The Cerebellum

, Volume 13, Issue 1, pp 121–138

Non-invasive Cerebellar Stimulation—a Consensus Paper

  • G. Grimaldi
  • G. P. Argyropoulos
  • A. Boehringer
  • P. Celnik
  • M. J. Edwards
  • R. Ferrucci
  • J. M. Galea
  • S. J. Groiss
  • K. Hiraoka
  • P. Kassavetis
  • E. Lesage
  • M. Manto
  • R. C. Miall
  • A. Priori
  • A. Sadnicka
  • Y. Ugawa
  • U. Ziemann
Review

DOI: 10.1007/s12311-013-0514-7

Cite this article as:
Grimaldi, G., Argyropoulos, G.P., Boehringer, A. et al. Cerebellum (2014) 13: 121. doi:10.1007/s12311-013-0514-7

Abstract

The field of neurostimulation of the cerebellum either with transcranial magnetic stimulation (TMS; single pulse or repetitive (rTMS)) or transcranial direct current stimulation (tDCS; anodal or cathodal) is gaining popularity in the scientific community, in particular because these stimulation techniques are non-invasive and provide novel information on cerebellar functions. There is a consensus amongst the panel of experts that both TMS and tDCS can effectively influence cerebellar functions, not only in the motor domain, with effects on visually guided tracking tasks, motor surround inhibition, motor adaptation and learning, but also for the cognitive and affective operations handled by the cerebro-cerebellar circuits. Verbal working memory, semantic associations and predictive language processing are amongst these operations. Both TMS and tDCS modulate the connectivity between the cerebellum and the primary motor cortex, tuning cerebellar excitability. Cerebellar TMS is an effective and valuable method to evaluate the cerebello-thalamo-cortical loop functions and for the study of the pathophysiology of ataxia. In most circumstances, DCS induces a polarity-dependent site-specific modulation of cerebellar activity. Paired associative stimulation of the cerebello-dentato-thalamo-M1 pathway can induce bidirectional long-term spike-timing-dependent plasticity-like changes of corticospinal excitability. However, the panel of experts considers that several important issues still remain unresolved and require further research. In particular, the role of TMS in promoting cerebellar plasticity is not established. Moreover, the exact positioning of electrode stimulation and the duration of the after effects of tDCS remain unclear. Future studies are required to better define how DCS over particular regions of the cerebellum affects individual cerebellar symptoms, given the topographical organization of cerebellar symptoms. The long-term neural consequences of non-invasive cerebellar modulation are also unclear. Although there is an agreement that the clinical applications in cerebellar disorders are likely numerous, it is emphasized that rigorous large-scale clinical trials are missing. Further studies should be encouraged to better clarify the role of using non-invasive neurostimulation techniques over the cerebellum in motor, cognitive and psychiatric rehabilitation strategies.

Keywords

CerebellumTranscranial magnetic stimulationDirect current stimulationAnodalCathodalMotor adaptationExcitabilityCerebellar inhibitionPaired associative stimulationVisionLanguagePredictionsMotor surround inhibitionWorking memorySemantic associationsAtaxia

Abbreviations

ADM

Abductor digiti minimi

BCIs

Brain–computer interfaces

CB

Cerebellum

CBI

Cerebellar–brain inhibition

cSP

Cortical silent period

cTBS

Continuous theta burst stimulation

DCS

Direct current stimulation

EMG

Electromyographic

FDI

First dorsal interosseous

fMRI

Functional magnetic resonance imaging

LICI

Long interval intracortical inhibition

LTD

Long-term depression

LTP

Long-term potentiation

M1

Primary motor cortex

MEP

Motor evoked potential

mSI

Motor surround inhibition

PAS

Paired associative stimulation

PET

Positron emission tomography

PSP

Progressive supranuclear palsy

rTMS

Repetitive transcranial magnetic stimulation

SICI

Short interval intracortical inhibition

SRTT

Serial reaction time task

STDP

Spike-timing-dependent plasticity

tDCS

Transcranial direct current stimulation

TES

Transcranial electric stimulation

TMS

Transcranial magnetic stimulation single shock

VAS

Visual analogue scale

VWM

Verbal working memory

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • G. Grimaldi
    • 1
  • G. P. Argyropoulos
    • 2
  • A. Boehringer
    • 3
    • 4
  • P. Celnik
    • 5
  • M. J. Edwards
    • 6
  • R. Ferrucci
    • 7
    • 8
  • J. M. Galea
    • 9
  • S. J. Groiss
    • 10
  • K. Hiraoka
    • 11
  • P. Kassavetis
    • 6
  • E. Lesage
    • 12
  • M. Manto
    • 1
    • 13
  • R. C. Miall
    • 12
  • A. Priori
    • 7
    • 8
  • A. Sadnicka
    • 6
  • Y. Ugawa
    • 14
  • U. Ziemann
    • 15
  1. 1.Unité d’Etude du MouvementHôpital Erasme-ULBBrusselsBelgium
  2. 2.Department of Psychology, Brain, Action and Cognition Lab, Royal HollowayUniversity of LondonEghamUK
  3. 3.Department of NeurologyMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
  4. 4.Central Institute for Mental HealthMannheimGermany
  5. 5.Johns Hopkins University BaltimoreBaltimoreUSA
  6. 6.Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyLondonUK
  7. 7.Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento Fondazione IRCCS Cà GrandaOspedale Maggiore PoliclinicoMilanItaly
  8. 8.Dipartimento di Fisiopatologia Medico-Chirurgica e dei TrapiantiUniversità degli Studi di MilanoMilanItaly
  9. 9.School of PsychologyUniversity of BirminghamBirminghamUK
  10. 10.Centre for Movement Disorders and Neuromodulation, Department of Neurology and Institute for Clinical Neuroscience and Medical Psychology, Medical FacultyHeinrich-Heine-UniversityDüsseldorfGermany
  11. 11.School of Comprehensive RehabilitationOsaka Prefecture UniversityHabikinoJapan
  12. 12.School of PsychologyUniversity of BirminghamBirminghamUK
  13. 13.FNRSBrusselsBelgium
  14. 14.Department of Neurology, School of MedicineFukushima Medical UniversityFukushimaJapan
  15. 15.Department of Neurology and Stroke, Hertie-Institute for Clinical Brain ResearchEberhard Karls UniversityTübingenGermany