abnormalities in PD, by introducing the brain network modulation approaches such as pharmacological interventions and brain stimulation techniques. We then present the potential underlying mechanisms of tDCS technique, and specifically highlight how tDCS can be applied to modulate brain network abnormality associated with cognitive dysfunction among PD patients. More importantly, we address the limitations of existing studies and suggest possible future directions, with the aim of helping researchers to further develop the use of tDCS technique in clinical settings.
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Affiliation(s)
- Iman Beheshti
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada.,Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, 130-745 Bannatyne Ave., Winnipeg, MB, R3E 0J9, Canada. .,Kleysen Institute for Advanced Medicine, Health Science Centre, Winnipeg, MB, Canada. .,Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada.
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29
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Monastero R, Baschi R, Nicoletti A, Pilati L, Pagano L, Cicero CE, Zappia M, Brighina F. Transcranial random noise stimulation over the primary motor cortex in PD-MCI patients: a crossover, randomized, sham-controlled study. J Neural Transm (Vienna) 2020; 127:1589-1597. [PMID: 32965593 PMCID: PMC7666273 DOI: 10.1007/s00702-020-02255-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
Mild cognitive impairment (MCI) is a very common non-motor feature of Parkinson’s disease (PD) and the non-amnestic single-domain is the most frequent subtype. Transcranial random noise stimulation (tRNS) is a non-invasive technique, which is capable of enhancing cortical excitability. As the main contributor to voluntary movement control, the primary motor cortex (M1) has been recently reported to be involved in higher cognitive functioning. The aim of this study is to evaluate the effects of tRNS applied over M1 in PD-MCI patients in cognitive and motor tasks. Ten PD-MCI patients, diagnosed according to the Movement Disorder Society, Level II criteria for MCI, underwent active (real) and placebo (sham) tRNS single sessions, at least 1 week apart. Patients underwent cognitive (Digit Span Forward and Backward, Digit Symbol, Visual Search, Letter Fluency, Stroop Test) and motor assessments (Unified Parkinson’s Disease Rating Scale [UPDRS-ME], specific timed trials for bradykinesia, 10-m walk and Timed up and go tests) before and after each session. A significant improvement in motor ability (UPDRS-ME and lateralized scores, ps from 0.049 to 0.003) was observed after real versus sham tRNS. On the contrary, no significant differences were found in other motor tasks and cognitive assessment both after real and sham stimulations. These results confirm that tRNS is a safe and effective tool for improving motor functioning in PD-MCI. Future studies using a multisession tRNS applied over multitargeted brain areas (i.e., dorsolateral prefrontal cortex and M1) are required to clarify the role of tRNS regarding rehabilitative intervention in PD.
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Affiliation(s)
- Roberto Monastero
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy.
| | - Roberta Baschi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Laura Pilati
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Lorenzo Pagano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Via La Loggia 1, 90129, Palermo, Italy
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Ganguly J, Murgai A, Sharma S, Aur D, Jog M. Non-invasive Transcranial Electrical Stimulation in Movement Disorders. Front Neurosci 2020; 14:522. [PMID: 32581682 PMCID: PMC7290124 DOI: 10.3389/fnins.2020.00522] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
Dysfunction within large-scale brain networks as the basis for movement disorders is an accepted hypothesis. The treatment options for restoring network function are limited. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation are now being studied to modify the network. Transcranial electrical stimulation (tES) is also a portable, cost-effective, and non-invasive way of network modulation. Transcranial direct current stimulation and transcranial alternating current stimulation have been studied in Parkinson’s disease, dystonia, tremor, and ataxia. Transcranial pulsed current stimulation and transcranial random noise stimulation are not yet studied enough. The literature in the use of these techniques is intriguing, yet many unanswered questions remain. In this review, we highlight the studies using these four potential tES techniques and their electrophysiological basis and consider the therapeutic implication in the field of movement disorders. The objectives are to consolidate the current literature, demonstrate that these methods are feasible, and encourage the application of such techniques in the near future.
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Affiliation(s)
- Jacky Ganguly
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Aditya Murgai
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Soumya Sharma
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Dorian Aur
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Mandar Jog
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
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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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Lee HK, Ahn SJ, Shin YM, Kang N, Cauraugh JH. Correction to: Does transcranial direct current stimulation improve functional locomotion in people with Parkinson's disease? A systematic review and meta-analysis. J Neuroeng Rehabil 2019; 16:139. [PMID: 31727089 PMCID: PMC6854778 DOI: 10.1186/s12984-019-0582-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyo Keun Lee
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.,Vector Biomechanics Inc., Yongin, South Korea
| | - Se Ji Ahn
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Yang Mi Shin
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Nyeonju Kang
- Division of Sport Science, Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea. .,Sport Science Institute, Incheon National University, Incheon, South Korea.
| | - James H Cauraugh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA
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