Cathodal high-definition transcranial direct current stimulation improves sleep and motor symptoms in Parkinson’s disease with possible rapid eye movement sleep behaviors disorder: A pilot open-label study

Objective

To observe the effects of high-definition transcranial direct current stimulation (HD-tDCS) on rapid eye movement sleep behaviors disorder (RBD) symptoms and sleep quality in Parkinson’s Disease (PD) patients with possible RBD (PD-pRBD).

Methods

74 subjects were recruited (32 females and 29 males), including 30 PD-pRBD patients, 27 PD patients without RBD, and 17 healthy controls. Among them, 17 PD-pRBD patients diagnosed by the Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire (RBDSQ) and meeting the inclusion criteria received cathodal HD-tDCS intervention in the left M1 area for 10 consecutive days, once a day for 20 min, on the basis of conventional anti-PD drug treatment. The RBDSQ, RBD Screening Questionnaire Hong Kong (RBDSQ-HK), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Parkinson’s Disease Sleep Scale (PDSS) were used to assess RBD symptoms and sleep quality. Additionally, the International Movement Disorders Society Sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the Hoehn & Yahr staging scale (H&Y) were used to assess motor symptoms and disease severity.

Result

After 10 days of continuous treatment, the RBD and sleep symptoms of PD-pRBD patients significantly improved. Specifically, the RBDSQ, RBDQ-HK, PSQI, and ESS scores decreased, while the PDSS score increased. We also observed a reduction in MDS-UPDRS III scores and an improvement in patients’ motor symptoms. At the same time, changes in PDSS were positively correlated with the baseline values of MDS-UPDRS III.

Conclusion

HD-tDCS could be a useful complementary treatment for improving sleep and movement in PD-pRBD patients.