Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy.
Cerebellum. 2024 Apr;23(2):570-578. doi: 10.1007/s12311-023-01578-6. Epub 2023 Jun 22.
Cerebellar transcranial direct current stimulation (tDCS) represents a promising therapeutic approach for both motor and cognitive symptoms in neurodegenerative ataxias. Recently, transcranial alternating current stimulation (tACS) was also demonstrated to modulate cerebellar excitability by neuronal entrainment. To compare the effectiveness of cerebellar tDCS vs. cerebellar tACS in patients with neurodegenerative ataxia, we performed a double-blind, randomized, sham controlled, triple cross-over trial with cerebellar tDCS, cerebellar tACS or sham stimulation in twenty-six participants with neurodegenerative ataxia. Before entering the study, each participant underwent motor assessment with wearable sensors considering gait cadence (steps/minute), turn velocity (degrees/second) and turn duration (seconds), and a clinical evaluation with the scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). After each intervention, participants underwent the same clinical assessment along with cerebellar inhibition (CBI) measurement, a marker of cerebellar activity. The gait cadence, turn velocity, SARA, and ICARS significantly improved after both tDCS and tACS, compared to sham stimulation (all p<0.010). Comparable effects were observed for CBI (p<0.001). Overall, tDCS significantly outperformed tACS on clinical scales and CBI (p<0.01). A significant correlation between changes of wearable sensors parameters from baseline and changes of clinical scales and CBI scores was detected. Cerebellar tDCS and cerebellar tACS are effective in ameliorating symptoms of neurodegenerative ataxias, with the former being more beneficial than the latter. Wearable sensors may serve as rater-unbiased outcome measures in future clinical trials. ClinicalTrial.gov Identifier: NCT05621200.
小脑经颅直流电刺激(tDCS)代表了一种有前途的治疗方法,可用于治疗神经退行性共济失调的运动和认知症状。最近,经颅交流电刺激(tACS)也被证明通过神经元的节律性驱动来调节小脑兴奋性。为了比较小脑 tDCS 与小脑 tACS 在神经退行性共济失调患者中的疗效,我们进行了一项双盲、随机、假对照、三交叉试验,共 26 例神经退行性共济失调患者接受小脑 tDCS、小脑 tACS 或假刺激。在进入研究之前,每位参与者都使用可穿戴传感器进行运动评估,考虑步态节奏(每分钟步数)、转弯速度(每秒度数)和转弯持续时间(秒),并使用共济失调评估和评分量表(SARA)和国际合作共济失调评分量表(ICARS)进行临床评估。在每次干预后,参与者接受相同的临床评估,同时进行小脑抑制(CBI)测量,这是小脑活动的标志物。与假刺激相比,tDCS 和 tACS 后步态节奏、转弯速度、SARA 和 ICARS 均显著改善(均 p<0.010)。CBI 也观察到类似的效果(p<0.001)。总体而言,tDCS 在临床量表和 CBI 方面显著优于 tACS(p<0.01)。从基线开始,可穿戴传感器参数的变化与临床量表和 CBI 评分的变化之间存在显著相关性。小脑 tDCS 和小脑 tACS 均能有效改善神经退行性共济失调的症状,前者比后者更有益。可穿戴传感器在未来的临床试验中可能作为无偏倚评估者的结局测量指标。临床试验.gov 标识符:NCT05621200。