Repetitive Transcranial Magnetic Stimulation in Spinocerebellar Ataxia: A Pilot Randomized Controlled Trial

Abstract

Spinocerebellar ataxia (SCA) is a neurodegenerative disorder caused by dysfunction of the cerebellum and its connected neural networks. There is currently no cure for SCA and symptomatic treatment remains limited. We aimed here to examine the effects of a repetitive transcranial magnetic stimulation (rTMS) targeting the cerebellum on clinical impression, postural control and gait in patients with SCA. In this randomized, double-blinded and sham-controlled study, 20 individuals aged 18–75 years with SCA confirmed by genetic testing completed rTMS or sham intervention comprising 20 sessions of MRI-guided stimulation over the cerebellum. Baseline assessments included the Standard Ataxia Rating Assessment (SARA), the 9-hole peg test of manual dexterity, the Timed Up-and-Go (TUG) test, standing postural control with eyes-open and eyes-closed, and gait. Immediate (within 1-week) and 1-month follow-ups were completed. Intervention compliance was high (19 ± 2 of 20 sessions) and no rTMS-related adverse events were reported. rTMS, compared to sham, was associated with greater percent improvement in SARA total score from baseline to the 1-month follow-up ( p = 0.008). Secondary analyses of individual SARA items revealed that rTMS improved performance within the “stance” sub-score only ( p = 0.002). This functional change was accompanied by improvement to several objective metrics of postural sway during eyes-open and eyes-closed standing ( p < 0.008). rTMS did not influence the 9-hole peg test, TUG, or gait kinematics. A 20-session rTMS intervention is safe and feasible for those with SCA. Additional research is warranted to confirm the observed longer-term benefits of this intervention on standing postural control. Clinical Trial Registration : www.ClinicalTrials.gov , identifier: NCT01975909

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

“…This functional change was accompanied by improvement in several objective metrics of postural sway during eyes-open and eyes-closed standing. rTMS did not influence performance in the nine-hole peg test, the timed up-and-go test, or gait kinematics [64].…”

The Role of the Cerebellum in Degenerative Ataxias and Essential Tremor: Insights From Noninvasive Modulation of Cerebellar Activity

“…56 Finally, Manor and colleagues recently published the outcomes of a randomized, double-blind, sham-controlled trial in which 20 subjects with various genetically confirmed spinocerebellar ataxias (SCAs) received 20 daily sessions of the aforementioned TMS regimen. 57 Unfortunately, there were significant baseline differences between the rTMS and sham groups, with the former exhibiting a lower score on the Scale for the Assessment and Rating of Ataxia (SARA), which denotes less severe ataxia, and a faster execution of the Nine-Hole Peg Test (9HPT). The investigators therefore computed the percent change in each outcome from baseline to follow-up and reported a larger decrease in SARA score after one month in rTMStreated patients, which proved to be due to a better performance on the stance item only.…”

“…Using an identical TMS protocol in a single patient with idiopathic late‐onset cerebellar atrophy, Farzan and colleagues noticed improvements in speech, dysmetria, and tremor, increased gait speed in normal walking and during cognitive dual tasking, and decreased postural sway, paralleled by a reduction of CBI that persisted after six months . Finally, Manor and colleagues recently published the outcomes of a randomized, double‐blind, sham‐controlled trial in which 20 subjects with various genetically confirmed spinocerebellar ataxias (SCAs) received 20 daily sessions of the aforementioned TMS regimen . Unfortunately, there were significant baseline differences between the rTMS and sham groups, with the former exhibiting a lower score on the Scale for the Assessment and Rating of Ataxia (SARA), which denotes less severe ataxia, and a faster execution of the Nine‐Hole Peg Test (9HPT).…”

Efeitos da estimulação magnética transcraniana profunda nas ataxias cerebelares: um ensaio clínico randomizado, duplo-cego e cruzado

“…Overall, these studies included patients with cerebellar ataxia due to stroke, 5,[72][73][74] degenerative causes, [75][76][77][78][79][80][81][82][83][84] or cerebral palsy, 85 with a total of 237 patients. Nine studies were double-blind.…”

“…Nine studies were double-blind. 5,73,74,76,80,[82][83][84][85] Eight studies used TMS stimulation, 5,72,73,[75][76][77]84,86 seven used transcranial direct current stimulation (tDCS), [78][79][80][81][82][83]85 and 1 implanted a DBS device. 74 The time of evaluation after the intervention ranged from immediately after the stimulation to 1 year after the stimulation.…”