Linking Invasive and Noninvasive Brain Stimulation in Parkinson's Disease: A Randomized Trial

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2024-07-25 DOI:10.1002/mds.29940

Lukas L. Goede MD, Simon Oxenford, Daniel Kroneberg MD, Garance M. Meyer PhD, Nanditha Rajamani, Clemens Neudorfer MD, Patricia Krause MD, Roxanne Lofredi MD, Michael D. Fox MD, PhD, Andrea A. Kühn MD, Andreas Horn MD, PhD

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Abstract

Background

Recent imaging studies identified a brain network associated with clinical improvement following deep brain stimulation (DBS) in Parkinson's disease (PD), the PD response network.

Objectives

This study aimed to assess the impact of neuromodulation on PD motor symptoms by targeting this network noninvasively using multifocal transcranial direct current stimulation (tDCS).

Methods

In a prospective, randomized, double-blinded, crossover trial, 21 PD patients (mean age 59.7 years, mean Hoehn & Yahr [H&Y] 2.4) received multifocal tDCS targeting the a-priori network. Twenty-minute sessions of tDCS and sham were administered on 2 days in randomized order. Movement Disorder Society-Unified Parkinson's Disease Rating Scale—Part III (MDS-UPDRS-III) scores were assessed.

Results

Before intervention, MDS-UPDRS-III scores were comparable in both conditions (stimulation days: 37.38 (standard deviation [SD] = 12.50, confidence interval [CI] = 32.04, 42.73) vs. sham days: 36.95 (SD = 13.94, CI = 30.99, 42.91), P = 0.63). Active stimulation resulted in a reduction by 3.6 points (9.7%) to 33.76 (SD = 11.19, CI = 28.98, 38.55) points, whereas no relevant change was observed after sham stimulation (36.43 [SD = 14.15, CI = 30.38, 42.48], average improvement: 0.5 [1.4%]). Repeated-measures analysis of variance (ANOVA) confirmed significance (main effect of time: F_(1,20)=4.35, P < 0.05). Tukey's post hoc tests indicated MDS-UPDRS-III improvement after active stimulation (t [20] = 2.9, P = 0.03) but not after sham (t [20] = 0.42, P > 0.05). In a subset of patients that underwent DBS surgery later, their DBS response correlated with tDCS effects (R = 0.55, P₍₁₎ = 0.04).

Conclusion

Noninvasive, multifocal tDCS targeting a DBS-derived network significantly improved PD motor symptoms. Despite a small effect size, this study provides proof of principle for the successful noninvasive neuromodulation of an invasively identified network. Future studies should investigate repeated tDCS sessions and their utility for screening before DBS surgery. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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将帕金森病的侵入性和非侵入性脑电波刺激联系起来：随机试验

背景：最近的成像研究发现了一个与帕金森病（PD）脑深部刺激（DBS）后临床改善相关的脑网络，即PD反应网络：本研究旨在评估神经调控对帕金森病运动症状的影响，方法是使用多灶经颅直流电刺激（tDCS）非侵入性地靶向这一网络：在一项前瞻性、随机、双盲、交叉试验中，21 名帕金森病患者（平均年龄 59.7 岁，平均 Hoehn & Yahr [H&Y] 2.4）接受了针对先验网络的多灶 tDCS 治疗。tDCS 和假治疗在 2 天内按随机顺序进行，每次 20 分钟。对运动障碍协会-统一帕金森病评分量表第三部分（MDS-UPDRS-III）的评分进行评估：结果：干预前，两种情况下的 MDS-UPDRS-III 评分相当（刺激日：37.38（标准偏差 [standard deviation]）；干预后：37.38（标准偏差 [standard deviation]）：37.38（标准差[SD] = 12.50，置信区间[CI] = 32.04，42.73）与假日相比：36.95（标准差 = 13.94，置信区间 = 30.99，42.91），P = 0.63）。主动刺激导致 33.76 分（SD = 11.19，CI = 28.98，38.55）降低了 3.6 分（9.7%），而假刺激后未观察到相关变化（36.43 [SD = 14.15，CI = 30.38，42.48]，平均改善：0.5 [1.4%]）。重复测量方差分析（ANOVA）证实了显著性（时间的主效应：F（1,20）=4.35，P 0.05）。在后来接受 DBS 手术的部分患者中，他们的 DBS 反应与 tDCS 效果相关（R = 0.55，P(1) = 0.04）：结论：针对 DBS 衍生网络的无创、多灶 tDCS 能显著改善帕金森病运动症状。尽管疗效较小，但这项研究证明了对侵入性识别网络进行非侵入性神经调节的成功原理。未来的研究应调查重复的 tDCS 治疗及其在 DBS 手术前筛查中的作用。© 2024 作者姓名运动障碍》由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.