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The effect of single and repeated tDCS sessions on motor symptoms in Parkinson’s disease: a systematic review

G. Orrù, M. Baroni, V. Cesari, C. Conversano, P. K. Hitchcott, A. Gemignani


Objectives: to update understanding of the effectiveness of transcranial direct current stimulation (tDCS) on motor dysfunction in Parkinson’s disease, since the last review was published in 2016.
Methods: in order to identify suitable publications for inclusion, an online search of the Pubmed, Scopus and Cochrane databases was carried out. Searches of relevant full-text articles were performed through specific keywords. The final database check was performed in July 2019. Papers were restricted to studies investigating motor rehabilitative effects of tDCS in adult patients with Parkinson’s disease. Studies involving either single or repeated tDCS sessions with a sham or controlled trial type design (which incorporated outcomes on motor performance measures) were considered. As studies varied widely in terms of methodology, a qualitative analysis of the selected studies was performed using the Newcastle-Ottawa Quality Assessment Scale or the Delphi list (depending on the study design).
Results: twenty-nine studies were retained in this systematic review. Of the studies included, fifteen involved single tDCS session (patients = 256) and fourteen involved repeated tDCS sessions (patients = 294). Eight investigations of single tDCS and ten investigations of repeated tDCS demonstrated significant results. Studies involving multi- target stimulation demonstrated significant improvements on mobility (p=0.006), balance (by 50.9%), gait velocity (by 29%), fall reduction (p<0.05) compared to mono-target stimulations.
Conclusions: despite increasing evidence that tDCS may improve motor symptoms, the results showed that fully optimized tDCS protocols are not yet established.


Motor symptoms, Non-invasive brain stimulation, Parkinson’s disease, Transcranial Direct Current stimulation

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Beitz J.M. Parkinson’s disease: a review, Front Biosci (Schol. Ed.),6: 65-74, 2014.

Benninger D.H., Lomarev M., Lopez G, Wasesermann X.L., Considine E., Hallet M. Transcranial direct current stimulation for the treatment of Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 81: 1105-1111, 2010.

Bloem B.R., de Vries N.M., Ebersbach G. Nonpharmacological treatments for patients with Parkinson’s disease. Movement Disorders, 30(11)1504-1520, 2015.

Bloem B.R., Hausdorff J.M.,Visser J.E., Giladi N. Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov. Disord, 19: 871–884, 2004.

Bortoletto M., Rodella C., Salvador R., Miranda P.C., Miniussi C. Reduced Current Spread by Concentric Electrodes in Transcranial Electrical Stimulation (tES). Brain Stimul. 9(4):525-8, 2016.

Broeder S., Heremans E., Pereira M.P., Nackaerts E., Meesen R., Verheyden G., Nieuwboer A. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study. Human movement science; 65: 142-153, 2018.

Bueno M.E.B., do Nascimento Neto L.I., Terra M.B., Barboza N.M., Okano A.H., Smaili S.M. Effectiveness of acute transcranial direct current stimulation on non-motor and motor symptoms in Parkinson’s disease. Neuroscience letters, 696: 46-51, 2019.

Coin A., Najjar M., Catanzaro S., Orru G., Sampietro S., Sergi G., ... & Imoscopi A. A retrospective pilot study on the development of cognitive, behavioral and functional disorders in a sample of patients with early dementia of Alzheimer type. Archives of gerontology and geriatrics, 49, 35-38, 2009.

Camara C., Isasi P., Warwick K., Ruiz V., Aziz T., Stein J., Bakštein E. Resting tremor classification and detection in Parkinson's disease patients. Biomedical Signal processing and Control, 16: 88-97, 2015.

Cosentino G., Valentino F., Todisco M., Alfonsi E., Davì R., Savettieri G., Fierro B., D’Amelio M., Brighina F. Effects of More-Affected vs. Less-Affected Motor Cortex tDCS in Parkinson’s Disease. Front. Hum. Neurosci, 11: 309, 2017.

Costa-Ribeiro A., Maux A., Bosford T., Tenòrio Y., Marques D., Carneiro M., Nitsche M.A., Filho A.M., Monte-Silva K. Dopamine-independent effects of combining transcranial direct current stimulation with cued gait training on cortical excitability and functional mobility in Parkinson’s disease. J Rehabil Med, 48: 819-823, 2016.

Costa-Ribeiro A., Maux A., Bosford T., Aoki Y., Castro R., Baltar A., Shirahige L., Filho A.M, Nitche M.A., Monte-Silva K. Transcranial direct current stimulation associated with gait training in Parkinson’s disease: A pilot randomized clinical trial. Developmental Neurorehabilitation, 20(3): 121-128, 2017.

Da Costa Santos C. M., Pimenta C. A. D. M., Nobre M. R. C. The PICO strategy for the research question construction and evidence search. Revista latino-americana de enfermagem, 15(3), 508-511, 2007.

Da Silva D.C.L., Lemos T., de Sa Ferreira A., Horsczaruk C.H.R., Pedron C.A., de Carvalho Rodrigues E., de Oliveira L.A.S. Effects of Acute Transcranial Direct Current Stimulation on Gait Kinematics of Individuals With Parkinson Disease. Geriatric Rehabilitation, 34(4): 262-268, 2018.

Dagan M., Herman T., Harrison R., Zhou J., Giladi N., Ruffini G., Manor B., Hausdorff J.M. Multitarget Transcranial Direct Current Stimulation for Freezing of Gait in Parkinson’s Disease. Movement Disorders, 33(4): 642-646, 2018.

Doruk D., Gray Z., Bravo G.L., Pascual-Leone A., Fregni F. Effects of tDCS on executive function in Parkinson’s disease. Neuroscience letters, 582: 27-31, 2014.

Fernàndez-Lago H., Bello O., Mora-Cerdà F., Montero-Càmara J., Fernàndez-del-Olmo M.A.Treadmill Walking Combined With Anodal Transcranial Direct Current Stimulation in Parkinson Disease. American Journal of Physical Medicine & Rehabilitation, 96(11): 801-808, 2017.

Ferrucci R., Cortese F., Bianchi M., Pittera D., Turrone R., Bocci T., Borroni B., Vergari M., Cogiamanian F., Ardolino G., Di Fonzo A., Padovani A., Priori A. Cerebellar and Motor Cortical Transcranial Stimulation Decrease Levodopa-Induced Dyskinesias in Parkinson’s Disease. The Cerebellum, 15(1): 43-47, 2016b.

Ferrucci R., Mameli F., Ruggiero F., Priori A. Transcranial direct current stimulation as treatment for Parkinson’s disease and other movement disorders. Basal Ganglia, 6: 53-61, 2016a.

Forogh B., Madani S.P, Rafiei M., Motamed R.M., Sajadi S. Effect of Repeated Sessions of Transcranial Direct Current Stimulation on Functional Balance in Parkinson’s Disease: A Pilot Randomized Controlled Study. Journal of Neurology and Neuroscience, 2: 1-4, 2018.

Fregni F., Boggio P.S., Santos M.C., Lima M., Vieira A.L., Rigonatti S.P., Silva M.T.A., Barbosa E.R., Nitsche M.A., Pascual‐Leone A. Non-invasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease. Movement Disorders, 21(10):1693-1702, 2006.

Gilat M., de Lima A.L.S., Bloem B.R., Shine J.M., Nonnekes J., Lewis S.J. Freezing of gait: promising avenues for future treatment. Park. Relat. Disord, 52: 7–16, 2018.

Hadoush H., Al-Jarrah M., Khalil H., Al-Sharman A., Al-Ghazawi S. Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson’s disease. Neuro Rehabilitation, 42: 63-68, 2018a.

Hadoush H., Banihani S.A., Khalil H, Al-Qaisi Y, Al-Sharman A., Al-Jarrah M. Dopamine, BDNF and motor function post bilateral anodal transcranial direct current stimulation in Parkinson’s disease. Neurodegener. Dis. Manag., 8(3): 171-179, 2018b.

Horiba M., Ueki Y., Nojima I., Shimizu Y., Sahashi K., Itamoto S., Suzuki A., Yamada G., Matsukawa N., Wada I. Impaired motor skill acquisition using mirror visual feedback improved by transcranial direct current stimulation (tDCS) in patients with Parkinson’s Disease. Frontiers in neuroscience, 13: 602, 2019.

Kaski D., Dominguez R.O., Allum J.H., Islam A.F., Bronstein A.M. Combining physical training with transcranial direct current stimulation to improve gait in Parkinson’s disease: a pilot randomized controlled study. Clinical rehabilitation, 28(11): 1115-1124, 2014.

Lattari E., Costa S.S., Campos C., de Oliveira A.J., Machado S., Neto G.A.M. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease? Neuroscience letters, 636: 165-169, 2017.

Lee D.J., Dallapiazza R.F., De Vloo P., Lozano A.M. Current surgical treatments for Parkinson's disease and potential therapeutic targets. Neural regeneration research, 13(8)1342, 2018.

Lu C., Huffmaster S.L.A., Tuite P.J., MacKinnon C.D. The effects of anodal tDCS over the supplementary motor area on gait initiation in Parkinson’s disease with freezing of gait: a pilot study. Journal of Neurology, 265(9): 2023-2032, 2018.

Manenti R., Brambilla M., Benussi A., Rosini S., Cobelli C., Ferrari C., Petesi M., Orizio I., Padovani A., Borroni B., Cotelli M. Mild Cognitive Impairment in Parkinson’s Disease Is Improved by Trascranial Direct Current Stimulation Combined With Physical Therapy. Movement Disorders 31(5): 715-724, 2016.

Manenti R., Brambilla M., Rosini S., Orizio I., Ferrari C., Borroni B., Cotelli M. Time up and go task performance improves after transcranial direct current stimulation in patient affected by Parkinson's disease. Neuroscience letters, 580: 74-77, 2014.

Mendeley. Getting Started with Mendeley. Mendeley Desktop. London: Mendeley Ltd. Retrieved from http://www., 2009.

Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6(7):e1000097, 2009.

Nitsche M.A. and Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology, 527(3): 633-639, 2000.

Opara J., Brola W., Leonardi M., Blaszcyk B. Quality of life in Parkinson’s Disease. Journal of Medicine and Life, 5(4): 375-381, 2012.

Putzolu M., Pelosin E., Ogliastro C., Lagravinese G., Bonassi G., Ravaschio A., Abbruzzese G., Avanzino L. Anodal tDCS over prefrontal cortex improves dual‐task walking in Parkinsonian patients with freezing. Movement Disorders, 33(12): 1972-1973, 2018.

Salimpour Y., Mari Z.K., Shadmeh R. Altering Effort Costs in Parkinson’s Disease with Noninvasive Cortical Stimulation. J. Neurosci, 35(35): 12287-12302, 2015.

Schlenstedt C.,Shalash A., Muthuraman M., Falk. D., Witt K., Deuschl G. Effect of high frequency subthalamic neurostimulation on gait and freezing of gait in Parkinson's disease: a systematic review and meta‐analysis. European journal of neurology, 24(1): 18-26, 2017.

Schoellmann A., Scholten M., Wasserka B., Govindan R.B., Krüger R., Gharabaghi A., Plewnia C., Weiss D. Anodal tDCS modulates cortical activity and synchronization in Parkinson's disease depending on motor processing. NeuroImage: Clinical, 22: 101689, 2019.

Shabrun S.M., Lamont R.M., Brauer S.G. Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson’s Disease: A Pilot RCT. PLos ONE, 11(6): e0158497, 2016.

Swank C., Mehta J., Criminger C. Transcranial direct current stimulation lessens dual task cost in people with Parkinson’s disease. Neuroscience letters, 626: 1-5, 2016.

Valentino F., Cosentino G., Brighina F., Pozzi N.G., Sandrini G., Fierro B., Savettieri G., D’Amelio M., Pacchetti C. Transcranial Direct Current Stimulation for Treatment of Freezing of Gait: A cross-over Study. Movement Disorders, 29(8): 1064-1069, 2014.

Verhagen A.P., de Vet H.C., de Bie R.C., Kessels A.G., Boers M., Bouter L.M., et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of Clinical Epidemiology; 51:1235–1241, 1998.

Verheyden G., Purdey J., Burnett M., Cole J., Ashburn A. Immediate effect of transcranial direct current stimulation on postural stability and functional mobility in Parkinson's disease. Movement Disorders, 28(14)2040-2041, 2013.

Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. 2010.

Yotnuengnit P., Bhidayasiri R., Donkhan R., Chaluaysrimuang J., Piravej K. Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients with Parkinson Disease. American Journal of Physical Medicine & Rehabilitation, 97(1): 7-15, 2018.



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