Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson’s Disease

Abstract

BackgroundSleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD.Material/MethodsTwenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation.ResultsPSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001).ConclusionsBilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.

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

“…• 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 …”

“…Sleep disturbance is a common non-motor symptom in patients with PD, adversely affecting their overall quality of life and promoting neuropsychiatric complications like depression (Kay et al, 2018). Bilateral anodal tDCS simultaneously over the left and the right prefrontal and motor areas (10 sessions, 20 min each, five sessions per week) improved their Pittsburgh Sleep Quality Index total score, sleep latency sub-score, Geriatric Depression Scale total score, and physical and mental component scores of the health-related quality-of-life questionnaire (SF-36) (Hadoush et al, 2018). A beneficial effect of bilateral DLPFC tDCS (eight sessions, 0.06 mA/cm 2 current, 20 min/session) on fatigue in PD patients, using left anodal and right cathodal stimulation, has been shown by Forogh et al (2017) when combined with occupational therapy.…”

Exploring the Therapeutic Effects of Transcranial Direct Current Stimulation on Sleep Quality Among Patients Under Methadone Maintenance Treatment

“…Also, the evidence suggests that tDCS might affect sleep quality and neurocognition in euthymia and is useful for relapse prevention [18]. Besides, bilateral anodal tDCS stimulation for 10 sessions (20 min each, 5 per week) demonstrated potential therapeutic effects on depression level improvement and sleep quality in patients with Parkinson disease [19].…”

“…The direct effect of tDCS stimulation and the indirect impact on sleep quality may be favorable in subjects under MMT through bilateral anodal stimulation, over DLPFC (dorsolateral prefrontal cortex), premotor, and M1 areas. Also, tDCS can change the cortical excitability and increases brain excitability by altering the resting potential of cortical neural cells [19,21]. The safety of tDCS in adults has been well documented and confirmed, and several reported side effects were mild and transient.…”