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Remotely Supervised Transcranial Direct Current Stimulation: An Update on Safety and Tolerability
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Transcranial Direct Current Stimulation on Parkinson's Disease: Systematic Review and Meta-Analysis.

Paloma Cristina Alves de Oliveira1, Thiago Anderson Brito de Araújo1, Daniel Gomes da Silva Machado2

  • 1Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Brazil.

Frontiers in Neurology
|January 27, 2022
PubMed
Summary

Transcranial direct current stimulation (tDCS) alone does not show significant short-term benefits for Parkinson's disease motor symptoms, balance, or gait. This systematic review found no effect regardless of brain area or stimulation targets used.

Keywords:
Parkinson's diseasemeta-analysismotor symptomsneuromodulationtranscranial direct current stimulation (tDCS)

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Area of Science:

  • Neurology
  • Neuroscience
  • Rehabilitation Medicine

Background:

  • Parkinson's disease (PD) management remains challenging, with the clinical impact of transcranial direct current stimulation (tDCS) as a standalone therapy needing further investigation.
  • A comprehensive synthesis and analysis of existing evidence are crucial to guide the application of tDCS in PD.
  • This study addresses the need for evidence-based recommendations regarding tDCS efficacy in PD.

Purpose of the Study:

  • To evaluate the isolated effect of transcranial direct current stimulation (tDCS) on motor symptoms in Parkinson's disease (PD).
  • To investigate how different brain areas and the number of stimulated targets influence tDCS outcomes in PD.
  • To provide a methodologically sound analysis of tDCS efficacy for PD motor impairments.

Main Methods:

  • A systematic review and meta-analysis were conducted, searching major databases up to February 2021.
  • Included studies evaluated active tDCS (anodic or cathodic) versus sham or control conditions for PD motor symptoms.
  • Data from 10 studies (n=236) were meta-analyzed, and 25 studies (n=405) were included in a qualitative synthesis.

Main Results:

  • No significant short-term effects of single-target tDCS were observed on motor aspects (UPDRS III), dyskinesias (UPDRS IV), motor fluctuations, gait (Timed Up and Go), or balance (Berg Balance Scale).
  • Comparing single versus multiple stimulation targets also yielded no significant differences in motor outcomes or gait.
  • Meta-regression analysis indicated no significant association between treatment dosage (number of sessions, cumulative time) and effect size.

Conclusions:

  • Transcranial direct current stimulation (tDCS) applied alone does not demonstrate significant short-term efficacy for improving motor function, balance, gait, dyskinesias, or motor fluctuations in Parkinson's disease.
  • The findings suggest that current tDCS protocols, irrespective of the stimulated brain area or target number, do not provide a measurable short-term clinical benefit for PD motor symptoms.
  • Further research may be needed to explore alternative tDCS parameters or combination therapies for Parkinson's disease.