Cerebellar TMS in Treatment of a Patient with Cerebellar Ataxia: Evidence from Clinical, Biomechanics and Neurophysiological Assessments

Farzan, Faranak; Wu, Yunfen; Manor, Brad; Anastasio, Elana M.; Lough, Matthew; Novak, Vera; Greenstein, Patricia E.; Pascual‐Leone, Álvaro

doi:10.1007/s12311-013-0485-8

Cited by 42 publications

(29 citation statements)

References 27 publications

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“…They observed an improvement in dysmetria and tremor in the finger to nose and finger-chase tests in standing postural control and gait, evaluated kinematically and electromyographically, which were maintained at 6-month follow-up. They also assessed changes in CBI, observing a significant increase in facilitation at interstimulus intervals of 5, 6, and 7 ms (between the cerebellar and opposite motor cortex stimuli) [60].…”

Section: Clinical Studiesmentioning

confidence: 99%

Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review

Benussi

Pascual‐Leone

Borroni

2020

IJMS

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Cerebellar ataxias are a heterogenous group of degenerative disorders for which we currently lack effective and disease-modifying interventions. The field of non-invasive brain stimulation has made much progress in the development of specific stimulation protocols to modulate cerebellar excitability and try to restore the physiological activity of the cerebellum in patients with ataxia. In light of limited evidence-based pharmacologic and non-pharmacologic treatment options for patients with ataxia, several different non-invasive brain stimulation protocols have emerged, particularly employing repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) techniques. In this review, we summarize the most relevant rTMS and tDCS therapeutic trials and discuss their implications in the care of patients with degenerative ataxias.

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Section: Clinical Studiesmentioning

confidence: 99%

Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review

Benussi

Pascual‐Leone

Borroni

2020

IJMS

Self Cite

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“…Further evidence for coupling between the cerebellum and the prefrontal cortex is described in the work by Hamada and colleagues, whereby associative plasticity induced by sensory/motor stimuli paired at 25 ms -paired associative stimulation (PAS), was observed to be blocked by cerebellar-tDCS 46 . And daily sessions of transcranial magnetic stimulation (TMS) over the cerebellum has been shown to improve postural control and walking, and dual-tasking in a patient with cerebellar atrophy 47 . These motor and cognitive improvements were marked by an increase in motor evoked potentials induced by motor cortical stimulation when the cerebellum was also excited a few milliseconds beforehand (investigated with dual-coil, paired-pulse TMS), due to reduced cerebellar-brain inhibition (CBI) that lasted 6 months after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…These motor and cognitive improvements were marked by an increase in motor evoked potentials induced by motor cortical stimulation when the cerebellum was also excited a few milliseconds beforehand (investigated with dual-coil, paired-pulse TMS), due to reduced cerebellar-brain inhibition (CBI) that lasted 6 months after treatment. Farzan and colleagues 47 credited the improvements in cognitive function to a consequence of enhanced motor function and the liberation of resources for the performance of the dual-task. The reduction in CBI induced by TMS may also have improved prefrontal cortical function directly, through exciting cerebro-cerebellar circuits -improving cognitive capacity.…”

Section: Discussionmentioning

confidence: 99%

Modulating Cognition Using Transcranial Direct Current Stimulation of the Cerebellum

Pope

2015

JoVE

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Numerous studies have emerged recently that demonstrate the possibility of modulating, and in some cases enhancing, cognitive processes by exciting brain regions involved in working memory and attention using transcranial electrical brain stimulation. Some researchers now believe the cerebellum supports cognition, possibly via a remote neuromodulatory effect on the prefrontal cortex. This paper describes a procedure for investigating a role for the cerebellum in cognition using transcranial direct current stimulation (tDCS), and a selection of information-processing tasks of varying task difficulty, which have previously been shown to involve working memory, attention and cerebellar functioning. One task is called the Paced Auditory Serial Addition Task (PASAT) and the other a novel variant of this task called the Paced Auditory Serial Subtraction Task (PASST). A verb generation task and its two controls (noun and verb reading) were also investigated. All five tasks were performed by three separate groups of participants, before and after the modulation of cortico-cerebellar connectivity using anodal, cathodal or sham tDCS over the right cerebellar cortex. The procedure demonstrates how performance (accuracy, verbal response latency and variability) could be selectively improved after cathodal stimulation, but only during tasks that the participants rated as difficult, and not easy. Performance was unchanged by anodal or sham stimulation. These findings demonstrate a role for the cerebellum in cognition, whereby activity in the left prefrontal cortex is likely dis-inhibited by cathodal tDCS over the right cerebellar cortex. Transcranial brain stimulation is growing in popularity in various labs and clinics. However, the after-effects of tDCS are inconsistent between individuals and not always polarity-specific, and may even be task-or loadspecific, all of which requires further study. Future efforts might also be guided towards neuro-enhancement in cerebellar patients presenting with cognitive impairment once a better understanding of brain stimulation mechanisms has emerged.

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“…Despite the limited literature on the use of therapeutic non-invasive cerebellar stimulation in patients [71], cerebellar TMS has shown the potential for therapeutic use, successfully alleviating ataxic symptoms [72,73] through facilitation of motor cortex excitability [74]. Conversely, a study testing the effects of anodal cerebellar tDCS on grip force in both ataxic patients and healthy controls did not reveal any effects in either group [75].…”

Section: Cerebellar Ataxiamentioning

confidence: 98%

Non-invasive Stimulation of the Cerebellum in Health and Disease

Darch¹,

Cerminara²,

Gilchrist³

et al. 2018

Transcranial Magnetic Stimulation in Neuropsychiatry

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The cerebellum is linked to motor, cognitive and affective functions. Anatomically, the cerebellum is part of an interconnected network including a wide range of other brain structures. This chapter reviews ways in which non-invasive stimulation has been used to activate or inhibit these circuits and how this has contributed to our understanding of cerebellar function in both motor and non-motor domains. The utility of non-invasive stimulation of the cerebellum in the treatment of neurological and psychiatric diseases (Parkinson's disease, cerebellar ataxia, stroke, depression and schizophrenia) is discussed. The chapter concludes with consideration of the challenges that must be overcome if noninvasive cerebellar stimulation is to be adopted in a wider clinical setting.

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Cerebellar TMS in Treatment of a Patient with Cerebellar Ataxia: Evidence from Clinical, Biomechanics and Neurophysiological Assessments

Cited by 42 publications

References 27 publications

Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review

Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review

Modulating Cognition Using Transcranial Direct Current Stimulation of the Cerebellum

Non-invasive Stimulation of the Cerebellum in Health and Disease

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