Objective: To evaluate the clinical efficacy, feasibility, and safety of targeted home-based cerebellar tDCS with remotely supervised functional assessment.

Background: Cerebellar ataxia is a disabling neurological syndrome. Effective symptomatic treatment options remain limited. Transcranial direct current stimulation (tDCS) targeting the cerebellum has been proposed as a potential neuromodulatory therapy.

Method: Ten patients with cerebellar ataxia (mean age 51.7 ± 17 years, disease duration 5.21 ± 4.44 years) participated in a randomized double-blind sham-controlled crossover study. Etiologies included SCA-3 (n = 7), SCA-2 (n = 1), multiple system atrophy–cerebellar type (n = 1), and idiopathic cerebellar ataxia (n = 1). Participants completed two 5-day intervention periods (active vs sham cerebellar tDCS; 2 mA, 20 min) separated by a 1-month washout. Outcomes included SARA-Home, Timed Up and Go (TUG), and 30-second Sit-to-Stand (30-STS), quantified by the Mon4t smartphone app. Subjective outcomes included SF-12, Falls Efficacy Scale (FES), Global Rating of Change (GROC), and Telehealth Usability Questionnaire (TUQ). Non-parametric analyses were applied.

Results: Telehealth usability was high (median TUQ 6.75/7). After a single active tDCS session, TUG completion time improved vs sham stimulation (median decrease 2.23 s; range -6.02 to +1.48 s; p = 0.009). Median change after the 5 days was small for SARA-Home (-0.5) and TUG (-1.3 s), with no significant differences between active and sham conditions (SARA-Home p = 0.95; TUG p = 0.20; 30-STS p = 0.73; FES p = 0.14; SF-12 physical p = 0.72; SF-12 mental p = 0.51). Moderate effect sizes were observed for TUG (r = 0.40) and FES (r = 0.46). GROC indicated mild perceived improvement (mean 2.6 vs 1.6; range 0-6; p = 0.45). No serious adverse events occurred; mild transient tingling (40%) and mild electrode-site discomfort (20%) were reported.

Conclusion: Targeted home-based cerebellar tDCS with remote supervision is feasible and safe in cerebellar ataxia. A single stimulation session significantly improved gait speed with active, but not sham stimulation. Repeated stimulation without task-specific training did not demonstrate sustained improvement. The results of this pilot, underpowered study warrant further investigation. The home-based targeted tDCS trial design with remote functional assessment appears feasible and promising.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/home-based-targeted-tdcs-for-cerebellar-ataxia-results-of-a-randomized-double-blind-crossover-study-with-remote-functional-assessment/