Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.
Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
Brain Stimul. 2018 Jul-Aug;11(4):759-771. doi: 10.1016/j.brs.2018.04.009. Epub 2018 Apr 11.
Cerebellar transcranial direct current stimulation has been reported to enhance motor associative learning and motor adaptation, holding promise for clinical application in patients with movement disorders. However, behavioral benefits from cerebellar tDCS have been inconsistent.
Identifying determinants of treatment success is necessary. BDNF Val66Met is a candidate determinant, because the polymorphism is associated with motor skill learning and BDNF is thought to mediate tDCS effects.
We undertook two cerebellar tDCS studies in subjects genotyped for BDNF Val66Met. Subjects performed an eyeblink conditioning task and received sham, anodal or cathodal tDCS (N = 117, between-subjects design) or a vestibulo-ocular reflex adaptation task and received sham and anodal tDCS (N = 51 subjects, within-subjects design). Performance was quantified as a learning parameter from 0 to 100%. We investigated (1) the distribution of the learning parameter with mixture modeling presented as the mean (M), standard deviation (S) and proportion (P) of the groups, and (2) the role of BDNF Val66Met and cerebellar tDCS using linear regression presented as the regression coefficients (B) and odds ratios (OR) with equally-tailed intervals (ETIs).
For the eyeblink conditioning task, we found distinct groups of learners (M = 67.2%; S = 14.7%; P = 61.6%) and non-learners (M = 14.2%; S = 8.0%; P = 38.4%). Carriers of the BDNF Val66Met polymorphism were more likely to be learners (OR = 2.7 [1.2 6.2]). Within the group of learners, anodal tDCS supported eyeblink conditioning in BDNF Val66Met non-carriers (B = 11.9% 95%ETI = [0.8 23.0]%), but not in carriers (B = 1.0% 95%ETI = [-10.2 12.1]%). For the vestibulo-ocular reflex adaptation task, we found no effect of BDNF Val66Met (B = -2.0% 95%ETI = [-8.7 4.7]%) or anodal tDCS in either carriers (B = 3.4% 95%ETI = [-3.2 9.5]%) or non-carriers (B = 0.6% 95%ETI = [-3.4 4.8]%). Finally, we performed additional saccade and visuomotor adaptation experiments (N = 72) to investigate the general role of BDNF Val66Met in cerebellum-dependent learning and found no difference between carriers and non-carriers for both saccade (B = 1.0% 95%ETI = [-8.6 10.6]%) and visuomotor adaptation (B = 2.7% 95%ETI = [-2.5 7.9]%).
The specific role for BDNF Val66Met in eyeblink conditioning, but not vestibulo-ocular reflex adaptation, saccade adaptation or visuomotor adaptation could be related to dominance of the role of simple spike suppression of cerebellar Purkinje cells with a high baseline firing frequency in eyeblink conditioning. Susceptibility of non-carriers to anodal tDCS in eyeblink conditioning might be explained by a relatively larger effect of tDCS-induced subthreshold depolarization in this group, which might increase the spontaneous firing frequency up to the level of that of the carriers.
已经有报道称,小脑颅直流电刺激可以增强运动联想学习和运动适应,这为治疗运动障碍患者提供了潜在的临床应用前景。然而,小脑 tDCS 的行为益处并不一致。
确定治疗成功的决定因素是必要的。BDNF Val66Met 是一个候选决定因素,因为该多态性与运动技能学习有关,而 BDNF 被认为介导 tDCS 的作用。
我们对 BDNF Val66Met 基因分型的受试者进行了两项小脑 tDCS 研究。受试者进行了眨眼条件反射任务,并接受了假刺激、阳极或阴极 tDCS(N=117,组间设计)或前庭眼反射适应任务,并接受了假刺激和阳极 tDCS(N=51 名受试者,组内设计)。表现被量化为从 0 到 100%的学习参数。我们研究了(1)使用混合模型以平均值(M)、标准差(S)和组的比例(P)呈现的学习参数分布,以及(2)BDNF Val66Met 和小脑 tDCS 的作用,使用线性回归以同等尾区间(ETI)呈现回归系数(B)和优势比(OR)。
对于眨眼条件反射任务,我们发现了不同的学习者群体(M=67.2%;S=14.7%;P=61.6%)和非学习者群体(M=14.2%;S=8.0%;P=38.4%)。BDNF Val66Met 多态性携带者更有可能成为学习者(OR=2.7[1.2 6.2])。在学习者群体中,阳极 tDCS 支持 BDNF Val66Met 非携带者的眨眼条件反射(B=11.9%95%ETI=[0.8 23.0]%),但不支持携带者(B=1.0%95%ETI=[-10.2 12.1]%)。对于前庭眼反射适应任务,我们没有发现 BDNF Val66Met(B=-2.0%95%ETI=[-8.7 4.7]%)或阳极 tDCS 的影响,无论是在携带者(B=3.4%95%ETI=[-3.2 9.5]%)还是非携带者(B=0.6%95%ETI=[-3.4 4.8]%)中。最后,我们进行了额外的扫视和视觉运动适应实验(N=72),以研究 BDNF Val66Met 在小脑依赖学习中的一般作用,发现携带者和非携带者在扫视(B=1.0%95%ETI=[-8.6 10.6]%)和视觉运动适应(B=2.7%95%ETI=[-2.5 7.9]%)方面没有差异。
BDNF Val66Met 在眨眼条件反射中的特定作用,而不是前庭眼反射适应、扫视适应或视觉运动适应中的作用,可能与小脑浦肯野细胞简单峰抑制的主导作用有关,这种作用在眨眼条件反射中具有较高的基线放电频率。非携带者对阳极 tDCS 在眨眼条件反射中的敏感性可能是由于 tDCS 诱导的阈下去极化在该组中具有相对更大的作用,这可能会使自发放电频率增加到携带者的水平。