Intrinsic Auricular Muscle Zone Stimulation Improves Walking Parameters of Parkinson's Patients Faster Than Levodopa in the Motion Capture Analysis: A Pilot Study

Abstract

It has been demonstrated that intrinsic auricular muscles zone stimulation (IAMZS) can improve the motor symptoms of Parkinson's disease (PD) patients who are examined with the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores. In the present pilot study, using motion capture technology, we aimed to investigate the efficacy of IAMZS compared to medication alone or in combination with medication. Ten PD patients (mean age: 54.8 ± 10.1 years) were enrolled. Each participant participated in three different sessions: sole medication, sole stimulation-20 min of IAMZS, and combined IAMZS (20 min) and medication. Each session was performed on different days but at the same time to be aligned with patients' drug intake. Motion capture recording sessions took place at baseline, 20, 40, and 60 min. Statistical analysis was conducted using one-way repeated measures ANOVA. Bonferroni correction was implemented for pairwise comparisons. The sole medication was ineffective to improve gait-related parameters of stride length, stride velocity, stance, swing, and turning speed. In the sole-stimulation group, pace-related gait parameters were significantly increased at 20 and 40 min. These improvements were observed in stride length at 20 (p = 0.0498) and 40 (p = 0.03) min, and also in the normalized stride velocity at 40 min (p-value = 0.02). Stride velocity also tended to be significant at 20 min (p = 0.06) in the sole-stimulation group. Combined IAMZS and medication demonstrated significant improvements in all the time segments for pace-related gait parameters [stride length: 20 min (p = 0.04), 40 min (p = 0.01), and 60 min (p < 0.01); stride velocity: 20 min (p < 0.01), 40 min (p = 0.01), and 60 min (p < 0.01)]. These findings demonstrated the fast action of the IAMZS on PD motor symptoms. Moreover, following the termination of IAMZS, a prolonged improvement in symptoms Cakmak et al. IAMZS Improves Walking in Parkinson's was observed at 40 min. The combined use of IAMZS with medication showed the most profound improvements. The IAMZS may be particularly useful during medication off periods and may also postpone the long-term side effects of high-dose levodopa. A large scale multicentric trial is required to validate the results obtained from this pilot study.

Transcutaneous auricular vagus nerve stimulation improves gait and cortical activity in Parkinson's disease: A pilot randomized study

“…Meanwhile, cervical nVNS 11,13 and single taVNS 14 therapy was found to ameliorate gait in PD patients. The IAMZs electrical stimulation was found to have a short‐term effect on improving gait 16 of PD patients. Similarly, significant increases in velocity, step length, and stride length with taVNS therapy were detected in our study compared with baseline, indicating that PD patients were walking at a faster pace after taVNS therapy.…”

“…Recently, a pilot‐controlled study found that transcutaneous auricular VNS (taVNS) could be a valuable tool for neuromodulation in PD 14 . Meanwhile, intrinsic auricular muscle zones (IAMZs) electrical stimulation which allows the potential to provide muscle feedback, modulate motor driver cortical areas, and stimulate multiple nerves including vagus nerve synchronously could improve the clinical motor symptoms 15 and gait parameters 16 of PD patients in the short term. Consequently, we used taVNS, a safer and better‐tolerated non‐invasive method of VNS through stimulating the auricular branch of the vagus nerve, 17 to verify its efficacy and safety of gait impairment in PD patients.…”

Transcutaneous auricular vagus nerve stimulation alters cough sensitivity depending on stimulation parameters: potential implications for aspiration risk

“…There were at least 2 days washout period between visits to mitigate crossover of stimulation effects. The washout period duration was based on previous auricular stimulation research that found that there were significant improvements in gait at 20 and 40 min after auricular stimulation, but these gains regressed and were not significantly different to baseline by 60 min after the initial stimulation (Cakmak et al, 2020). Therefore, for our study, a washout period of at least 2 days was considered adequate for the participant's cough sensitivity to fully return to baseline before the next stimulation visit.…”

Technological support for people with Parkinson’s disease: a narrative review

“…The results showed that auditory cues improve gait parameters by evoking gait-related internal rhythm information in PD participants. In 2020, Cakmak et al 78 focused on the efficacy of intrinsic stimulation of the ear muscle area (IAMZS). Study participants underwent three test sessions structured as follows: only drug; only stimulation; combined use drug and stimulation (n = 10).…”