Background Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait. However, the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown. The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes. Methods Twenty patients with Parkinson’s disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits. Trans-cranial direct current stimulation targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously, primary motor cortex only, or sham stimulation (order randomized and double-blinded assessments). Participants completed a freezing of gait-provoking test, the Timed Up and Go, and the Stroop test before and after each transcranial direct current stimulation session. Results Performance on the freezing of gait-provoking test (P = 0.010), Timed Up and Go (P = 0.006), and the Stroop test (P = 0.016) improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after primary motor cortex only or sham stimulation. Conclusions Transcranial direct current stimulation designed to simultaneously target motor and cognitive regions apparently induces immediate aftereffects in the brain that translate into reduced freezing of gait and improvements in executive function and mobility.

This proof-of-concept, double-blind study is designed to determine the effects of transcranial direct current stimulation (tDCS) on the “cost” of performing a secondary cognitive task on gait and postural control in healthy young adults. Twenty adults aged 22±2yrs completed two separate double-blind visits in which gait and postural control were assessed immediately before and after a 20-minute session of either real or sham tDCS (1.5 mA) targeting the left dorsolateral prefrontal cortex. Gait speed and stride duration variability, along with standing postural sway speed and area, were recorded under normal conditions and while simultaneously performing a serial-subtraction cognitive task. Dual task cost was calculated as the percent change in each outcome from normal to dual task conditions. tDCS was well-tolerated by all subjects. Stimulation did not alter gait or postural control under normal conditions. As compared to sham stimulation, real tDCS led to increased gait speed (p=0.006), as well as decreased standing postural sway speed (p=0.01) and area (p=0.01), when performing serial-subtraction task. Real tDCS also diminished (p<0.01) the dual task cost on each of these outcomes. No effects of tDCS were observed for stride duration variability. A single session of tDCS targeting the left dorsolateral prefrontal cortex improved the ability to adapt one’s gait and postural control to a concurrent cognitive task and reduced the cost normally associated with such dual tasking. These results highlight the involvement of cortical brain networks in gait and posture control, and implicate the modulation of prefrontal cortical excitability as a potential therapeutic intervention.

tDCS intervention designed to stimulate the left dorsolateral prefrontal cortex may improve executive function and dual tasking in older adults with functional limitations.