Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial

• Published in: Neurology Vol. 91; no. 12; p. e1090
• Main Authors: Benussi, Alberto, Dell'Era, Valentina, Cantoni, Valentina, Bonetta, Elisa, Grasso, Roberto, Manenti, Rosa, Cotelli, Maria, Padovani, Alessandro, Borroni, Barbara
• Format: Journal Article
• Language: English
• Published: United States 18.09.2018
• Subjects: Aged; Ataxia - therapy; Cerebellum - physiology; Cross-Over Studies; Double-Blind Method; Female; Humans; Male; Middle Aged; Motor Cortex - physiology; Neural Inhibition - physiology; Neurodegenerative Diseases - therapy; Spinal Cord - physiology; Time Factors; Transcranial Direct Current Stimulation
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0000000000006210

To investigate whether a 2-week treatment with cerebellar anodal and spinal cathodal transcranial direct current stimulation (tDCS) could reduce symptoms in patients with neurodegenerative ataxia and could modulate cerebello-motor connectivity at the short and long terms. We performed a double-blind, randomized, sham-controlled, crossover trial with cerebello-spinal tDCS (5 d/wk for 2 weeks) in 20 patients with neurodegenerative ataxia. Each patient underwent a clinical evaluation before and after real tDCS or sham stimulation. A follow-up evaluation was performed at 1 and 3 months with a crossover washout period of 3 months. Cerebello-motor connectivity was evaluated with transcranial magnetic stimulation at baseline and at each follow-up. Cerebello-spinal tDCS showed a significant improvement in all performance scores (Scale for the Assessment and Rating of Ataxia, International Cooperative Ataxia Rating Scale, 9-Hole Peg Test, 8-m walking time), in motor cortex excitability, and in cerebellar brain inhibition compared to sham stimulation. A 2-week treatment with cerebello-spinal tDCS reduces symptoms in patients with ataxia and restores motor cortex inhibition exerted by cerebellar structures. Cerebello-spinal tDCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia, still an orphan disorder of any pharmacologic intervention. NCT03120013. This study provides Class II evidence that cerebello-spinal stimulation is effective and safe in cerebellar ataxia.