Objective: To evaluate the feasibility of home-based transcranial direct current stimulation (tDCS) for people with cerebellar ataxia (CA).

Background: tDCS induces non-invasive cortical plasticity via subthreshold neuronal membrane polarization [1] that may improve gait in neurodegenerative diseases, including CA [2-4]. tDCS can be applied as a home-based treatment [5]. Combining home-based tDCS with instrumental remote assessments could benefit those who have limited access to ongoing care at specialist centres.

Method: We designed a randomized, double-blind, sham-controlled, crossover feasibility study. Clinical evaluation includes: (a) Synchronous video-based cognitive and motor assessments of the 5-item SARA-Home scale, Sit-to-stand and the Timed Up and Go, quantified by the Mon4t^TM smartphone app (Mon4t, FDA approved); (b) Subjective battery of questionnaires addressing falls, quality of life, levels of activity, including the Telehealth usability questionnaire (TUQ).
Test validation is optimized by repeating functional assessments remotely at the first visit. Participants receive two intervention periods, 5 days each, 1-month apart (‘wash-out’). Interventions are randomized between Anodal (2mA current, 20 minutes), and sham cerebellar tDCS. Participants are remotely assessed after the first intervention and before and after the second intervention. Ethical approval was obtained to commence this study.

Results: The study is in progress. To maintain blinding, only baseline data is provided.
Eight independently ambulatory individuals (4 female) have successfully completed the protocol: Age range 25-78 years (=50.42), average years of disease is 4.21, average SARA-Home score is 5.92, average MOCA is 26.28, three are multiple fallers. On a scale of 1-7, the average TUQ score is 6.65 showing high compliance and satisfaction.

Conclusion: Initial study findings indicate that our novel platform for home-based, remotely supervised, transcranial direct current stimulation and assessment is feasible for patients with CA. This may open new doors for remote clinical trials, as well as for tele-rehabilitation.  Effectivity of the tDCS treatment in CA will be reported after completion of the study.

References: 1. Benussi, A., Dell’Era, V., Cotelli, M. S., Turla, M., Casali, C., Padovani, A., & Borroni, B. (2017). Long term clinical and neurophysiological effects of cerebellar transcranial direct current stimulation in patients with neurodegenerative ataxia. Brain stimulation, 10(2), 242-250.‏
2. Chen, T. X., Yang, C. Y., Willson, G., Lin, C. C., & Kuo, S. H. (2021). The efficacy and safety of transcranial direct current stimulation for cerebellar ataxia: A systematic review and meta-analysis. The Cerebellum, 20(1), 124-133.‏
3. Orru, G., Cesari, V., Conversano, C., & Gemignani, A. (2021). The clinical application of transcranial direct current stimulation in patients with cerebellar ataxia: a systematic review. International Journal of Neuroscience, 131(7), 681-688.‏
4. Benussi, A., Pascual-Leone, A., & Borroni, B. (2020). Non-invasive cerebellar stimulation in neurodegenerative ataxia: A literature review. International Journal of Molecular Sciences, 21(6), 1948.‏
5. Alonzo A., Charvet L. (2021) Home-Based tDCS: Applications and Approaches, Design, Feasibility, and Safety. In: Brunoni A.R., Nitsche M.A., Loo C.K. (eds) Transcranial Direct Current Stimulation in Neuropsychiatric Disorders. Springer, Cham.‏

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-novel-platform-for-home-based-remotely-supervised-transcranial-direct-current-stimulation-treatment-and-assessment-for-cerebellar-ataxia-a-randomized-double-blind-sham-controlled-crossover-fe/