Shashank Agarwal1, Natalie Pawlak2, Alberto Cucca3, Kush Sharma4, Bryan Dobbs5, Michael Shaw6, Leigh Charvet7, Milton Biagioni8. 1. Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU School of Medicine, New York, NY 10016, USA. Electronic address: shashank.agarwal@nyumc.org. 2. NYU Langone Multiple Sclerosis Comprehensive Care Center, NYU School of Medicine, New York, NY 10016, USA. Electronic address: Natalie.pawlak@tufts.edu. 3. Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU School of Medicine, New York, NY 10016, USA. Electronic address: alberto.cucca@nyumc.org. 4. Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU School of Medicine, New York, NY 10016, USA. Electronic address: kush.sharma@nyumc.org. 5. NYU Langone Multiple Sclerosis Comprehensive Care Center, NYU School of Medicine, New York, NY 10016, USA. Electronic address: bryan.dobbs@nyumc.org. 6. NYU Langone Multiple Sclerosis Comprehensive Care Center, NYU School of Medicine, New York, NY 10016, USA. Electronic address: michael.shaw@nyumc.org. 7. NYU Langone Multiple Sclerosis Comprehensive Care Center, NYU School of Medicine, New York, NY 10016, USA. Electronic address: leigh.charvet@nyumc.org. 8. Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU School of Medicine, New York, NY 10016, USA. Electronic address: milton.biagioni@nyumc.org.
Abstract
BACKGROUND: Transcranial direct current stimulation (tDCS) has been explored as a potential intervention in Parkinson's disease (PD) and recent studies have shown promising results in cognitive, gait and motor function. However, evidence of efficacy is limited due to small size studies, short treatment periods, lack of standardization of methodologies and other study design limitations. Remotely supervised-tDCS (RS-tDCS) allows "at-home" study participation, potentially easing recruitment, compliance and overall feasibility for clinical studies. OBJECTIVE: Here, we aim to explore preliminary effects of RS-tDCS paired with cognitive training in PD by delivering RS-tDCS neuromodulation at participant's home while still maintaining clinical trial standards. METHODS: This was a prospective, open-label study using RS-tDCS paired with cognitive training. Each PD participant completed 10 tDCS sessions (20-min, 1.5-2.0-mA, bi-hemispheric DLPFC montage, left anodal), over a span of two weeks. All tDCS sessions were supervised in real-time through videoconferencing. Outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS) and Grooved Pegboard Test. RESULTS: All RS-tDCS sessions were well tolerated and completed successfully. Total UPDRS and motor UPDRS-III scores decreased significantly. Pegboard completion time improved significantly for the non-dominant hand. There was a strong positive correlation between the time of the sessions, and motor improvements in UPDRS part-III. CONCLUSION: RS-tDCS paradigm through a 'telemedicine protocol' holds therapeutic potential for motor symptoms in PD while maximizing compliance and ease of recruitment. Conducting afternoon sessions might be more effective than during the morning. Our paradigm may be influential in designing future studies and facilitating larger and longer duration clinical trials.
BACKGROUND: Transcranial direct current stimulation (tDCS) has been explored as a potential intervention in Parkinson's disease (PD) and recent studies have shown promising results in cognitive, gait and motor function. However, evidence of efficacy is limited due to small size studies, short treatment periods, lack of standardization of methodologies and other study design limitations. Remotely supervised-tDCS (RS-tDCS) allows "at-home" study participation, potentially easing recruitment, compliance and overall feasibility for clinical studies. OBJECTIVE: Here, we aim to explore preliminary effects of RS-tDCS paired with cognitive training in PD by delivering RS-tDCS neuromodulation at participant's home while still maintaining clinical trial standards. METHODS: This was a prospective, open-label study using RS-tDCS paired with cognitive training. Each PDparticipant completed 10 tDCS sessions (20-min, 1.5-2.0-mA, bi-hemispheric DLPFC montage, left anodal), over a span of two weeks. All tDCS sessions were supervised in real-time through videoconferencing. Outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS) and Grooved Pegboard Test. RESULTS: All RS-tDCS sessions were well tolerated and completed successfully. Total UPDRS and motor UPDRS-III scores decreased significantly. Pegboard completion time improved significantly for the non-dominant hand. There was a strong positive correlation between the time of the sessions, and motor improvements in UPDRS part-III. CONCLUSION: RS-tDCS paradigm through a 'telemedicine protocol' holds therapeutic potential for motor symptoms in PD while maximizing compliance and ease of recruitment. Conducting afternoon sessions might be more effective than during the morning. Our paradigm may be influential in designing future studies and facilitating larger and longer duration clinical trials.
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