Objective: The primary endpoint of this study was to evaluate the effect of a transcranial direct current stimulation (tDCS) protocol with anodal stimulation of the left the dorsolateral prefrontal cortex (DLPFC) in patients with Parkinson’s disease presenting freezing of gait (FOG).

Background: Freezing of gait (FOG) is one of the most disabling and poorly understood complication of Parkinson’s disease (PD). Several lines of evidence suggest that FOG is not only a motor problem, but also arises in part because of deficits in executive function, a cognitive domain mediated by the dorsolateral prefrontal cortex (DLPFC). Overtime, these symptoms may become refractory to both pharmacological and non-pharmacological treatments. Transcranial direct current stimulation (tDCS) is a low-cost, noninvasive neuromodulatory technique, currently considered a valuable option to fill the therapeutic gaps in PD .

Method: This study involved PD patients presenting FOG. They underwent 20 minutes of electric current of 2mA on 10 separate visits (5 in a week) using a pair of large sponges soaked in saline solution. Unified Parkinson’s Disease Rating Scale pars 2 and 3 (UPDRSII-III), Hoehn and Yahr (H&Y), New Freezing of Gait Questionnaire (N-FOGQ), Berg Balance Scale (BBS) were performed at baseline (T0), after last stimulation (T1) and at one month follow-up (T2). Moreover, kinematic parameters of gait abnormalities were measured by means of wearable devices (MOVIT G1®) in order to obtaining an objective and reproducible evaluation.

Results: Our preliminary results obtained from a limited cohort of patients demonstrate a significant clinical improvement. Each evaluation scale demonstrate a benefit from our tDCS protocol, both between T0-T1 and additional improvement at T2. Specifically, disturbance of balance and the severity of FOG episodes showed the best outcome (+15% at BBS and -17% at N-FOGQ).

Conclusion: Coherently with the hypothesis that cognitive executive circuit plays a role in FOG, we may consider anodal tDCS of the DLPFC as a potential adjunctive therapy in PD patients with FOG.

References: Valentino F, Cosentino G, Brighina F, Pozzi NG, Sandrini G, Fierro B, Savettieri G, D’amelio M, Pacchetti C. Transcranial direct current stimulation for treatment of freezing of gait: A cross‐over study. Movement Disorders. 2014 Jul 1;29(8):1064-9. Dagan M, Herman T, Harrison R, Zhou J, Giladi N, Ruffini G, Manor B, Hausdorff JM. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Movement Disorders. 2018 Apr;33(4):642-6. Lattari E, Costa SS, Campos C, de Oliveira AJ, Machado S, Neto GA. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?. Neuroscience letters. 2017 Jan 1;636:165-9. Das S, Trutoiu L, Murai A, Alcindor D, Oh M, De la Torre F, Hodgins J. Quantitative measurement of motor symptoms in Parkinson’s disease: a study with full-body motion capture data. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:6789-92.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-direct-current-stimolation-tdcs-on-pd-patients-with-freezing-of-gait-preliminary-findings/