Background Progression of Parkinson’s disease (PD) is characterized by motor deficits, which eventually respond less to dopaminergic therapy and, thus, pose a therapeutic challenge. Deep brain stimulation has proven efficacy, but carries risks and is not possible in all patients. Non-invasive brain stimulation has shown promising results and may provide a therapeutic alternative. Objective To investigate the efficacy of transcranial direct current stimulation (tDCS) in the treatment of PD Design Randomized, double blind, sham-controlled study. Setting Research institution Methods We investigated efficacy of anodal tDCS applied to the motor and prefrontal cortices in 8 sessions over 2.5 weeks. Assessment over a 3-month period included timed tests of gait (primary outcome measure) and bradykinesia in the upper extremities, UPDRS, Serial Reaction Time Task, Beck Depression Inventory, Health Survey and self-assessment of mobility. Results Twenty-five PD patients were investigated, 13 receiving tDCS and 12 sham stimulation. TDCS improved gait by some measures for a short time and improved bradykinesia in both the on- and off-states for longer than 3 months. Changes in UPDRS, reaction time, physical and mental well-being, and self-assessed mobility did not differ between tDCS and sham intervention. Conclusion TDCS of the motor and prefrontal cortices may have therapeutic potential in PD, but better stimulation parameters need to be established to make the technique clinically viable.

Background and Purpose To characterize patients with benign essential blepharospasm (BEB) by diagnosis, environmental risk factors and family history. Methods 240 patients with BEB were evaluated through a clinical examination and questionnaire. The questionnaire reviewed personal medical history, demographic factors, risk factors for the development of blepharospasm and family history of dystonia and other neurological conditions. Results BEB was more commonly found in females (2.8:1) and 93% of the patients were Caucasian. Fifty percent had pure BEB, 31% had BEB/Meige's syndrome, and 4% had BEB and eyelid opening apraxia (+/- Meige's syndrome). A minority of patients reported preceding photophobia (25%) or other eye conditions (22%). The majority were non-smokers, had no exposure to anti-emetic or antipsychotic agents, had a normal birth history and had no history of head trauma. Seventy-two percent did report a stressful event immediately prior to the development of symptoms. Treatments reported included botulinum toxin (BoNT), oral medications, surgical procedures and acupuncture. Thirty-two percent of patients reported a family history of focal dystonia and BEB was the most commonly reported. Conclusion This study confirms previous reports of usual age, sex, caffeine and tobacco use and family history in patients with blepharospasm. New findings include a report on occupation, lower reports of preceding eye conditions and photophobia, and higher reported stressful events. Further, this study shows a change in treatment with an increase in BoNT use and decrease in surgical procedures.

Background The treatment of Writer’s Cramp, a task-specific focal hand dystonia, needs new approaches. A deficiency of inhibition in the motor cortex might cause Writer’s Cramp. Transcranial direct current stimulation modulates cortical excitability and may provide a therapeutic alternative. Methods In this randomized, double-blind, sham-controlled study, we investigated efficacy of cathodal stimulation of contralateral motor cortex in 3-sessions within one week. Assessment over a 2-week period included clinical scales, subjective ratings, kinematic handwriting analysis and neurophysiological evaluation. Results Twelve patients with unilateral dystonic Writer’s Cramp were investigated, 6 received transcranial direct current and 6 sham-stimulation. Cathodal transcranial direct current stimulation had no favorable effects on clinical scales, and failed to restore normal handwriting kinematics and cortical inhibition. Subjective worsening remained unexplained leading to premature study termination. Conclusion Repeated sessions of cathodal transcranial direct current stimulation of the motor cortex yielded no favorable results supporting a therapeutic potential in Writer’s Cramp.

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