Effects of Acute Transcranial Direct Current Stimulation on Gait Kinematics of Individuals With Parkinson Disease

Abstract

Background: One of the most disabling problems in Parkinson disease (PD) is gait impairment. Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have been introduced as a therapeutic alternative for coping with PD motor problems. However, the effects of tDCS on gait performance in PD have not yet been fully established. Therefore, the main objective of this study was to evaluate whether a single session of tDCS modifies gait kinematics in individuals with PD. Methods: Twenty-one individuals with PD were included in this randomized, double-blinded, sham-controlled design study. They were randomly allocated in one real (N = 8) or sham (N = 9) tDCS group. Real tDCS comprises a 2-mA anodic current applied over 15 minutes in the supplementary motor area and medial areas of the primary motor cortices through a bipolar electrode montage. Gait kinematics and the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) were assessed before and immediately after a single stimulation session. Pre- minus poststimulation (Δ) values were computed and compared through a Mann-Whitney test. Data are shown as the median (lower, upper quartile). Results: There was a significant group difference with a large effect size for Δ values of gait cadence (P = .014, d = 0.87), indicating its reduction after anodic stimulation in the real (−0.28 [−1.16, 0.01] steps/s) compared with sham tDCS group (0.17 [0.00, 0.40] steps/s). No other significant effect was found. Conclusion: The findings of this study suggest that anodic tDCS administered in a single session improves gait cadence in PD individuals.

The effects of transcranial direct current stimulation on gait in patients with Parkinson’s disease: a systematic review

“…Thirteen studies had a PEDro score of 9 and 10, representing excellent quality [ 26 , 32 , 38 , 39 , 42 – 49 ], four studies had a score of 8 [ 50 – 53 ], and one study had a score of 7 [ 27 ]. Sixteen studies were designed double-blinded.…”

“…Two studies were single-blinded but had otherwise good quality, as shown by a score of 8 [ 52 , 53 ]. Three studies reported dropouts without conduction of an intention-to-treat analysis [ 27 , 50 , 51 ]. In all studies, the allocation procedure was not described (Table 1 ).…”

Tolerability and Blinding of Transcranial Direct Current Stimulation in People with Parkinson’s Disease: A Critical Review

“…One study tested in both off and on dopaminergic medication [ 33 ], one tested in the off state [ 49 ], and one did not report medication status [ 52 ]. Five investigations had open-label designs [ 38 , 43 , 45 , 46 , 47 ]; seven were parallel arm, randomized, double-blind, sham-controlled designs [ 33 , 40 , 41 , 42 , 44 , 50 , 52 ]; and eight were crossover, randomized, sham-controlled designs, with six being double-blind [ 36 , 37 , 39 , 48 , 49 , 51 ] and two with unstated blinding [ 34 , 35 ]. The tDCS intensities ranged from 1 to 2.8 mA (range of current densities = 0.02 mA/cm 2 –0.12 mA/cm 2 ) and stimulation was applied for 7–30 min (mode = 20 min).…”

Non-invasive Transcranial Electrical Stimulation in Movement Disorders

“…Anodal tDCS may also induce dopamine release in the basal ganglia by the activation of glutamatergic corticostriatal fibers (Siebner et al, 1999;Fregni et al, 2006;Valentino et al, 2014). Studies have been done by targeting either the motor cortex (M1, 1-2 mA, 13-30 min) (Verheyden et al, 2013;Kaski et al, 2014b;Mak and Yu, 2014;Valentino et al, 2014;Costa-Ribeiro et al, 2016Schabrun et al, 2016;Fernandez-Lago et al, 2017;da Silva et al, 2018;Yotnuengnit et al, 2018) or the dorsolateral prefrontal cortex (DLPFC, 2 mA, 7-20 min) (Manenti et al, 2014;Lattari et al, 2017). At post-stimulation, a short-term benefit in gait was noted in most of these studies.…”

“…• Gait and balance (Benninger et al, 2010;Verheyden et al, 2013;Capecci et al, 2014;Kaski et al, 2014a;Mak and Yu, 2014;Manenti et al, 2014;Valentino et al, 2014;Costa-Ribeiro et al, 2016Schabrun et al, 2016;Swank et al, 2016;Fernandez-Lago et al, 2017;Lattari et al, 2017;Criminger et al, 2018;da Silva et al, 2018;Dagan et al, 2018;Harris et al, 2018;Yotnuengnit et al, 2018;Alizad et al, 2019;Putzolu et al, 2019) • Upper limb function (Fregni et al, 2006;Benninger et al, 2010;Doruk et al, 2014;Salimpour et al, 2015;Costa-Ribeiro et al, 2016;Ferrucci et al, 2016;Schabrun et al, 2016;Cosentino et al, 2017;Ishikuro et al, 2018;Broeder et al, 2019) • Cognition (Nitsche et al, 2005;Boggio et al, 2006;Biundo et al, 2015;Manenti et al, 2016;Elder et al, 2017;Lawrence et al, 2018;Adenzato et al, 2019) • Impulsive pathological gambling behavior (Benussi et al, 2017a) • Speech (Pereira et al, 2013) • Sleep (Hadoush et al, 2018) • Fatigue …”