Randomized Single Blind Sham Controlled Trial of Adjunctive Home-Based tDCS after rTMS for Mal De Debarquement Syndrome: Safety, Efficacy, and Participant Satisfaction Assessment
Randomized Single Blind Sham Controlled Trial of Adjunctive Home-Based tDCS after rTMS for Mal De Debarquement Syndrome: Safety, Efficacy, and Participant Satisfaction Assessment
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DOI：
10.1016/j.brs.2016.03.016
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发表时间：
2016-07-01
影响因子：
7.7
通讯作者：
Pariseau, Nicole
中科院分区：
文献类型：
--
作者：
Cha, Yoon-Hee;Urbano, Diamond;Pariseau, Nicole
背景资料：Mal de debarquement综合征是一种医学难治性疾病，其特征是暴露于被动运动后发生的慢性摇摆性头晕。重复经颅磁刺激（Repetitive transcranial magnetic stimulation，rTMS）可有效抑制摇摆性眩晕，但仍需进一步治疗，目的：1）确定rTMS后加用经颅直流电刺激（transcranial direct current stimulation，tDCS）是否能延长rTMS的疗效; 2）确定受试者是否能安全地在家进行tDCS。根据先前的试点协议，参与者接受了为期五天的rTMS（右撇子1 Hz右DLPFC/左DLPFC 10 Hz，左撇子反之亦然）。他们接受了为期三天的tDCS自我给药培训，然后随机分配至真实的或假tDCS，持续四个星期（右撇子使用阳极左DLPFC/阴极右DLPFC，反之亦然）左撇子）。结果：23名参与者完成了研究。那些在rTMS后接受真实的tDCS的患者，在tDCS的第4周时，通过MDDS平衡评定量表和焦虑评定量表测量的摇摆感知程度显示出显著改善，并且头晕障碍量表有改善的趋势。2例rTMS无应答者对后续开放标签tDCS反应良好。副作用轻微，真实的和假tDCS之间没有差异。在总共556次tDCS治疗中，没有皮肤烧伤事件。满意度被评为high.Conclusions：家庭为基础的tDCS可以安全地进行，并可能是有益的，在选定的个人。充分的教学，自动设备安全功能和良好的通信基础设施是成功的家庭治疗的组成部分。(C)2016作者爱思唯尔公司出版这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Background: Mal de debarquement syndrome is a medically refractory disorder characterized by chronic rocking dizziness that occurs after exposure to passive motion. Repetitive transcranial magnetic stimulation (rTMS) can acutely suppress the rocking dizziness but treatment options that extend the benefit of rTMS are needed.Objectives: 1) To determine whether transcranial direct current stimulation (tDCS) added after rTMS can extend the benefit of rTMS; 2) to determine whether participants can safely perform tDCS at home.Methods: Participants were given five days of rTMS (1 Hz right DLPFC/10 Hz left DLPFC in right-handers, vice versa in left-handers), according to a previously piloted protocol. They received three days of training on tDCS self-administration and were then randomized to either real or sham tDCS for four-weeks (anode left DLPFC/cathode right DLPFC for right-handers, vice versa for left-handers).Results: Twenty-three participants completed the study. Those who received real tDCS after rTMS showed significant improvements in the degree of rocking perception as measured by the MdDS Balance Rating Scale and anxiety ratings by Week 4 of tDCS and a trend for improvement on the Dizziness Handicap Inventory. Two rTMS non-responders responded well to subsequent open-label tDCS. Side effects were mild and not different between real and sham tDCS. There were no episodes of skin burns in a group total of 556 sessions of tDCS. Satisfaction was rated high.Conclusions: Home-based tDCS can be performed safely and may be beneficial in selected individuals. Adequate teaching, automatic device safety features, and a good communications infrastructure are components of successful home therapy. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).