Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
Int J Environ Res Public Health. 2021 Oct 12;18(20):10690. doi: 10.3390/ijerph182010690.
Cerebellar transcranial direct current stimulation (cerebellar tDCS) is a promising therapy for cerebellar ataxias and has attracted increasing attention from researchers and clinicians. A timely systematic review focusing on randomized sham-controlled trials and repeated measures studies is warranted. This study was to systematically review existing evidence regarding effects of anodal cerebellar tDCS on movements in patients with cerebellar ataxias. The searched databases included Web of Science, MEDLINE, PsycINFO, CINAHL, EMBASE, Cochrane Library, and EBSCOhost. Methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Five studies with 86 patients were identified. Among these, four studies showed positive effects of anodal cerebellar tDCS. Specifically, anodal cerebellar tDCS decreased disease severity and improved finger dexterity and quality of life in patients, but showed incongruent effects on gait control and balance, which may be due to heterogeneity of research participants and choices of measures. The protocols of anodal cerebellar tDCS that improved movements in patients commonly placed the anode over the whole cerebellum and provided ten 2-mA 20-min stimulation sessions. The results may show preliminary evidence that anodal cerebellar tDCS is beneficial to reducing disease severity and improving finger dexterity and quality of life in patients, which lays the groundwork for future studies further examining responses in the cerebello-thalamo-cortical pathway. An increase in sample size, the use of homogeneous patient groups, exploration of the optimal stimulation protocol, and investigation of detailed neural mechanisms are clearly needed in future studies.
小脑经颅直流电刺激(cerebellar tDCS)是治疗小脑性共济失调的一种有前途的方法,引起了研究人员和临床医生的越来越多的关注。有必要及时进行一项系统评价,重点关注随机假对照试验和重复测量研究。本研究旨在系统评价现有的关于小脑阳极经颅直流电刺激对小脑性共济失调患者运动影响的证据。检索的数据库包括 Web of Science、MEDLINE、PsycINFO、CINAHL、EMBASE、Cochrane Library 和 EBSCOhost。使用物理治疗证据数据库量表评估所选研究的方法学质量。确定了五项研究,共 86 名患者。其中四项研究显示阳极小脑 tDCS 具有积极影响。具体来说,阳极小脑 tDCS 降低了疾病的严重程度,改善了患者的手指灵巧度和生活质量,但对步态控制和平衡的影响不一致,这可能是由于研究参与者和选择的措施存在异质性。改善患者运动的阳极小脑 tDCS 方案通常将阳极放置在整个小脑上,并提供十个 2 mA 20 分钟的刺激疗程。结果可能初步表明阳极小脑 tDCS 有利于降低疾病严重程度,改善患者的手指灵巧度和生活质量,为进一步研究小脑-丘脑-皮质通路的反应奠定了基础。未来的研究显然需要增加样本量、使用同质的患者群体、探索最佳刺激方案以及研究详细的神经机制。
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