Objective: To investigate whether a 2-week treatment with anodal cerebellar and cathodal spinal transcranial pulse current stimulation (tPCS) can improve symptoms in neurodegenerative ataxia at short and long term.

Background: In the absence of an effective treatment for neurodegenerative ataxia, non-invasive brain stimulation (NIBS) has become a promising option. NIBS has developed specific stimulation protocols to modulate cerebellar excitability and try to restore the physiological activity of the cerebellum in patients with ataxia[1]. tPCS, a type of NIBS, modifies neuronal excitability by a combination of tonic and phasic effects of the resting membrane potential[2]. Beneficial effect of combined anodal cerebellar and cathodal spinal stimulation has been published in ataxia. A single session of cerebellar stimulation has shown temporary benefit in patients with ataxia[3]. This has led us to hypothesized if prolonged stimulation could be more effective. This study is designed to assess the short and long-term effects of repeated cerebellar-spinal tPCS in patients with neurodegenerative ataxia.

Method: This is a double-blind, randomized, sham-controlled, crossover trial with daily cerebello-spinal tPCS for 14 days in 16 patients with neurodegenerative ataxia. Patients and caregivers will be trained to perform stimulation at home. Each patient will receive real and sham tPCS with a crossover washout period of 3 months.  Patients will be assessed at baseline, 2 weeks, 1 month and 3 months after every intervention. All visits will include the Scale for the Assessment and Rating of Ataxia (SARA), upper limb movements using KinArm, gait analysis using ZenoWalkway and PKMAS software, quantitative EEG and speech assessment. Primary endpoint will be the change in the SARA score after 2 weeks of cerebello-spinal tPCS.

Results: Upon completion of recruitment, quantitative results from every assessment will be compared between sham and real stimulation. Also, a “horizontal comparison” of quantitative assessments will be performed to assess effect duration and changes in time after tPCS.

Conclusion: This is an ongoing study actively recruiting patients. So far, home-based tPCS is a well-tolerated, cost effective, NIBS form with good compliance. Cerebello-spinal tPCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia.

References: Benussi A, Pascual-Leone A, Borroni B. Non-invasive cerebellar stimulation in neurodegenerative ataxia: A literature review. Int J Mol Sci 2020;21:1–14. https://doi.org/10.3390/ijms21061948.
[2] Jaberzadeh S, Bastani A, Zoghi M, Morgan P, Fitzgerald PB. Anodal transcranial pulsed current stimulation: The effects of pulse duration on corticospinal excitability. PLoS One 2015;10:1–14. https://doi.org/10.1371/journal.pone.0131779.
[3] Benussi A, Dell’Era V, Cantoni V, Bonetta E, Grasso R, Manenti R, et al. Cerebello-spinal tDCS in ataxia A randomized, double-blind, sham-controlled, crossover trial. Neurology 2018;91:E1090–101. https://doi.org/10.1212/WNL.0000000000006210.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-at-home-repeated-transcranial-pulse-current-stimulation-tpcs-sessions-for-treatment-of-neurodegenerative-ataxia/