Manor Brad, Greenstein Patricia E, Davila-Perez Paula, Wakefield Seth, Zhou Junhong, Pascual-Leone Alvaro
Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Neurol. 2019 Feb 12;10:73. doi: 10.3389/fneur.2019.00073. eCollection 2019.
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 ( = 0.008). Secondary analyses of individual SARA items revealed that rTMS improved performance within the "stance" sub-score only ( = 0.002). This functional change was accompanied by improvement to several objective metrics of postural sway during eyes-open and eyes-closed standing ( < 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. : www.ClinicalTrials.gov, identifier: NCT01975909.
脊髓小脑共济失调（SCA）是一种由小脑及其相连神经网络功能障碍引起的神经退行性疾病。目前尚无治愈SCA的方法，对症治疗仍然有限。我们的目的是研究针对小脑的重复经颅磁刺激（rTMS）对SCA患者的临床印象、姿势控制和步态的影响。在这项随机、双盲和假对照研究中，20名年龄在18 - 75岁、经基因检测确诊为SCA的个体完成了rTMS或假干预，干预包括在小脑上进行20次MRI引导的刺激。基线评估包括标准共济失调评分评估（SARA）、手部灵巧性的9孔插钉试验、定时起立行走（TUG）试验、睁眼和闭眼站立姿势控制以及步态。完成了即时（1周内）和1个月随访。干预依从性高（20次疗程中完成19±2次），未报告与rTMS相关的不良事件。与假刺激相比，rTMS从基线到1个月随访时SARA总分的改善百分比更高（P = 0.008）。对SARA单个项目的二次分析显示，rTMS仅改善了“ stance”子评分中的表现（P = 0.002）。这种功能变化伴随着睁眼和闭眼站立时姿势摆动的几个客观指标的改善（P < 0.008）。rTMS不影响9孔插钉试验、TUG或步态运动学。20次疗程的rTMS干预对SCA患者是安全可行的。有必要进行更多研究以证实该干预对站立姿势控制观察到的长期益处。试验注册：www.ClinicalTrials.gov，标识符：NCT01975909 。
