Spinal direct current stimulation (tsDCS) in hereditary spastic paraplegias (HSP): A sham-controlled crossover study - PubMed (original) (raw)

Randomized Controlled Trial

Spinal direct current stimulation (tsDCS) in hereditary spastic paraplegias (HSP): A sham-controlled crossover study

Gianluca Ardolino et al. J Spinal Cord Med. 2021 Jan.

Abstract

Objective: Hereditary spastic paraplegia (HSP) represents a heterogeneous group of neurodegenerative diseases characterized by progressive spasticity and lower limb weakness. We assessed the effects of transcutaneous spinal direct current stimulation (tsDCS) in HSP.Design: A double-blind, randomized, crossover and sham-controlled study.Setting: Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan.Participants: eleven patients with HSP (six men, mean age ± SD: 37.3 ± 8.1 years), eight affected by spastin/SPG4,1 by atlastin1/SPG3a, 1 by paraplegin/SPG7 and 1 by ZFYVE26/SPG15.Interventions: tsDCS (anodal or sham, 2.0 mA, 20', five days) delivered over the thoracic spinal cord (T10-T12).Outcome measures: Motor-evoked potentials (MEPs), the H-reflex (Hr), F-waves, the Ashworth scale for clinical spasticity, the Five Minutes Walking test and the Spastic Paraplegia Rating Scale (SPRS) were assessed. Patients were evaluated before tsDCS (_T_0), at the end of the stimulation (_T_1), after one week (_T_2), one month (_T_3) and two months (_T_4).Results: The score of the Ashworth scale improved in the anodal compared with sham group, up to two months following the end of stimulation (T1, P = .0137; T4, P = .0244), whereas the Five Minutes Walking test and SPRS did not differ between the two groups. Among neurophysiological measures, both anodal and sham tsDCS left Hr, F-waves and MEPs unchanged over time.Conclusions: Anodal tsDCS significantly decreases spasticity and might be a complementary strategy for the treatment of spasticity in HSP.

Keywords: Hereditary spastic paraplegias; Movement disorders; Non-invasive spinal stimulation; Spasticity treatment; Transcutaneous spinal direct current stimulation.

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Figure 1

Figure 1

Ashworth scale for lower limbs and sub-items. Anodal tsDCS (white circles) significantly reduced total Ashworth score compared with sham stimulation (black squares), at _T_1 and _T_4; this improvement with respect to hip flexion and knee extension (left and right, bottom row). The data are expressed as mean values ± S.E. (*P< .05; **P< .01).

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The study was supported by Associazione Italiana Vi.P.S. Onlus “Vivere la Paraparesi Spastica”. The study was partly supported by POR-FESR 2014–2010 (ELOQUENTSTIM, Regione Lombardia, ID 247367), by donation in memory of Aldo Ravelli, by the Italian Ministry of Health grant (RC-2017 and GR-2011- 02352807) and Roche Research grant 2017.

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