Department of Neurology, University of Minnesota, Minneapolis, MN, 55414, USA.
J Neurol. 2018 Sep;265(9):2023-2032. doi: 10.1007/s00415-018-8953-1. Epub 2018 Jun 28.
We investigated if anodal transcranial direct current stimulation (A-tDCS), applied over the supplementary motor areas (SMAs), could improve gait initiation in Parkinson's disease (PD) with freezing of gait (FOG).
In this double-blinded cross-over pilot study, ten PD with FOG underwent two stimulation sessions: A-tDCS (1 mA, 10 min) and sham stimulation. Eight blocks of gait initiation were collected per session: (1) pre-tDCS, with acoustic cueing; (2) pre-tDCS, self-initiated (no cue); and (3-8) post-tDCS, self-initiated. Gait initiation kinetics were analyzed with two-way repeated measures ANOVAs for the effects of A-tDCS.
A-tDCS did not significantly improve the magnitude or timing of anticipatory postural adjustments or the execution of the first step during self-initiated gait compared with baseline measures (p > .13). The lack of significant change was not due to an inability to generate functional APAs since external cueing markedly improved gait initiation (p < .01).
A single dose of A-tDCS over the SMAs did not improve self-initiated gait in PD and FOG. Alternative approaches using a different dose or cortical target are worthy of exploration since individuals demonstrated the capacity to improve.
Neuromodulation strategies tailored to facilitate SMA activity may be ineffective for the treatment of gait initiation impairment in people with PD and FOG.
研究经颅直流电刺激（tDCS）对补充运动区（SMA）进行阳极刺激是否可以改善伴有冻结步态（FOG）的帕金森病（PD）患者的步态起始。
在这项双盲交叉先导研究中，10 名伴有 FOG 的 PD 患者接受了两次刺激治疗：阳极 tDCS（1 mA，10 分钟）和假刺激。每次治疗采集 8 组步态起始：（1）tDCS 前，使用声音提示；（2）tDCS 前，自主启动（无提示）；和（3-8）tDCS 后，自主启动。使用双向重复测量方差分析评估 tDCS 的效果，分析步态起始动力学。
与基线测量相比，阳极 tDCS 并未显著改善预期姿势调整的幅度或时间，也未显著改善自主步态起始时的第一步执行情况（p>.13）。缺乏显著变化并非由于无法产生功能性 APA，因为外部提示明显改善了步态起始（p<.01）。
SMA 单次阳极 tDCS 剂量不能改善 PD 和 FOG 患者的自主步态起始。由于个体表现出改善的能力，因此值得探索使用不同剂量或皮质靶点的替代方法。
针对 SMA 活动促进的神经调节策略可能对伴有 FOG 的 PD 患者的步态起始障碍治疗无效。
