UNASSIGNED: We report a series of 5 patients with cervical dystonia (CD) poorly controlled by botulinum toxin injections. They were initially treated by a protocol of repeated daily sessions (for 3 or 5 days) of cerebellar anodal tDCS (cer-atDCS) applied alone. In a second time, additional protocols of cer-atDCS were performed in combination with a program of goal-oriented motor training exercises (Mot-Training), specifically developed for the treatment of CD. The clinical impact of the procedures was assessed on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).
UNASSIGNED: Compared to baseline, the maximum percentage of TWSTRS total score improvement was 37% on average after cer-atDCS performed alone (p = 0.147, not significant) and 53% on average after cer-atDCS combined with Mot-Training (p = 0.014, significant). The TWSTRS pain and functional handicap subscores also improved after the combined protocol. A score of (+3) to (+5) was rated on the TWSTRS response scale after cer-atDCS performed alone or the combined protocol, corresponding to a moderate to striking improvement on dystonia and pain. This improvement lasted longer after the combined protocol than after cer-atDCS alone (3.4 vs. 1.4 months on average, p = 0.011).
UNASSIGNED: The combination of cer-atDCS with Mot-Training produced a greater and more prolonged improvement than the application of cer-atDCS alone. Such a combined therapeutic procedure is easy to perform and opens important perspectives in the long-term treatment of CD. These results remain to be confirmed by a randomized sham-controlled trial on a larger sample.
■我们报告了一系列5例通过肉毒杆菌毒素注射控制不佳的宫颈肌张力障碍(CD)患者。最初通过单独使用小脑阳极tDCS(cer-atDCS)的每日重复疗程(3或5天)的方案进行治疗。第二次,cer-atDCS的附加协议与目标导向的运动训练练习(Mot-Training)计划相结合,专门用于治疗CD。在多伦多西部痉挛性斜颈评定量表(TWSTRS)上评估了该程序的临床影响。
■与基线相比,单独进行cer-atDCS后,TWSTRS总分改善的最大百分比平均为37%(p=0.147,无显著性),cer-atDCS联合Mot-Training后,平均为53%(p=0.014,显著性).联合方案后,TWSTRS疼痛和功能障碍子评分也有所改善。在单独或联合方案进行cer-atDCS后,TWSTRS反应量表评分为(+3)至(+5),对应于肌张力障碍和疼痛的中度至显著改善。这种改进在联合方案后比单独使用cer-atDCS后持续的时间更长(3.4vs.平均1.4个月,p=0.011)。
■与单独使用cer-atDCS相比,cer-atDCS与Mot-Training的结合产生了更大,更长时间的改善。这种联合治疗程序易于执行,并在CD的长期治疗中开辟了重要的前景。这些结果仍有待更大样本的随机假对照试验证实。