The Efficacy and Safety of Transcranial Direct Current Stimulation for Cerebellar Ataxia: a Systematic Review and Meta-A
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REVIEW
The Efficacy and Safety of Transcranial Direct Current Stimulation for Cerebellar Ataxia: a Systematic Review and Meta-Analysis Tiffany X. Chen 1,2 & Chen-Ya Yang 2,3,4 & Gloria Willson 5 & Chih-Chun Lin 2,3 & Sheng-Han Kuo 2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A promising new approach, transcranial direct current stimulation (tDCS) has recently been used as a therapeutic modality for cerebellar ataxia. However, the strength of the conclusions drawn from individual studies in the current literature may be constrained by the small sample size of each trial. Following a systematic literature retrieval of studies, meta-analyses were conducted by pooling the standardized mean differences (SMDs) using random-effects models to assess the efficacy of tDCS on cerebellar ataxia, measured by standard clinical rating scales. Domain-specific effects of tDCS on gait and hand function were further evaluated based on 8-m walk and 9-hole peg test performance times, respectively. To determine the safety of tDCS, the incidences of adverse effects were analyzed using risk differences. Out of 293 citations, 5 randomized controlled trials involving a total of 72 participants with cerebellar ataxia were included. Meta-analysis indicated a 26.1% (p = 0.003) improvement in ataxia immediately after tDCS with sustained efficacy over months (28.2% improvement after 3 months, p = 0.04) when compared with sham stimulation. tDCS seems to be domain-specific as the current analysis suggested a positive effect on gait (16.3% improvement, p = 0.04) and failed to reveal differences for hand function (p = 0.10) with respect to sham. The incidence of adverse events in tDCS and sham groups was similar. tDCS is an effective intervention for mitigating ataxia symptoms with lasting results that can be sustained for months. This treatment shows preferential effects on gait ataxia and is relatively safe. Keywords Transcranial direct current stimulation . Electric stimulation . Ataxia . Cerebellum . Gait
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12311-020-01181-z) contains supplementary material, which is available to authorized users. * Sheng-Han Kuo [email protected] 1
Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
2
Department of Neurology, College of Physicians and Surgeons, Columbia University, 650 West 168th Street, Room 305, New York, NY 10032, USA
3
Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
4
Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Chiayi and Wanqiao Branch, Chiayi, Taiwan
5
Augustus C. Long Health Sciences Library, Columbia University New York, New York, NY, USA
Introduction Cerebellar ataxia arises from a variety of genetic or acquired etiologies that ultimately lead to cerebellar dysfunction. As a result, patients with cerebellar ataxia may suffer from eye movement abnormalitie
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