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DIRECT CURRENT STIMULATION AND TRAINING IN PARKINSON'S DISEASE: BETTER OUTCOMES IN MORE ADVANCED DISEASE
  1. Diego Kaski,
  2. Raul Dominguez,
  3. John Allum,
  4. Adolfo Bronstein
  1. Imperial College London; Universidad de Buenos Aires; University ORL clinic

    Abstract

    Background Gait disturbance in Parkinson's disease is notoriously difficult to treat. We attempted to improve gait and balance in sixteen patients with Parkinson's disease by combining neurostimulation with clinically–relevant physical training.

    Methods In a double–blind design, one group (physical training; n=8) underwent task–specific gait and balance training during transcranial direct current stimulation (real/sham). The stimulation was crossed–over one week later (sham/real); the second group (No physical training; n=8) received stimulation but no training, and also repeated a crossed–over session. We recorded walking time in the Timed Up and Go, gait velocity, postural stability, and trunk sway.

    Results Our training protocol decreased walking time (6 m walk, p=0.007), increased gait velocity (p=0.02), and improved balance (retropulsion test, p=0.04). Although we observed no overall effect of stimulation alone, or with training (p>0.05), greater stimulation–related improvements were seen in patients with more advanced disease. Levodopa equivalent dose correlated strongly with improvements in gait in patients receiving combined training/neurostimulation.

    Conclusions Physical training, but not direct current stimulation, improves gait and balance in Parkinson's disease. Therapeutic effects of neurostimulation may require a pre–selection process of patients, or the concomitant use of dopaminergic drugs.

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