Review

The Cerebellum

, Volume 13, Issue 1, pp 121-138

Non-invasive Cerebellar Stimulation—a Consensus Paper

  • G. GrimaldiAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULB Email author 
  • , G. P. ArgyropoulosAffiliated withDepartment of Psychology, Brain, Action and Cognition Lab, Royal Holloway, University of London
  • , A. BoehringerAffiliated withDepartment of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesCentral Institute for Mental Health
  • , P. CelnikAffiliated withJohns Hopkins University Baltimore
  • , M. J. EdwardsAffiliated withSobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology
  • , R. FerrucciAffiliated withCentro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento Fondazione IRCCS Cà Granda, Ospedale Maggiore PoliclinicoDipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano
  • , J. M. GaleaAffiliated withSchool of Psychology, University of Birmingham
  • , S. J. GroissAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBCentre for Movement Disorders and Neuromodulation, Department of Neurology and Institute for Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University
  • , K. HiraokaAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBSchool of Comprehensive Rehabilitation, Osaka Prefecture University
    • , P. KassavetisAffiliated withSobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology
    • , E. LesageAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBSchool of Psychology, University of Birmingham
    • , M. MantoAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBFNRS
    • , R. C. MiallAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBSchool of Psychology, University of Birmingham
    • , A. PrioriAffiliated withCentro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento Fondazione IRCCS Cà Granda, Ospedale Maggiore PoliclinicoDipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano
    • , A. SadnickaAffiliated withSobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology
    • , Y. UgawaAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBDepartment of Neurology, School of Medicine, Fukushima Medical University
    • , U. ZiemannAffiliated withUnité d’Etude du Mouvement, Hôpital Erasme-ULBDepartment of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, Eberhard Karls University

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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

Cerebellum Transcranial magnetic stimulation Direct current stimulation Anodal Cathodal Motor adaptation Excitability Cerebellar inhibition Paired associative stimulation Vision Language Predictions Motor surround inhibition Working memory Semantic associations Ataxia