Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

Manor, Brad; Dagan, Moria; Herman, Talia; Gouskova, Natalia; VanderHorst, Veronique; Giladi, Nir; Travison, Thomas G.; Pascual‐Leone, Álvaro; Lipsitz, Lewis A.; Hausdorff, Jeffrey M.

doi:10.1002/mds.28759

Cited by 23 publications

(18 citation statements)

References 40 publications

(80 reference statements)

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“…While the total current for tDCS was 4mA, stimulation was designed to simultaneously target spatially-distinct regions of the brain. While this approach is aligned with previous research suggesting that 4 mA direct current is safe and tolerable in younger ( Nitsche and Bikson, 2017 ; Khadka et al, 2020 ) and older ( Manor et al, 2021 ; Zhou et al, 2021 ) adults, the effects of the tested montage on cortical excitability and other aspects of neuronal function were not examined. There also exists the possibility that the tested Sham control either directly or indirectly modulated cortical excitability by a non-trivial amount.…”

Section: Discussionsupporting

confidence: 60%

Network-Based Transcranial Direct Current Stimulation May Modulate Gait Variability in Young Healthy Adults

Zhou¹,

Zhou²,

Xiao³

et al. 2022

Front. Hum. Neurosci.

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PurposePrevious studies have linked gait variability to resting-state functional connectivity between the dorsal attention network (DAN) and the default network (DN) in the brain. The purpose of this study was to examine the effects of a novel transcranial direct current stimulation (tDCS) paradigm designed to simultaneously facilitate the excitability of the DAN and suppress the excitability of the DN (i.e., DAN+/DN-tDCS) on gait variability and other gait characteristics in young healthy adults.MethodsIn this double-blinded randomized and sham-controlled study, 48 healthy adults aged 22 ± 2 years received one 20-min session of DAN+/DN-tDCS (n = 24) or no stimulation (the Sham group, n = 24). Immediately before and after stimulation, participants completed a gait assessment under three conditions: walking at self-selected speed (i.e., normal walking), walking as fast as possible (i.e., fast walking), and walking while counting backward (i.e., dual-task walking). Primary outcomes included gait stride time variability and gait stride length variability in normal walking conditions. Secondary outcomes include gait stride time and length variability in fast and dual-task conditions, and other gait metrics derived from the three walking conditions.ResultsCompared to the Sham group, DAN+/DN-tDCS reduced stride length variability in normal and fast walking conditions, double-limb support time variability in fast and dual-task walking conditions, and step width variability in fast walking conditions. In contrast, DAN+/DN-tDCS did not alter average gait speed or the average value of any other gait metrics as compared to the sham group.ConclusionIn healthy young adults, a single exposure to tDCS designed to simultaneously modulate DAN and DN excitability reduced gait variability, yet did not alter gait speed or other average gait metrics, when tested just after stimulation. These results suggest that gait variability may be uniquely regulated by these spatially-distinct yet functionally-connected cortical networks. These results warrant additional research on the short- and longer-term effects of this type of network-based tDCS on the cortical control of walking in younger and older populations.

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Section: Discussionsupporting

confidence: 60%

Network-Based Transcranial Direct Current Stimulation May Modulate Gait Variability in Young Healthy Adults

Zhou¹,

Zhou²,

Xiao³

et al. 2022

Front. Hum. Neurosci.

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“…Stimulation effects on FOG are likely transient rather than long-term, with a subgroup meta-analysis ( Xie et al, 2020 ) of four rTMS studies with follow-up at ≥4 weeks ( El-Tamawy et al, 2013 ; Ma et al, 2019 ; Mi et al, 2019 , 2020 ) showing no significant difference in outcome by this time point. The effects of non-invasive stimulation may also be additive, as there appears to be a potential beneficial effect from multi-target compared to single target stimulation ( Chang et al, 2017 ; Dagan et al, 2018 ; Manor et al, 2021 ). For example, simultaneous tDCS to the M1 and the left dorsolateral prefrontal cortex (DLPFC) improved freezing parameters immediately after the combined session, but not following primary motor cortex stimulation alone ( Dagan et al, 2018 ).…”

Section: Non-pharmacological Approachesmentioning

confidence: 99%

Future Therapeutic Strategies for Freezing of Gait in Parkinson’s Disease

Cui

Lewis

2021

Front. Hum. Neurosci.

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Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.

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“…To date, large variability has been reported in response to tDCS protocols [ 42 ] accredited to the participants’ clinical profiles and the cognitive decline in PD [ 43 – 45 ]. Using a stratified randomization procedure for age and disease stage, clinical assessments and writing performance were comparable between groups in this study.…”

Section: Discussionmentioning

confidence: 99%

Transcranial direct current stimulation enhances motor learning in Parkinson’s disease: a randomized controlled trial

et al. 2023

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Writing training has shown clinical benefits in Parkinson’s disease (PD), albeit with limited retention and insufficient transfer effects. It is still unknown whether anodal transcranial direct current stimulation (atDCS) can boost consolidation in PD and how this interacts with medication. To investigate the effects of training + atDCS versus training + sham stimulation on consolidation of writing skills when ON and OFF medication. Second, to examine the intervention effects on cortical excitability. In this randomized sham-controlled double-blind study, patients underwent writing training (one session) with atDCS ( N = 20) or sham ( N = 19) over the primary motor cortex. Training was aimed at optimizing amplitude and assessed during online practice, pre- and post-training, after 24-h retention and after continued learning (second session) when ON and OFF medication (interspersed by 2 months). The primary outcome was writing amplitude at retention. Cortical excitability and inhibition were assessed pre- and post-training. Training + atDCS but not training + sham improved writing amplitudes at retention in the ON state ( p = 0.017, g = 0.75). Transfer to other writing tasks was enhanced by atDCS in both medication states ( g between 0.72 and 0.87). Also, training + atDCS improved continued learning. However, no online effects were found during practice and when writing with a dual task. A post-training increase in cortical inhibition was found in the training + atDCS group ( p = 0.039) but not in the sham group, irrespective of medication. We showed that applying atDCS during writing training boosted most but not all consolidation outcomes in PD. We speculate that atDCS together with medication modulates motor learning consolidation via inhibitory processes ( https://osf.io/gk5q8/ , 2018-07-17). Supplementary Information The online version contains supplementary material available at 10.1007/s00415-023-11669-3.

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Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial

Cited by 23 publications

References 40 publications

Network-Based Transcranial Direct Current Stimulation May Modulate Gait Variability in Young Healthy Adults

Network-Based Transcranial Direct Current Stimulation May Modulate Gait Variability in Young Healthy Adults

Future Therapeutic Strategies for Freezing of Gait in Parkinson’s Disease

Transcranial direct current stimulation enhances motor learning in Parkinson’s disease: a randomized controlled trial

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