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Single-Session Cerebellar Transcranial Direct Current Stimulation Improves Postural Stability and Reduces Ataxia Symptoms in Spinocerebellar Ataxia

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Abstract

Spinocerebellar ataxia (SCA) results in balance and coordination impairment, and current treatments have limited efficacy. Recent evidence suggests that combining postural training with cerebellar transcranial direct current stimulation (ctDCS) can improve these symptoms. However, the combined effects of ctDCS and postural training on individuals with spinocerebellar ataxia remain underexplored. Ten volunteers with (SCA type 3) participated in a triple-blind, randomized, crossover study to receive a single session of ctDCS (2 mA for 20 min) and a sham ctDCS session separated by at least one week. The Biodex Balance System was used to assess balance at each session, measuring overall stability index, anteroposterior stability index, and medial-lateral stability index. As secondary outcomes, cerebellar ataxia symptoms were evaluated using the 8-item Scale for Assessment and Rating of Ataxia. The assessments were conducted before and after each session. The results indicated that ctDCS enhanced the overall stability index when compared to sham ctDCS (Z = -2.10, p = 0.03), although it did not significantly affect the anteroposterior or medial-lateral stability indices. Compared to the baseline, a single session of ctDCS reduced appendicular symptoms related to cerebellar ataxia, as evidenced by improvements in the nose-finger test (Z = -2.07, p = 0.04), fast alternating hand movements (Z = -2.15, p = 0.03), and heel-to-shin slide (Z = -1.91, p = 0.05). In conclusion, our study suggests that a single session of ctDCS, in combination with postural training, can enhance balance and alleviate ataxia symptoms in individuals with cerebellar ataxia. This study was approved by the local research ethics committee (No. 2.877.813) and registered on clinicaltrials.org (NCT04039048 - https://www.clinicaltrials.gov/study/NCT04039048) on 2019-07-28.

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Data Availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We thank the patients for their commitment to the study.

Funding

this research was supported by grant (nº 310369/2022-3) from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. Kátia Monte-Silva is supported by CNPq/Brazil (Grant No.310369/2022-3).

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Authors and Affiliations

  1. Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Jornalista Aníbal Fernandes Avenue, Recife, 50740-560, PE, Brasil

    Rodrigo Brito, João Victor Fabrício, Aurine Araujo, Gabriel Barreto, Adriana Baltar & Kátia Monte-Silva

  2. NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Palmares, Pernambuco, Brazil

    Rodrigo Brito, Gabriel Barreto, Adriana Baltar & Kátia Monte-Silva

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  1. Rodrigo Brito
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Contributions

RB, AB, and KMS designed the study. RB, JVF, and KMS conducted the literature search and extracted the information. RB evaluated the volunteers. JVF and AA performed the interventions on the volunteers. RB, GB, and KMS analyzed the data. RB and KMS drafted the manuscript. All the authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Kátia Monte-Silva.

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Ethics Approval

This study was approved by the local research ethics committee (No. 2.877.813), registered at clinicaltrials.org (NCT04039048), and performed according to the Declaration of Helsinki.

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informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 2.

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The authors declare no competing interests.

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Brito, R., Fabrício, J.V., Araujo, A. et al. Single-Session Cerebellar Transcranial Direct Current Stimulation Improves Postural Stability and Reduces Ataxia Symptoms in Spinocerebellar Ataxia. Cerebellum (2024). https://doi.org/10.1007/s12311-024-01696-9

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