Eun Jong Dae, Bang Yu Min, Youn Jinyoung, Cho Jin Whan, Kim Yun-Hee, Chang Won Hyuk
Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Brain Neurorehabil. 2020 Apr 6;13(3):e13. doi: 10.12786/bn.2020.13.e13. eCollection 2020 Nov.
Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS. Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.
尽管深部脑刺激（DBS）已被报道可有效改善运动和非运动功能障碍，但帕金森病（PD）患者的冻结步态（FoG）通常对DBS有抵抗性。经颅直流电刺激（tDCS）已被报道为改善PD患者FoG的一种替代治疗策略。在本病例报告中，我们描述了对2例接受DBS治疗的PD患者的小腿初级运动皮层进行累积tDCS以减轻FoG的效果。2例接受丘脑底核DBS治疗的PD患者因难治性FoG到康复医学科就诊。每位患者均接受了小腿初级运动皮层的累积tDCS以减轻FoG。在tDCS期间，2例患者均无需改变多巴胺能药物剂量，且在tDCS期间及之后均未出现明显副作用。尽管病例1在10次tDCS治疗后FoG问卷（FoG-Q）未显示变化，但病例2的患者在tDCS 5天后报告FoG-Q从11显著改善至3。我们展示了tDCS在表现为难治性FoG的接受DBS治疗的PD患者中的安全性和可行性。
