Motor and cognitive outcomes of cerebello-spinal stimulation in neurodegenerative ataxia
Motor and cognitive outcomes of cerebello-spinal stimulation in neurodegenerative ataxia
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DOI：
10.1093/brain/awab157
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发表时间：
2021-08-01
期刊：
影响因子：
14.5
通讯作者：
Borroni, Barbara
中科院分区：
文献类型：
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作者：
Benussi, Alberto;Cantoni, Valentina;Borroni, Barbara
小脑共济失调是一组以运动和认知障碍为特征的异质性致残性疾病，目前尚无有效的治疗方法。在这项随机、双盲、假对照试验中，随后是开放标签阶段，我们研究了小脑-脊髓经颅直流电刺激（tDCS）可以改善神经退行性共济失调患者的运动和认知症状。61例患者在第一对照期随机分为两组。在基线（T0）时，第1组接受安慰剂刺激（假tDCS），而第2组接受阳极小脑tDCS和阴极脊髓tDCS（真实的tDCS），持续S天/周，持续2周（T1），随访12周（T2）（随机化、双盲、假对照阶段）。在12周随访（T2）时，所有患者（第1组和第2组）均接受了阳极小脑tDCS和阴极脊髓tDCS（真实的tDCS）的第二次治疗，每周S天，持续2周，并进行了14周（T3）、24周（T4）、36周（T5）和52周（T6）随访（开放标签期）。在每个时间点，进行临床、神经心理学和神经生理学评价。使用经颅磁刺激评估小脑-运动皮层的连通性。我们观察到所有运动评分都有显著改善（共济失调评估和评级量表，国际合作共济失调评级量表），认知（用小脑认知情感综合征量表评估），在生活质量评分中，在短期和长期，与假刺激和基线（T0）相比，真实的tDCS后运动皮层兴奋性和小脑抑制。与真实的tDCS单次治疗相比，我们观察到了两次真实的tDCS重复治疗后的附加效应。运动和认知评分的改善与经颅磁stimulation.Cerebello-spinal tDCS评价的小脑抑制的恢复相关，是神经退行性共济失调患者运动和认知症状的一种有前途的治疗方法，神经退行性共济失调是一种任何药物干预的孤儿疾病。
Cerebellar ataxias represent a heterogeneous group of disabling disorders characterized by motor and cognitive disturbances, for which no effective treatment is currently available.In this randomized, double-blind, sham-controlled trial, followed by an open-label phase, we investigated whether treatment with cerebello-spinal transcranial direct current stimulation (tDCS) could improve both motor and cognitive symptoms in patients with neurodegenerative ataxia at short and long-term. Sixty-one patients were randomized in two groups for the first controlled phase. At baseline (T0), Group 1 received placebo stimulation (sham tDCS) while Group 2 received anodal cerebellar tDCS and cathodal spinal tDCS (real tDCS) for S days/week for 2 weeks (T1), with a 12-week (T2) follow-up (randomized, double-blind, sham controlled phase). At the 12-week follow-up (T2), all patients (Group 1 and Group 2) received a second treatment of anodal cerebellar tDCS and cathodal spinal tDCS (real tDCS) for S days/week for 2 weeks, with a 14-week (T3), 24-week (T4), 36-week (T5) and 52-week follow-up (T6) (open-label phase). At each time point, a clinical, neuropsychological and neurophysiological evaluation was performed. Cerebellar-motor cortex connectivity was evaluated using transcranial magnetic stimulation.We observed a significant improvement in all motor scores (scale for the assessment and rating of ataxia, international cooperative ataxia rating scale), in cognition (evaluated with the cerebellar cognitive affective syndrome scale), in quality-of-life scores, in motor cortex excitability and in cerebellar inhibition after real tDCS compared to sham stimulation and compared to baseline (T0), both at short and long-term. We observed an addon-effect after two repeated treatments with real tDCS compared to a single treatment with real tDCS. The improvement at motor and cognitive scores correlated with the restoration of cerebellar inhibition evaluated with transcranial magnetic stimulation.Cerebello-spinal tDCS represents a promising therapeutic approach for both motor and cognitive symptoms in patients with neurodegenerative ataxia, a still orphan disorder of any pharmacological intervention.