Objective: Patients of degenerative cerebellar ataxia present with slurring of speech, imbalance during walking and problem of co-ordination in limbs.  Currently no effective treatment is available to manage these symptoms. We have evaluated the efficacy of Transcranial pulsed current stimulation (tPCS) to modify the symptoms of degenerative ataxia.

Background: Neurodegenerative ataxia represents a group of disabling diseases. Currently, studies are ongoing on the effectiveness of non-invasive brain stimulation (NIBS) in different neurodegenerative diseases. In most of the studies, transcranial direct current stimulation (tDCS) has been used (1-3). Transcranial pulsed current stimulation (tPCS) is a new modality of NIBS, which has been studied in enhancement of cortical excitability (4) and also in gait and balance in Parkinson’s disease (5). In this pilot study, we investigated the efficacy of single session of tPCS with anodal cerebellar and cathodal spinal stimulation in these patients of neurodegenerative ataxias.

Method: 12 patients with neurodegenerative ataxias of varying etiology were assessed for the following parameters-
Speech, using standardized speech recording protocol
Upper limb ataxia using KinArm with a validated recording protocol of arm motion
Gait using ZenoWalkway gait carpet and PKMAS software
Quantitative EEG (qEEG)
Scale for the assessment and rating of ataxia (SARA)
tPCS was delivered through a pair of saline-soaked surface sponge electrodes. Anode was placed on the scalp over the cerebellum area (2 cm under the inion) and cathode was placed over the mid-thoracic spine. Each patient received active and sham stimulation with a 1-month gap in between, in a randomized blinded fashion. Each patient was assessed before and after a single session of 20 min stimulation (real/sham).

Results: In the KinArm tasks, improvement was noted mainly in tasks where force was applied during reaching tasks (70-80%). In the characteristics tested for gait analysis, maximum improvement was noted in stride width (50%). qEEG showed evidence of transitory changes of brain activity post stimulation. SARA scale remained unchanged in 41.66%, improved in 41.66% and worsened in 16.66%.

Conclusion: Cerebello-spinal tPCS can be an effective therapeutic tool for patients with degenerative cerebellar ataxia. Chronic stimulation is indeed needed for persisting benefit.

References: 1. Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for idiopathic Parkinson’s disease. Cochrane Database Syst Rev. 2016 Jul 18;7:CD010916. doi: 10.1002/14651858.CD010916.pub2. 2. van Dun K, Bodranghien FC, Mariën P, Manto MU. tDCS of the Cerebellum: Where Do We Stand in 2016? Technical Issues and Critical Review of the Literature. Front Hum Neurosci. 2016 May 11; 10:199. doi: 10.3389/fnhum.2016.00199. eCollection 2016. 3. Benussi A, Dell’Era V, Cantoni V, Bonetta E, Grasso R, Manenti R, Cotelli M, Padovani A, Borroni B. Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial. Neurology. 2018 Sep 18;91(12):e1090-e1101. doi: 10.1212/WNL.0000000000006210. Epub 2018 Aug 22. 4. Jaberzadeh S, Bastani A, Zoghi M, Morgan P, Fitzgerald PB. Anodal Transcranial Pulsed Current Stimulation: The Effects of Pulse Duration on Corticospinal Excitability. PLoS One. 2015;10(7):e0131779. Published 2015 Jul 15. doi:10.1371/journal.pone.0131779 5. Alon G, Yungher DA, Shulman LM, Rogers MW. Safety and immediate effect of noninvasive transcranial pulsed current stimulation on gait and balance in Parkinson disease. Neurorehabil Neural Repair. 2012 Nov-Dec;26(9):1089-95. doi: 10.1177/1545968312448233. Epub 2012 May 10.

« Back to MDS Virtual Congress 2020

MDS Abstracts - https://www.mdsabstracts.org/abstract/a-randomized-sham-controlled-crossover-trial-on-cerebello-spinal-transcranial-pulsed-current-stimulation-tpcs-in-ataxia/