Ghosh Soumya, Tucak Claire, Eisenhauer Jennifer, Jacques Angela, Hathorn Dave, Dixon Jesse, Cooper Ian D
Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia; Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA 6009, Australia.
Mult Scler Relat Disord. 2024 Dec;92:106149. doi: 10.1016/j.msard.2024.106149. Epub 2024 Oct 31.
Impairment of balance and gait is common in Multiple Sclerosis (MS). Non-invasive Brain Stimulation techniques are promising adjuncts to physical therapy to improve disability.
To determine if combining transcranial direct current stimulation (tDCS) with conventional exercise therapy enhances balance and mobility in people with multiple sclerosis (PwMS) compared to exercise alone.
In a double-blind randomised controlled trial, PwMS were randomised into a real or sham tDCS group. All patients received individualized exercise treatment. Twelve sessions of real (intensity 2mA, bipolar) or sham tDCS was administered over the primary motor area for 20 minutes followed by one hour of physiotherapy focusing on balance, strength, and mobility, twice a week for six weeks. Outcome measures included balance (Berg Balance Score), mobility (10m Walk Test), fatigue (Fatigue Severity Scale) and quality of life (Multiple Sclerosis Quality of Life - 54) performed 1 week before intervention, at week 7 (1-week post-intervention), and at six months post-intervention. Falls questionnaire was completed 1 week before intervention and at 6 months post-intervention. Generalised linear mixed model analysis was used to compare outcomes at different time points within groups (before and after exercise treatment) and between groups (sham vs real stimulation groups).
Forty participants (mean age 54 and mean EDSS 3.5) were randomly allocated to receive real (n=19) or sham (n=21) stimulation, with 36 completing the post-intervention (real 17, sham 19) and 32 completing the 6-month assessments (real 15, sham 17). All participants had significantly improved balance and mobility scores post exercise treatment (within groups comparison, p<0.05). Between groups comparison found a small but significant improvement in the Berg Balance Score (mean improvement 1.9 and 2 points, p <0.05) and 10-metre Walk Test (mean improvement of 0.09 and 0.11m/s, p <0.05) in the real tDCS group compared to the sham group after six weeks of training and at six months follow-up, respectively. There was no benefit in fatigue, falls and QOL scores in the real stimulation group compared to the control group.
Our results suggest that the addition of tDCS prior to exercise treatment provides a significant improvement in walking speed and balance in people with MS which lasts longer, compared to exercise alone. Further study is needed to optimize the use of this relatively inexpensive and well tolerated device for rehabilitation.
Australia and New Zealand Clinical Trial Registry (ACTRN12628001836224).
平衡和步态障碍在多发性硬化症（MS）中很常见。非侵入性脑刺激技术有望成为物理治疗的辅助手段，以改善残疾状况。
确定与单纯运动疗法相比，经颅直流电刺激（tDCS）与传统运动疗法相结合是否能增强多发性硬化症患者（PwMS）的平衡能力和活动能力。
在一项双盲随机对照试验中，PwMS被随机分为真正的tDCS组或假刺激组。所有患者均接受个体化运动治疗。在初级运动区进行12次真正的（强度2mA，双极）或假tDCS治疗，每次20分钟，然后进行1小时专注于平衡、力量和活动能力的物理治疗，每周两次，共六周。结局指标包括干预前1周、第7周（干预后1周）和干预后6个月进行的平衡（伯格平衡量表）、活动能力（10米步行测试）、疲劳（疲劳严重程度量表）和生活质量（多发性硬化症生活质量-54）。在干预前1周和干预后6个月完成跌倒问卷。使用广义线性混合模型分析来比较组内（运动治疗前后）和组间（假刺激与真正刺激组）不同时间点的结局。
40名参与者（平均年龄54岁，平均扩展残疾状态量表评分为3.5）被随机分配接受真正的（n = 19）或假（n = 21）刺激，36人完成了干预后评估（真正刺激组17人，假刺激组19人），32人完成了6个月评估（真正刺激组15人，假刺激组17人）。所有参与者在运动治疗后平衡和活动能力得分均有显著改善（组内比较，p < 0.05）。组间比较发现，在训练六周后和六个月随访时，真正的tDCS组与假刺激组相比，伯格平衡量表有小幅但显著的改善（平均改善1.9分和2分，p < 0.05），10米步行测试也有改善（平均改善0.09米/秒和0.11米/秒，p < 0.05）。与对照组相比，真正刺激组在疲劳、跌倒和生活质量得分方面没有益处。
我们的结果表明，与单纯运动疗法相比，在运动治疗前添加tDCS可显著改善MS患者的步行速度和平衡能力，且效果持续时间更长。需要进一步研究以优化这种相对便宜且耐受性良好的设备在康复中的使用。
澳大利亚和新西兰临床试验注册中心（ACTRN12628001836224）。
