Multitarget transcranial direct current stimulation for freezing of gait in Parkinson's disease

Abstract

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.

Anodal tDCS over prefrontal cortex improves dual‐task walking in Parkinsonian patients with freezing

“…Although this does not exclude a left‐DLPFC involvement during dual‐task gait in the FOG‐ group, this suggests that left DLPFC is more involved in gait worsening under dual task in the FoG + group, thus making this area more susceptible to tDCS modulation. Our findings expand those by Dagan and colleagues, suggesting that noninvasive brain stimulation could represent an adjunctive method to integrated or consecutive dual‐task training to treat FOG.…”

“…We read with interest the article by Dagan and colleagues showing that a single session of multitarget excitatory transcranial Direct Current Stimulation (tDCS) over the primary motor cortex and the left dorsolateral prefrontal cortex (DLPFC) induced improvements in motor and cognitive clinical measures in Parkinson's disease (PD) patients with freezing of gait (FoG). This finding fits well with the recent idea that gait disturbances in PD patients with FoG might be the consequence of an altered integration in the striatum of cognitive, emotional, and sensory information coming from the prefrontal and limbic regions .…”

Invasive and Noninvasive Brain Stimulation in Parkinson's Disease: Clinical Effects and Future Perspectives

“…A study applied multibipolar tDCS electrodes simultaneously in both M1 and left DLPFC, M1 alone, or sham stimulation for 20 minutes in patients with PD with FOG. The results showed significant improvement in gait‐provoking test, Stroop, and time up and go tests after dual location tDCS, but not after M1 or sham stimulation …”

Reply to “Anodal tDCS Over Prefrontal Cortex Improves Dual‐Task Walking in Patients With Freezing”

“…We were pleased to read the Letter to the Editor by Putzolu and colleagues . We appreciate the interest in our recently published study on transcranial direct current stimulation (tDCS) for freezing of gait (FOG) and to learn about these new results.…”

“…The effects of tDCS on dual‐task gait performance in those with FOG are intriguing and extend our previous work. In our earlier study, we applied multitarget stimulation using an array of gel electrodes to facilitate the excitability of M1 and the left DLPFC based on the idea that both motor and cognitive functions are involved in FOG. We observed positive effects on FOG, gait, and executive function in freezers.…”