The effects of 1 Hz rTMS preconditioned by tDCS on gait kinematics in Parkinson’s disease

Abstract

Hypokinetic gait is a common and very disabling symptom of Parkinson's disease (PD). Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex has been used with variable effectiveness to treat hypokinesia in PD. Preconditioning rTMS by transcranial direct current stimulation (tDCS) may enhance its effectiveness to treat hypokinetic gait in PD. Three-dimensional kinematic gait analysis was performed (1) prior to, (2) immediately after and (3) 30 min after low-frequency rTMS (1 Hz, 900 pulses, 80% of resting motor threshold) over M1 contralateral to the more affected body side preconditioned by (1) cathodal, (2) anodal or (3) sham tDCS (amperage: 1 mA, duration: 10 min) in ten subjects with PD (7 females, mean age 63 ± 9 years) and ten healthy subjects (four females, mean age 50 ± 11 years). The effects of tDCS-preconditioned rTMS on gait kinematics were assessed by the following parameters: number of steps, step length, stride length, double support time, cadence, swing and stance phases. Our data suggest a bilateral improvement of hypokinetic gait in PD after 1 Hz rTMS over M1 of the more affected body side preceded by anodal tDCS. In contrast, 1 Hz rTMS alone (preceded by sham tDCS) and 1 Hz rTMS preceded by cathodal tDCS were ineffective to improve gait kinematics in PD. In healthy subjects, gait kinematics was unaffected by either intervention. Preconditioning motor cortex rTMS by tDCS is a promising approach to treat hypokinetic gait in PD.

Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson’s Disease Patients

“…Our results show a reduction of step and stance duration and an increment of lower limb velocity during TUG, S&G and NW tests. These achievements confirm the findings reported in other works, which evidenced some improvement of hypokinetic gait in PD after tDCS treatment [29,30,51].…”

Parkinson's disease treatments: focus on transcranial direct current stimulation (tDCS)

“…Similar to Lefaucheur's comprehensive review, 8 we chose to exclude three studies that used tDCS as a priming mechanism for testing an alternative intervention, namely rTMS. [9][10][11] tDCS tDCS involves the delivery of a low-intensity current (1-2 mA) using relatively large electrodes (~2-10 cm) generally placed on the scalp. Most studies of tDCS employ a " bipolar" montage consisting of one anode and one cathode to induce an electric field that passes across the various cranial structures (skin, bone, pia, and cerebrospinal fluid) to reach the brain parenchyma.…”

Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015

“…Cathodal tDCS interferes with beneficial effects of 1 Hz rTMS in finger tapping and pointing movements (Gruner et al, 2010), but anodal stimulation does not. Grasping cannot be modulated by tDCSprimed 1 Hz rTMS (Eggers, Gruner, Ameli, Sarfeld, & Nowak, 2012), and anodal tDCS, but not cathodal stimulation, with subsequent 1 Hz rTMS improves gait (von Papen, Fisse, Sarfeld, Fink, & Nowak, 2014). This combined approach of tDCS-priming with a subsequent rTMS protocol remains to be tested in a therapeutic trial in PD.…”