Objective: To evaluate whether home-based, remotely supervised cerebellar transcranial direct current stimulation (tDCS) can improve motor, cognitive and affective symptoms in patients with the cerebellar variant of multiple system atrophy (MSA-C).

Background: MSA-C is a leading cause of sporadic degenerative ataxia, but it currently lacks disease-modifying or effective symptomatic therapies. Anodal (tDCS) targeting the cerebellum has recently emerged as a promising therapeutic approach for cerebellar ataxias.

Method: In this double-blind, randomized, sham-controlled trial, patients with MSA-C received 84 sessions (once daily for 12 weeks) of home-based anodal tDCS over the cerebellum (2 mA for 20 minutes). Clinical assessments included the International Cooperative Ataxia Rating Scale (ICARS), Montreal Cognitive Assessment, Cerebellar Cognitive Affective Syndrome (CCAS) Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Quantitative measurements of gait velocity, cadence, and postural sway area were also conducted. Follow-up evaluations were performed at the day, four weeks, 16 weeks after the stimulation period.

Results: Thirty-four patients were randomized and 26 completed the active (n = 13) or sham (n = 13) tDCS protocol. Linear mixed-effects regression models revealed significant group-by-time interactions for the ICARS: F(3,78) = 6.204, P = 0.0008), posture and gait disturbances ICARS subdomain (F(3,78) = 7.716, P = 0.0001), kinetic functions ICARS subdoamain (F(3,78) = 2.930, P = 0.0388), gait velocity (F(3,78) = 6.557, P = 0.0005), and  CCAS scale: F(3,78) = 3.990, P = 0.0107). Exploratory volumetric analyses showed alterations in regional cortical volumes, including the bilateral pars orbitalis, right frontal pole, left lateral occipital cortex and right inferior parietal region, in the active tDCS group, but these changes did not survive correction for multiple comparisons.

Conclusion: These results demonstrated that a 12-week course of home-based, remotely supervised cerebellar tDCS yielded beneficial effects on gait ataxia, limb dysmetria and cerebellar cognitive impairment in individuals with MSA-C, supporting its potential as a promising therapeutic option for this otherwise treatment-refractory disorder.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/home-based-cerebellar-transcranial-stimulation-for-multiple-system-atrophy-a-randomized-trial/