Iannone Aline, Allam Nasser, Brasil-Neto Joaquim P
Universidade de Brasília, Laboratório de Neurociência e Comportamento, Instituto de Biologia, Brasília DF, Brasil.
Universidade de Brasília, Departamento de Ciências Fisiológicas, Instituto de Biologia, Brasília DF, Brasil.
Arq Neuropsiquiatr. 2019 Mar;77(3):174-178. doi: 10.1590/0004-282X20190019.
Transcranial direct current stimulation (tDCS) has been investigated in movement disorders, making it a therapeutic alternative in clinical settings. However, there is still no consensus on the most appropriate treatment protocols in most cases, and the presence of deep brain stimulation (DBS) electrodes has been regarded as a contraindication to the procedure. We recently studied the effects of cerebellar tDCS on a female patient already undergoing subthalamic nucleus deep brain stimulation (STN-DBS) for generalized dystonia. She also presented with chronic pain and depression. With STN-DBS, there was improvement of dystonia, and botulinum toxin significantly reduced pain. However, depressive symptoms were worse after STN-DBS surgery.
Neuromodulation with 2 mA anodal cerebellar tDCS was initiated, targeting both hemispheres in each daily 30 minute session: 15 minutes of left cerebellar stimulation followed by 15 minutes of right cerebellar stimulation. The DBS electrodes were in place and functional, but the current was turned off during tDCS.
Although our goal was to improve dystonic movements, after 10 tDCS sessions there was also improvement in mood with normalization of Beck Depression Inventory scores. There were no complications in spite of the implanted STN-DBS leads.
Our results indicate that tDCS is safe in patients with DBS electrodes and may be an effective add-on neuromodulatory tool in the treatment of potential DBS partial efficacy in patients with movement disorders.
经颅直流电刺激（tDCS）已在运动障碍中进行了研究，使其成为临床环境中的一种治疗选择。然而，在大多数情况下，对于最合适的治疗方案仍未达成共识，并且深部脑刺激（DBS）电极的存在被视为该手术的禁忌症。我们最近研究了小脑tDCS对一名已接受丘脑底核深部脑刺激（STN-DBS）治疗全身性肌张力障碍的女性患者的影响。她还伴有慢性疼痛和抑郁症。通过STN-DBS，肌张力障碍有所改善，肉毒杆菌毒素显著减轻了疼痛。然而，STN-DBS手术后抑郁症状加重。
开始采用2 mA阳极小脑tDCS进行神经调节，每次30分钟，针对双侧半球：先进行15分钟的左侧小脑刺激，然后进行15分钟的右侧小脑刺激。DBS电极已就位且功能正常，但在tDCS期间关闭电流。
尽管我们的目标是改善肌张力障碍运动，但在进行10次tDCS治疗后，情绪也有所改善，贝克抑郁量表评分恢复正常。尽管植入了STN-DBS电极，但未出现并发症。
我们的结果表明，tDCS对植入DBS电极的患者是安全的，并且可能是一种有效的附加神经调节工具，用于治疗运动障碍患者中潜在的DBS部分疗效。
