Table_1_Multichannel Transcranial Direct Current Stimulation Combined With Treadmill Gait Training in Patients With Parkinson's Disease: A Pilot Study.DOCX

BackgroundGait problems are critical impairments in Parkinson's disease (PD) and are related to increased risk of fall and negatively impact activities of daily life. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modify the cortical excitability of gait-related brain regions. In this study, we investigated whether multichannel tDCS with simultaneous treadmill gait training could improve gait in PD.
MethodsTwenty-four patients with PD were assigned randomly to a real or sham tDCS group. Before intervention, one patient of the real tDCS group was dropped out, leaving 23 patients to be analyzed in this study. Each patient underwent 30 min of treadmill gait training for 10 sessions over four consecutive weeks. Multichannel 4x1 tDCS was applied using five 6-cm-diameter round electrodes. One anode was placed on the CZ, and four cathodes were positioned symmetrically over the FZ, C5, C6, and PZ. Anodal tDCS (2mA) and sham tDCS were delivered for 20 min. The secondary outcomes were gait performance, as measured by the timed up and go test (TUG) and freezing of gait questionnaire (FOG-Q), and balance was assessed using the dynamic gait index (DGI), Berg balance scale (BBS), and functional reach test (FRT). Motor and non-motor performance of patients with PD were assessed using the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Participants were assessed before the intervention, immediately after the intervention, and 4 weeks after completion of the intervention.
ResultsThe real tDCS group showed a significant improvement in the 10-m walk test, but the sham group did not. Among the secondary outcome measures, MDS-UPDRS part II, TUG, and BBS were improved only in the real tDCS group. Particularly, MDS-UPDRS part II showed a significant group*time interaction effect, indicating that real tDCS demonstrated a better effect on the activities of daily living patients with PD.
ConclusionsThe results of this pilot study suggest that multichannel tDCS applied on the leg motor cortex during treadmill gait training is a safe and effective means to improve gait velocity in patients with PD. Additional rigorous, large-sample, multicenter, randomized controlled trials are needed to confirm the effect of tDCS as a therapeutic adjunct for gait rehabilitation of patients with PD.

【研究背景】步态障碍是帕金森病（PD）患者的严重功能缺损，与跌倒风险升高显著相关，并会对患者的日常生活活动能力造成负面影响。经颅直流电刺激（tDCS）是一种非侵入性脑刺激技术，可调节步态相关脑区的皮层兴奋性。本研究旨在探究多通道经颅直流电刺激联合同步跑步机步态训练，是否能够改善帕金森病患者的步态功能。

【研究方法】本研究将24名帕金森病患者随机分为真刺激组与假刺激组。干预前，真刺激组有1例患者脱落，最终纳入23例患者完成本研究的数据分析。所有患者接受为期4周、共10次的跑步机步态训练，每次训练时长30分钟。本研究采用5枚直径6cm的圆形电极实施4×1型多通道经颅直流电刺激：1枚阳极电极置于CZ点位，4枚阴极电极对称分布于FZ、C5、C6及PZ点位。真阳极tDCS刺激电流强度为2mA，与假刺激的持续时长均为20分钟。本研究的次要结局指标包括：通过计时起立行走测试（TUG）与步态冻结问卷（FOG-Q）评估的步态表现，以及通过动态步态指数（DGI）、伯格平衡量表（BBS）与功能伸距测试（FRT）评估的平衡功能。采用运动障碍学会赞助修订的统一帕金森病评定量表（MDS-UPDRS）评估患者的运动与非运动功能。分别于干预前、干预结束即刻以及干预完成后4周，对所有受试者进行评估。

【研究结果】真刺激组在10米步行测试中表现出显著的步态改善，而假刺激组无此变化。在次要结局指标中，仅真刺激组的MDS-UPDRS第二部分、TUG测试结果与BBS评分得到显著改善。尤为关键的是，MDS-UPDRS第二部分呈现出显著的组间×时间交互效应，表明真经颅直流电刺激对帕金森病患者的日常生活活动能力具有更优的改善效果。

【研究结论】本预试验结果表明，在跑步机步态训练期间于腿部运动皮层施加多通道经颅直流电刺激，是改善帕金森病患者步态速度的安全有效手段。未来仍需开展严谨的大样本多中心随机对照试验，以验证经颅直流电刺激作为帕金森病患者步态康复辅助治疗手段的临床效果。