Electrical Stimulation Helps Ataxia Symptoms

Just in case you have ataxia from your stroke. You can see how long it takes for your doctor to set this up as a protocol. They don't tell you what type of tDCS(anodal tDCS? cathodal tDCS? HD-tDCS?)
Electrical Stimulation Helps Ataxia Symptoms

• by Judy George, Contributing Writer, MedPage Today August 22, 2018

Action Points

• Brain and spinal cord direct current electrical stimulation appeared effective in treating symptoms of neurodegenerative ataxia.
• Note that the least affected ataxia patients tended to have the greatest benefit.

Direct current electrical stimulation to the brain and spinal cord appeared effective in treating symptoms of neurodegenerative ataxia, researchers in Italy said.
In a double-blind, randomized, crossover trial, ataxia patients who had transcranial direct current stimulation (tDCS) showed improvement in all performance areas, motor cortex excitability, and cerebellar brain inhibition compared with sham stimulation, reported Barbara Borroni, MD, of the University of Brescia, and co-authors in Neurology.
"We found that treatment with concurrent cerebellar and spinal electrical stimulation in patients with ataxia may reduce clinical symptoms, improve quality of life and restore the physiological inhibition, mediated by the cerebellum, on the motor cortex," co-author Alberto Benussi, MD, also of the University of Brescia, told MedPage Today. "This is of particular relevance in light of limited pharmacologic and nonpharmacologic treatment options for patients with ataxia."
tDCS delivers a low-voltage electrical current to the scalp or spine. It is non-invasive and has been studied in chronic pain, post-stroke dysphagia, and as adjunctive treatment in bipolar depression.
For most hereditary and sporadic ataxias, no effective treatment exists. While tDCS has shown promise in posture, gait, and kinetic functions in ataxia patients, much research focused on the brain alone, not the brain and spinal cord together.
In this study, researchers studied 20 patients with different kinds of cerebellar ataxia. Patients were an average of age 55 and had ataxia an average of 13 years.
They randomized patients 1:1. Each group received cerebello-spinal stimulation (2 mA for 20 minutes) or sham stimulation for 5 days a week for 2 weeks; after a 3-month washout period, patients received the opposite treatment.
At baseline and follow-up, researchers evaluated cerebello-motor connectivity with transcranial magnetic stimulation. They used the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS) to evaluate cerebellar deficits, the 9-Hole Peg Test (9HPT) to gauge finger dexterity and upper limb coordination, and the 8-meter walking time (8MW) to assess gait speed.
Compared with sham, cerebello-spinal tDCS showed a significant improvement in all performance scores, in motor cortex excitability, and in cerebellar brain inhibition. In the 8MW test, for example, participants took an average of 9.4 seconds at baseline and 7.8 seconds 1 month after tDCS treatment. In the 9HPT test, they took an average of 53 seconds at baseline to place and remove pegs from a peg board, and 47 seconds to complete the task 1 month later.
The least affected ataxia patients tended to have the greatest benefit. "If we consider that repeated sessions of electrical stimulation have been shown to induce and enhance neuronal plasticity with long-term after-effects, it is reasonable to believe that patients who were least affected, and thus with an increased plasticity potential, might be the ones to benefit the most after this treatment," Benussi said.
The effects of tDCS lasted 3 months, but may be lost after that. "On the basis of this observation, patients should receive stimulation treatment 5 d/wk for 2 weeks or possibly more, potentially repeated once a month to maintain effectiveness," wrote Shinsuke Fujioka, MD, of Fukuoka University in Japan, and colleagues in an accompanying editorial.
While frequent follow-up visits may be challenging for ataxia patients, portable stimulators might help, they added. But other problems remain to be solved: "How many times do we treat patients per time period? What is the best interval between treatments? What is the optimal stimulus intensity?"
This trial had a small sample size with a heterogeneous population, so associations need to be made with caution, the authors pointed out. And further research is needed to increase the duration and intensity of improvements, Benussi noted.
"Another important aspect we are trying to figure out is if the stimulation may improve cognitive symptoms in patients with ataxia, characterized by deficits in executive functions, spatial cognition and language, which are frequently overlooked in this patient population," he added.

The study was supported by the Italian Association for Alzheimer Research Onlus COOP.
Borroni and Benussi disclosed no relevant relationships with industry. Co-authors disclosed relevant relationships with GE Healthcare, Eli-Lilly, Actelion Ltd Pharmaceuticals, Nutricia, PIAM, Lansgstone Technology, UCB Pharma, and Chiesi Pharmaceuticals.
Fujioka disclosed relevant relationships with Parkinsonism and Related Disorders, the Polish Journal of Neurology and Neurosurgery, and support from JSPS KAKENHI. Co-authors disclosed relevant relationships with Acadia Pharmaceuticals, Gerson Lerhman, Coleman Research Group, and the Michael J. Fox Foundation.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  Neurology

  Source Reference: Benussi A, et al "Cerebello-spinal tDCS in ataxia: A randomized, double-blind, sham-controlled, crossover trial" Neurology 2018; DOI:10.1212/WNL.0000000000006210.

• Secondary Source

  Neurology

  Source Reference: Fujioka S, et al "A novel promising therapeutic approach for patients with ataxic disorders?" Neurology 2018; DOI:10.1212/WNL.0000000000006190.