背景:最近的影像学研究发现了与帕金森病(PD)深部脑刺激(DBS)后临床改善相关的脑网络,PD响应网络。
目的:本研究旨在通过使用多灶性经颅直流电刺激(tDCS)无创地针对该网络来评估神经调节对PD运动症状的影响。
方法:在前瞻性中,随机化,双盲,交叉试验,21例PD患者(平均年龄59.7岁,meanHoehn&Yahr[H&Y]2.4)接受了针对先验网络的多灶性tDCS。在2天以随机顺序施用tDCS和假手术的20分钟疗程。评估运动障碍协会-帕金森病统一评定量表-第三部分(MDS-UPDRS-III)评分。
结果:干预前,MDS-UPDRS-III评分在两种情况下具有可比性(刺激天数:37.38(标准偏差[SD]=12.50,置信区间[CI]=32.04,42.73)与假天数:36.95(SD=13.94,CI=30.99,42.91),P=0.63)。主动刺激导致下降3.6点(9.7%)至33.76(SD=11.19,CI=28.98,38.55)点,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(时间的主要影响:F(1,20)=4.35,P<0.05)。Tukey的事后检验显示,主动刺激后MDS-UPDRS-III改善(t[20]=2.9,P=0.03),但假手术后无改善(t[20]=0.42,P>0.05)。在后来接受DBS手术的患者中,他们的DBS反应与tDCS效应相关(R=0.55,P(1)=0.04)。
结论:非侵入性,针对DBS衍生网络的多灶性tDCS显着改善了PD运动症状。尽管效果很小,这项研究为有创识别网络的成功非侵入性神经调节提供了原理证明.未来的研究应该调查重复的tDCS会话及其在DBS手术前筛查的效用。©2024作者(S)。由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
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.
OBJECTIVE: 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).
CONCLUSIONS: 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.