Abstract
Background
Transcranial direct current stimulation (tDCS) has been explored as a potential intervention
in Parkinson’s disease (PD) and recent studies have shown promising results in cognitive,
gait and motor function. However, evidence of efficacy is limited due to small size
studies, short treatment periods, lack of standardization of methodologies and other
study design limitations. Remotely supervised-tDCS (RS-tDCS) allows “at-home” study
participation, potentially easing recruitment, compliance and overall feasibility
for clinical studies.
Objective
Here, we aim to explore preliminary effects of RS-tDCS paired with cognitive training
in PD by delivering RS-tDCS neuromodulation at participant’s home while still maintaining
clinical trial standards.
Methods
This was a prospective, open-label study using RS-tDCS paired with cognitive training.
Each PD participant completed 10 tDCS sessions (20-min, 1.5–2.0-mA, bi-hemispheric
DLPFC montage, left anodal), over a span of two weeks. All tDCS sessions were supervised
in real-time through videoconferencing. Outcomes included the Unified Parkinson’s
Disease Rating Scale (UPDRS) and Grooved Pegboard Test.
Results
All RS-tDCS sessions were well tolerated and completed successfully. Total UPDRS and
motor UPDRS-III scores decreased significantly. Pegboard completion time improved
significantly for the non-dominant hand. There was a strong positive correlation between
the time of the sessions, and motor improvements in UPDRS part-III.
Conclusion
RS-tDCS paradigm through a ‘telemedicine protocol’ holds therapeutic potential for
motor symptoms in PD while maximizing compliance and ease of recruitment. Conducting
afternoon sessions might be more effective than during the morning. Our paradigm may
be influential in designing future studies and facilitating larger and longer duration
clinical trials.
Abbreviations:
AC (anticholinergic), BDI (Beck’s depression inventory), DA (dopamine agonist), DLPFC (dorsolateral prefrontal cortex), GP (Grooved Pegboard), LTD (long term depression), LTP (long term potentiation), mA (milliamperes), MAOIs (monoamine oxidase inhibitors), Mini-CT (mini clinical trials), MS (multiple sclerosis), NIBS (noninvasive brain stimulation), PD (Parkinson’s disease), rTMS (repetitive transcranial magnetic stimulation), RS-tDCS (remotely supervised transcranial direct current stimulation), SD (standard deviation), SDMT (symbol digit modalities test), SEM (standard error of mean), SPSS (Statistical Package for the Social Sciences), tDCS (transcranial direct current stimulation), TMS (transcranial magnetic stimulation), UPDRS (Unified Parkinson’s Disease Rating Scale), VAS (visual analog scale)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Time to redefine PD? Introductory statement of the MDS Task Force on the definition of Parkinson’s disease.Mov Disord. 2014; 29: 454-462
- The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations.Mov Disord. 2003; 18: 738-750
- Novel formulations and modes of delivery of levodopa.Mov Disord. 2015; 30: 114-120
- Levodopa: effect on cell death and the natural history of Parkinson’s disease.Mov Disord. 2015; 30: 37-44
- Behavioral effects of levodopa.Mov Disord. 2015; 30: 90-102
- Clinical spectrum of levodopa-induced complications.Mov Disord. 2015; 30: 80-89
- Effects of repetitive transcranial magnetic stimulation on motor symptoms in Parkinson disease: a systematic review and meta-analysis.JAMA Neurol. 2015;
- Non-invasive brain stimulation for Parkinson’s disease: a systematic review and meta-analysis of the literature.J Neurol Neurosurg Psychiatry. 2005; 76: 1614-1623
- Effect of transcranial magnetic stimulation on Parkinson motor function–systematic review of controlled clinical trials.Mov Disord. 2009; 24: 357-363
- Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans.Neurology. 2001; 57: 1899-1901
- Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.J Physiol. 2000; 527: 633-639
- Polarization of the human motor cortex through the scalp.NeuroReport. 1998; 9: 2257-2260
- External modulation of visual perception in humans.NeuroReport. 2001; 12: 3553-3555
- Origins of specificity during tDCS: anatomical, activity-selective, and input-bias mechanisms.Front Hum Neurosci. 2013; 7: 688
- It’s the thought that counts: examining the task-dependent effects of transcranial direct current stimulation on executive function.Brain Stimul. 2015; 8: 253-259
- Neural plasticity and behavior – sixty years of conceptual advances.J Neurochem. 2016; 139: 179-199
- Effects of tDCS on executive function in Parkinson’s disease.Neurosci Lett. 2014; 17: 27-31
- Transcranial direct current stimulation associated with gait training in Parkinson’s disease: a pilot randomized clinical trial.Dev Neurorehabil. 2017; 20: 121-128
- Combining physical training with transcranial direct current stimulation to improve gait in Parkinson’s disease: a pilot randomized controlled study.Clin Rehabil. 2014; 28: 1115-1124
- Transcranial direct current stimulation for treatment of freezing of gait: a cross-over study.Mov Disord. 2014; 29: 1064-1069
- Time up and go task performance improves after transcranial direct current stimulation in patient affected by Parkinson’s disease.Neurosci Lett. 2014; 19: 74-77
- Immediate effect of transcranial direct current stimulation on postural stability and functional mobility in Parkinson’s disease.Mov Disord. 2013; 28: 2040-2041
- Transcranial direct current stimulation for the treatment of Parkinson’s disease.J Neurol Neurosurg Psychiatry. 2010; 81: 1105-1111
- Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?.Neurosci Lett Elsevier. 2017; 1: 165-169
- Modulation of verbal fluency networks by transcranial direct current stimulation (tDCS) in Parkinson’s disease.Brain Stimul. 2013; 6: 16-24
- Facilitative effects of bi-hemispheric tDCS in cognitive deficits of Parkinson disease patients.Med Hypotheses. 2014; 82: 138-140
- Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols.Front Syst Neurosci. 2015; 17: 26
- Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial.Mult Scler J. 2017; 22 (135245851773284)
- Transcranial direct current stimulation is feasible for remotely supervised home delivery in multiple sclerosis.Neuromodulation. 2016; 19: 824-831
- Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases.J Neurol Neurosurg Psychiatry. 1992; 55: 181-184
- Symbol Digit Modalities Test (SDMT).Man Los Angeles West Psychol Serv, 1982
Vsee: World’s Largest Video Telemedicine Platform [Internet]. 2015. Available from: https://vsee.com/
TeamViewer. TeamViewer – the All-In-One Software for Remote Support and Online Meetings [Internet]. 2015. Available from: https://www.teamviewer.com/en/index.aspx.
Soterix. Soterix Medical. Mini-CT: the device that defined the supervised neuromodulation class. [Internet]. Available from: http://soterixmedical.com/remote/mini-CT.
- Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols.Front Syst Neurosci. 2015 Jan; 9: 26
- The Pursuit of DLPFC: non-neuronavigated methods to target the left dorsolateral pre-frontal cortex with symmetric bicephalic transcranial direct current stimulation (tDCS).Brain Stimul. 2015;
Lumosity [Internet]. Available from: https://www.lumosity.com/hcp/research/bibliography.
- Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease.Neurology. 2016; 87: 1907-1915
- A new method of administering the Grooved Pegboard Test: performance as a function of handedness and sex.Brain Cogn. 2005; 58: 258-268
- Grooved pegboard test as a biomarker of nigrostriatal denervation in Parkinson’s disease.Neurosci Lett. 2007; 424: 185-189
- The science behind lumosity.Lumosity. 2009;
- Circadian regulation of synaptic plasticity.Biology (Basel). 2016; 5: 31
- Interactions of the circadian CLOCK system and the HPA axis.Trends Endocrinol Metab. 2010; 21: 277-286
- The stress hormone cortisol blocks perceptual learning in humans.Psychoneuroendocrinology. 2017; 77: 63-67
Article info
Publication history
Published online: September 04, 2018
Accepted:
August 13,
2018
Received:
April 18,
2018
Footnotes
☆Poster presentation (interim results) at AAN 2017 (abstract published in Neurology) and NYC Neuromodec 2017 (proceedings published in Brain Stimulation).
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
