Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015

Abstract

Abstract. BACKGROUND AND PURPOSE:In advanced Parkinson's disease (PD), the emergence of symptoms refractory to conventional therapy poses a therapeutic challenge. The success of deep brain stimulation (DBS) and advances in the understanding of the pathophysiology of PD have raised interest in non-invasive brain stimulation as an alternative therapeutic tool. The rationale for its use draws from the concept that reversing abnormalities in brain activity and physiology thought to cause the clinical deficits may restore normal functioning. Currently the best evidence in support of this concept comes from DBS, which improves motor deficits, and modulates brain activity and motor cortex physiology, though whether a causal interaction exists remains largely undetermined. CONCLUSION: Most trials of non-invasive brain stimulation in PD have applied repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex and cortical areas of the motor circuit. Published studies suggest a possible therapeutic potential of rTMS and transcranial direct current stimulation (tDCS), but clinical effects so far have been small and negligible regarding functional independence and quality of life. Approaches to potentiate the efficacy of rTMS, including increasing stimulation intensity and novel stimulation parameters, derive their rationale from studies of brain physiology. These novel parameters simulate normal firing patterns or act on the hypothesized role of oscillatory activity in the motor cortex and basal ganglia in motor control. There may also be diagnostic potential of TMS in characterizing individual traits for personalized medicine.

Limb Kinetic Apraxia Is an Independent Predictor for Quality of Life in Parkinson's Disease

“…Our findings clearly favor the concept that LKA accounts for dexterous impairment beyond parkinsonian symptoms, a controversial debate that started a decade ago. 19,20 Because dopaminergic treatment only minimally improves LKA, 1 nonpharmacologic treatment options, such as noninvasive, repetitive brain-stimulation techniques 21,22 or specific home-based dexterity training, 23 may offer an improvement in dexterous functions for patients with PD.…”

A durable gain in motor and non-motor symptoms of Parkinson’s Disease following repeated caloric vestibular stimulation: A single-case study

“…As highlighted by Benninger and Hallett (2015), the shortcomings of conventional pharmacological therapy coupled with the recent success of deep brain stimulation in advanced PD has raised interest in non-invasive forms of neuro-stimulation, however, there has so far been little evidence from transcranial studies that the reported gains translate to long-lasting improvements in well-being and functional independence. We recognize that the inferential power of the present single-case study is limited, however, the improved response profile demonstrated by the participant, perhaps most notably at 5months follow-up, alludes to a practical patient benefit that, in our opinion, justifies larger-scale investigation.…”

Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study

“…Recent evidence shows that stimulation of specific brain areas with non-invasive brain stimulation (e.g. transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)) can be used as a supplementary therapeutic option to enhance training benefits (Benninger & Hallett, 2015;Buch et al, 2017). Pairing tDCS with a biologically relevant stimulus (i.e.…”