Long-Term Transcranial Direct Current Stimulation in Parkinson's Disease

建议的研究目的是确定经颅直流电刺激的影响。 帕金森病患者长期运动学习、运动学习迁移和皮质功能的研究 (Pd)。帕金森病是第二种最常见的神经退行性疾病，影响着大约100万人 在美国，每年的总成本接近110亿美元。当前的医疗和治疗 治疗帕金森病的方法要么只有轻微的有效、昂贵，要么与各种副作用有关。 因此，开发实用、安全、负担得起、有效的治疗辅助药物是当前 治疗方法将会有很大的好处。最近，tdcs已经成为一种很有前途的工具。 增强帕金森病患者的运动能力和皮质兴奋性，并可能代表这样的干预 转化为临床实践的现实潜力。TDCs安全可靠地改变大脑皮质的这种能力 兴奋性很重要，因为练习任务后大脑皮层兴奋性的增加被解释为 作为运动皮质中依赖使用的可塑性的指标，并与运动改善相关 功能。因此，将tdcs应用于运动皮质可以改善在各种运动任务中的表现。 健康受试者、老年人、中风和帕金森病患者。然而，这些都是尖锐的研究，测量了 在tdcs期间和术后皮质兴奋性一过性增加时的表现。尽管如此 有希望的初步发现，但目前对几个关键问题缺乏可用的研究阻碍了 TDCs作为帕金森病辅助干预的可行性的测定。例如，它的大小 在帕金森病患者中，TDC可能能够改善长期的运动学习，而不是仅仅通过练习就能达到的效果 是未知的，尽管最近对年轻人的长期tdcs研究的观察表明，这是 有可能。此外，目前还不清楚tdcs和tdcs对运动功能的短期改善。 在PD的OFF状态下测量可以长期在ON状态下获得，这是必要的 实际应用的先决条件。此外，还不确定tdcs的影响是否推广到非 已实践的任务或未与tdcs相关的任务。同样，也不知道长期应用 左侧大脑半球的TDC可改善未受刺激的同侧手或 如果这些影响仅限于受刺激的对侧手。最后，生理机制 这些问题中的任何一个都没有被发现，因为在 到目前为止，PD已经同时量化了行为、临床和生理指标。拟议中的项目 通过为期两周的培训学习，同时解决所有这些关键障碍，该培训学习将涉及tDC 在练习运动任务时应用，并在基线时进行行为、临床和生理评估 训练后第1、14、28天。建议的研究结果应该具有重要的临床意义。 帕金森病综合干预治疗发展的意义及应用。 。

The goal of the proposed research is to determine the influence of transcranial direct current stimulation (tDCS) on long-term motor learning, transfer of motor learning, and cortical function in Parkinson’s disease (PD). PD is the second most common neurodegenerative disorder and affects approximately 1 million people in the United States with total annual costs approaching 11 billion dollars. Current medical and treatment approaches for PD are either only mildly effective, expensive, or associated with a variety of side effects. Therefore, the development of practical, safe, affordable, and effective therapeutic adjuncts to current treatment approaches would have significant benefits. Recently, tDCS has emerged as a promising tool to enhance motor performance and cortical excitability in PD and may represent such an intervention with a realistic potential to be translated into clinical practice. This ability of tDCS to safely and reliably alter cortical excitability is important because increased cortical excitability following practice of a task has been interpreted as an indicator of use-dependent plasticity in the motor cortex and associated with improvements in motor function. Accordingly, tDCS applied to the motor cortex improves performance in a variety of motor tasks in healthy subjects, older adults, stroke, and in PD. However, these were acute studies that measured performance when cortical excitability was transiently increased during and after tDCS. Despite these promising preliminary findings, lack of available research on several crucial issues currently prevents the determination of the viability of tDCS as an adjunct intervention in PD. For example, the magnitude to which tDCS may be able to improve long-term motor learning beyond what can be achieved by practice alone in PD is unknown, although recent observations from long-term tDCS studies in young adults suggest this is possible. Furthermore, it is unclear if short-term improvements in motor function induced by tDCS and measured in the OFF state in PD can be attained over the long-term in the ON state, which is a necessary prerequisite for real world application. In addition, it is uncertain if the effects of tDCS generalize to non- practiced tasks or tasks not done in association with tDCS. Similarly, it is unknown if long-term application of tDCS to the left hemisphere leads to an improvement in performance of the non-stimulated, ipsilateral hand or if these effects are limited to the stimulated, contralateral hand only. Finally, the physiological mechanisms underlying any of these issues have not been identified because no long-term motor learning tDCS studies in PD to date have concurrently quantified behavioral, clinical, and physiological measures. The proposed project simultaneously addresses all of these critical obstacles through a 2 week training study that will involve tDCS applied during practice motor tasks with behavioral, clinical, and physiological evaluations at baseline as well as 1, 14 and 28 days following training. The findings of the proposed studies should have significant clinical significance and applications to comprehensive intervention therapy development in the treatment of PD. .