Spinal direct current stimulation (tsDCS) in hereditary spastic paraplegias (HSP): A sham-controlled crossover study

Ardolino, Gianluca; Bocci, Tommaso; Nigro, Martina; Vergari, Maurizio; Fonzo, Alessio Di; Bonato, Sara; Cogiamanian, F.; Cortese, Francesca; Cova, Ilaria; Barbieri, S.

doi:10.1080/10790268.2018.1543926

Cited by 35 publications

(75 citation statements)

References 48 publications

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“…Trans‐spinal direct current stimulation (tsDCS) is emerging as a promising neuromodulative technique that can be used to treat neurological disorders or to facilitate sport performance (Angius, Hopker, & Mauger, ; Ardolino et al , ; Berry, Tate, & Conway, ; Estes, Iddings, & Field‐Fote, ; Lefaucheur et al, ). However, despite the broad application of tsDCS, the physiological mechanisms underlying the observed effects remain unclear, although some significant advances have been made towards our understanding of DC‐evoked neuronal plasticity.…”

Section: Introductionmentioning

confidence: 99%

Long‐lasting modifications of motoneuron firing properties by trans‐spinal direct current stimulation in rats

Bączyk¹,

Drzymała‐Celichowska²,

Mrówczyński³

et al. 2019

Eur J of Neuroscience

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Trans-spinal direct current stimulation (tsDCS) is a novel neuromodulatory technique that has been used during neurological rehabilitation and sports to modulate muscle activation. However, the physiological mechanisms that underly the longlasting functional effects of polarization are not yet fully understood, nor are their relationships with specific neuronal populations. The acute facilitatory and depressive effects of anodal and cathodal polarization on motoneurons have been recently demonstrated, and the aim of this study was to determine whether tsDCS-evoked modulations of motoneuron properties are able to persist over several hours. Intracellular recordings from multiple antidromically identified rat motoneurons were performed both before and after the application of tsDCS (0.1 mA for 15 min), at various time points up to 180 min after the offset of anodal or cathodal tsDCS. The examined effects of anodal polarization included decreased rheobase, voltage threshold, the minimum and maximum currents necessary for rhythmic firing, increased rhythmic firing frequencies and the slope of the f-I relationship. The majority of these facilitatory changes to threshold and firing properties were sustained for 30-60 min after polarization. In contrast, the significant effects of cathodal polarization were absent, except the short-lasting decreased ability for motoneurons to induce rhythmic activity. This study provides direct evidence that a single polarization session can alter the electrophysiological properties of motoneurons for at least one hour and provides a basis for the further use of tsDCS techniques under conditions where the sustained modification of motoneuron firing is desired.

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Section: Introductionmentioning

confidence: 99%

Long‐lasting modifications of motoneuron firing properties by trans‐spinal direct current stimulation in rats

Bączyk¹,

Drzymała‐Celichowska²,

Mrówczyński³

et al. 2019

Eur J of Neuroscience

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“…Recently, in a clinical study of hereditary spastic paraplegia, repeated anodal transcutaneous spinal DCS has also been shown to reduce muscle hypertonia up to 2 months after the end of stimulation, although no improvement in gait function was identified (Ardolino et al . ).…”

Section: Measurement Of Cutaneous Lower Limb Hyperreflexia As a Charamentioning

confidence: 97%

“…Spasticity following spinal cord injury (SCI) has been clinically defined as an increase in velocity-dependent tonic stretch reflexes (muscle tone) with exaggerated tendon jerks to passive movement. However, the development of other debilitating symptoms in parallel, such as severe spasms and cutaneous flexor hyperreflexia, may equally contribute to the SCI spasticity syndrome (Bravo-Esteban et al 2013;Gomez-Soriano et al 2016), by dramatically reducing residual gait function (Bravo-Esteban et al 2013) or activities of daily living. Severe SCI spasticity is usually managed with systemic or intrathecal baclofen therapy, but without careful titration this treatment may lead to excessive muscle weakness, complicating the patient's ability to perform essential motor tasks or transfer functions.…”

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confidence: 99%

“…Furthermore, the team demonstrates that repeated anodal trans-spinal DCS potentiates spinal reflex inhibition, as shown by an increase in rate-dependent H reflex depression, and normalises the expression of the Na-K-Cl cotransporter isoform 1 (NKCC1), highlighting one mechanism of action by which spinal stimulation may modulate SCI spasticity. Recently, in a clinical study of hereditary spastic paraplegia, repeated anodal transcutaneous spinal DCS has also been shown to reduce muscle hypertonia up to 2 months after the end of stimulation, although no improvement in gait function was identified (Ardolino et al 2018).…”

mentioning

confidence: 99%

“…1C) and individuals with motor complete SCI (Hubli et al 2013), following application at the T11 vertebral level. In contrast, five 20-min sessions of anodal transcutaneous spinal DCS delivered to the T10-T12 'thoracic spinal cord' lead to long-term inhibition of muscle hypertonia, albeit for people with hereditary spastic paraplegia (Ardolino et al 2018). More emphasis should be made to standardise the spinal level of non-invasive stimulation so that optimal modulation of key lower limb muscles can be achieved (Fig.…”

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confidence: 99%

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Non‐invasive spinal direct current simulation for spasticity therapy following spinal cord injury: mechanistic insights contributing to long‐term treatment effects

Gómez-Soriano

Megía-García

Serrano-Muñóz

et al. 2019

The Journal of Physiology

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A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

Hvingelby,

Carra,

Terkelsen

et al. 2024

Movement Disord Clin Pract

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BackgroundParkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS.ObjectivesIn this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD.MethodsWe included pre‐clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism.ResultsA total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence‐based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered.ConclusionTherapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.

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Spinal direct current stimulation (tsDCS) in hereditary spastic paraplegias (HSP): A sham-controlled crossover study

Cited by 35 publications

References 48 publications

Long‐lasting modifications of motoneuron firing properties by trans‐spinal direct current stimulation in rats

Long‐lasting modifications of motoneuron firing properties by trans‐spinal direct current stimulation in rats

Non‐invasive spinal direct current simulation for spasticity therapy following spinal cord injury: mechanistic insights contributing to long‐term treatment effects

A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies

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