Oveisgharan Shahram, Karimi Zahra, Abdi Siamak, Sikaroodi Hajir
Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Neurol. 2019 Apr 4;18(2):57-63.
Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. In a single-center randomized double-blind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the C point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients' mobility in daily activities.
经颅直流电刺激（tDCS）下肢初级运动皮层已被用于治疗中风和下肢痉挛性轻瘫患者。我们研究了这种刺激疗法对治疗多发性硬化症（MS）相关步行障碍的疗效。在一项单中心随机双盲临床试验研究中，13名患有MS且有步行障碍、扩展残疾状态量表（EDSS）评分为3至6的患者被随机分为真刺激组和假刺激组。在真tDCS刺激中，7名患者在C点前方1厘米处接受2.5毫安的阳极刺激，每天一次，每次30分钟，连续7天。另一组接受相同方案的假刺激。试验的主要结局是刺激前后定时25英尺步行（T25-FW）的变化。我们还评估了多发性硬化症步行量表12（MSWS-12）。我们采用线性混合效应模型来研究tDCS刺激对改变结局的疗效。平均而言，接受真tDCS刺激的患者在7次刺激后步行速度加快[估计值=-2.7，标准误差（SE）=1.3，P=0.049]，而接受假刺激的患者步行速度没有变化。对于每次刺激，接受真tDCS刺激的患者步行25英尺的时间减少2.7秒。真tDCS刺激在改善MSWS-12评分方面无效。tDCS刺激下肢运动皮层可加快MS患者的步行速度，但患者日常活动中的活动能力没有改善。
