Umemura Atsushi, Sato Kazunori, Iwamuro Hirokazu, Uchiyama Saki, Yanagisawa Naotake, Kondo Akihide, Hattori Nobutaka
Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan.
PLoS One. 2025 Aug 21;20(8):e0330286. doi: 10.1371/journal.pone.0330286. eCollection 2025.
Gait disturbance is one of the most disabling symptoms in patients with Parkinson's disease (PD). In particular, freezing of gait (FOG) is a major cause of falls and significantly impairs the activities of daily living. Neither drug therapy nor current neuromodulation therapy are effective against FOG in most patients, so the development of new treatments is needed.
This pilot study investigated the effects and safety of neuromodulation by single session anodal transcranial direct current stimulation (tDCS) to the cerebral cortex (supplementary motor area [SMA] or primary motor cortex [M1]) on gait in PD patients with FOG. We purposely used a commercially available tDCS device (Halo Sport 2; Halo Neuroscience, San Francisco, CA, USA) that patients can use themselves. This single arm, open label, sham-controlled study enrolled 20 advanced PD patients who complained of FOG.
Analysis of the 30-second walking distance, which was the primary endpoint, and the 10-m natural walking and 360-degree rotation tests showed that neither SMA nor M1 stimulation had a superior effect compared to sham stimulation. On the other hand, only SMA stimulation showed a significant improvement in the required time and the number of steps in the Timed Up and Go test compared to sham stimulation (p < 0.05).
These results suggest that tDCS to the SMA using a commercially available device may improve the actual walking ability of PD patients with FOG.
步态障碍是帕金森病（PD）患者最致残的症状之一。特别是冻结步态（FOG）是跌倒的主要原因，严重损害日常生活活动能力。在大多数患者中，药物治疗和目前的神经调节治疗对FOG均无效，因此需要开发新的治疗方法。
这项前瞻性研究调查了单次阳极经颅直流电刺激（tDCS）对大脑皮层（辅助运动区[SMA]或初级运动皮层[M1]）进行神经调节对伴有FOG的PD患者步态的影响和安全性。我们特意使用了一种患者可自行使用的市售tDCS设备（Halo Sport 2；美国加利福尼亚州旧金山的Halo Neuroscience公司）。这项单臂、开放标签、假对照研究纳入了20名主诉有FOG的晚期PD患者。
对主要终点30秒步行距离以及10米自然步行和360度旋转测试的分析表明，与假刺激相比，SMA和M1刺激均未显示出更优效果。另一方面，与假刺激相比，仅SMA刺激在计时起立行走测试中的所需时间和步数方面有显著改善（p < 0.05）。
这些结果表明，使用市售设备对SMA进行tDCS可能会改善伴有FOG的PD患者的实际步行能力。
