Treatment of cervical dystonia and blepharospasm by anodal tDCS of cerebellar hemispheres. A case report

Nǵuyen, Jean-Paul; Suarez, Alcira; Malineau, Catherine; Dixneuf, Véronique; Mazaltarine, G.; Damier, Philippe

doi:10.1016/j.neucli.2020.09.006

Cited by 2 publications

(5 citation statements)

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“…It is possible that the combined strategy could have restored a certain efficacy to the BTX injections and therefore that this also contributed to the clinical improvement through an additive or synergistic effect. Thus, a potentiating effect of neuromodulation techniques (rTMS or tDCS) with BTX injections could be expected for the treatment of CD or blepharospasm for example ( 12 , 13 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

“…Exercises are interspersed with a rest period equivalent to the duration of the exercise. It has been shown that it was necessary to repeat the exercise for about 20 min to obtain a significant clinical impact ( 3 , 15 ). Thus, motor training is able to promote neuroplasticity and therefore provide lasting effects over time ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

“…In their therapeutic application for focal dystonia, these techniques (rTMS or tDCS) have mainly targeted the motor or premotor cortex and the cerebellum [see review in Lefaucheur et al ( 11 )] and have shown some efficacy in the treatment of CD. In particular, a beneficial effect of cerebellar anodal tDCS (cer-atDCS) was reported in two patients with CD ( 12 , 13 ). Despite positive short-term results, the therapeutic effect was reported to be only transient, requiring repeated stimulation sessions to be maintained ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…In particular, a beneficial effect of cerebellar anodal tDCS (cer-atDCS) was reported in two patients with CD ( 12 , 13 ). Despite positive short-term results, the therapeutic effect was reported to be only transient, requiring repeated stimulation sessions to be maintained ( 13 ). By analogy with what has been shown for motor rehabilitation of stroke patients ( 14 ), we proposed a combined approach, associating tDCS and physical therapy for the treatment of dystonia.…”

Section: Introductionmentioning

confidence: 99%

“…By analogy with what has been shown for motor rehabilitation of stroke patients ( 14 ), we proposed a combined approach, associating tDCS and physical therapy for the treatment of dystonia. Thus, we aimed at improving and prolonging the therapeutic effect of tDCS by combining repeated sessions of cer-atDCS with a program of physiotherapy (Mot-Training) specifically developed for the management of dystonic patients ( 3 , 15 ). We report five cases of patients with CD initially treated with cer-atDCS alone then with the combination of cer-atDCS and Mot-Training.…”

Section: Introductionmentioning

confidence: 99%

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Combination of anodal tDCS of the cerebellum with a goal-oriented motor training to treat cervical dystonia: a pilot case series

Bleton,

Cossé,

Caloc’h

et al. 2024

Front. Neurol.

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BackgroundTranscranial Direct Current Stimulation (tDCS) of the cerebellum shows promise for the treatment of dystonia. Specific motor rehabilitation programs have also been developed in this context. However, the combination of these two approaches has not yet been evaluated to determine their therapeutic potential.MethodsWe report a series of 5 patients with cervical dystonia (CD) poorly controlled by botulinum toxin injections. They were initially treated by a protocol of repeated daily sessions (for 3 or 5 days) of cerebellar anodal tDCS (cer-atDCS) applied alone. In a second time, additional protocols of cer-atDCS were performed in combination with a program of goal-oriented motor training exercises (Mot-Training), specifically developed for the treatment of CD. The clinical impact of the procedures was assessed on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).ResultsCompared to baseline, the maximum percentage of TWSTRS total score improvement was 37% on average after cer-atDCS performed alone (p = 0.147, not significant) and 53% on average after cer-atDCS combined with Mot-Training (p = 0.014, significant). The TWSTRS pain and functional handicap subscores also improved after the combined protocol. A score of (+3) to (+5) was rated on the TWSTRS response scale after cer-atDCS performed alone or the combined protocol, corresponding to a moderate to striking improvement on dystonia and pain. This improvement lasted longer after the combined protocol than after cer-atDCS alone (3.4 vs. 1.4 months on average, p = 0.011).ConclusionThe combination of cer-atDCS with Mot-Training produced a greater and more prolonged improvement than the application of cer-atDCS alone. Such a combined therapeutic procedure is easy to perform and opens important perspectives in the long-term treatment of CD. These results remain to be confirmed by a randomized sham-controlled trial on a larger sample.

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Section: Discussionmentioning

confidence: 99%