Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
Mov Disord. 2024 Nov;39(11):1971-1981. doi: 10.1002/mds.29940. Epub 2024 Jul 25.
Recent imaging studies identified a brain network associated with clinical improvement following deep brain stimulation (DBS) in Parkinson's disease (PD), the PD response network.
This study aimed to assess the impact of neuromodulation on PD motor symptoms by targeting this network noninvasively using multifocal transcranial direct current stimulation (tDCS).
In a prospective, randomized, double-blinded, crossover trial, 21 PD patients (mean age 59.7 years, mean Hoehn & Yahr [H&Y] 2.4) received multifocal tDCS targeting the a-priori network. Twenty-minute sessions of tDCS and sham were administered on 2 days in randomized order. Movement Disorder Society-Unified Parkinson's Disease Rating Scale-Part III (MDS-UPDRS-III) scores were assessed.
Before intervention, MDS-UPDRS-III scores were comparable in both conditions (stimulation days: 37.38 (standard deviation [SD] = 12.50, confidence interval [CI] = 32.04, 42.73) vs. sham days: 36.95 (SD = 13.94, CI = 30.99, 42.91), P = 0.63). Active stimulation resulted in a reduction by 3.6 points (9.7%) to 33.76 (SD = 11.19, CI = 28.98, 38.55) points, whereas no relevant change was observed after sham stimulation (36.43 [SD = 14.15, CI = 30.38, 42.48], average improvement: 0.5 [1.4%]). Repeated-measures analysis of variance (ANOVA) confirmed significance (main effect of time: F=4.35, P < 0.05). Tukey's post hoc tests indicated MDS-UPDRS-III improvement after active stimulation (t [20] = 2.9, P = 0.03) but not after sham (t [20] = 0.42, P > 0.05). In a subset of patients that underwent DBS surgery later, their DBS response correlated with tDCS effects (R = 0.55, P = 0.04).
Noninvasive, multifocal tDCS targeting a DBS-derived network significantly improved PD motor symptoms. Despite a small effect size, this study provides proof of principle for the successful noninvasive neuromodulation of an invasively identified network. Future studies should investigate repeated tDCS sessions and their utility for screening before DBS surgery. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
最近的影像学研究发现，深部脑刺激（DBS）治疗帕金森病（PD）后，存在一个与临床改善相关的脑网络，即 PD 反应网络。
本研究旨在通过使用多焦点经颅直流电刺激（tDCS）非侵入性地靶向该网络，评估神经调节对 PD 运动症状的影响。
在一项前瞻性、随机、双盲、交叉试验中，21 名 PD 患者（平均年龄 59.7 岁，平均 Hoehn & Yahr [H&Y] 2.4）接受了靶向预先确定的网络的多焦点 tDCS。tDCS 和假刺激以随机顺序在 2 天内进行 20 分钟的治疗。使用运动障碍学会统一帕金森病评定量表第三部分（MDS-UPDRS-III）进行评分。
干预前，两种情况下的 MDS-UPDRS-III 评分相当（刺激日：37.38（标准差 [SD] = 12.50，置信区间 [CI] = 32.04，42.73）与假刺激日：36.95（SD = 13.94，CI = 30.99，42.91），P = 0.63）。主动刺激导致评分降低 3.6 分（9.7%），降至 33.76（SD = 11.19，CI = 28.98，38.55）分，而假刺激后无明显变化（36.43 [SD = 14.15，CI = 30.38，42.48]，平均改善：0.5 [1.4%]）。重复测量方差分析（ANOVA）证实了差异的显著性（时间的主要效应：F=4.35，P < 0.05）。Tukey 事后检验表明，主动刺激后 MDS-UPDRS-III 改善（t [20] = 2.9，P = 0.03），但假刺激后无明显改善（t [20] = 0.42，P > 0.05）。在后来接受 DBS 手术的患者亚组中，他们的 DBS 反应与 tDCS 效应相关（R = 0.55，P = 0.04）。
靶向 DBS 衍生网络的非侵入性多焦点 tDCS 显著改善了 PD 运动症状。尽管效应量较小，但本研究为成功非侵入性调节经侵袭性确定的网络提供了原理证明。未来的研究应探讨重复 tDCS 治疗和它们在 DBS 手术前筛选中的应用。
