Objective: To assess the effects of dentate nucleus transcranial magnetic stimulation and deep brain stimulation on patients with cerebellar ataxia of different etiologies.

Background: Cerebellar neuromodulation is a new therapeutic tendency in movement disorders. A few recent studies showed that cerebellar TMS might be a new frontier regarding the treatment of cerebellar ataxias. We previously published a case report of a patient with cerebellar stroke that had a great response to dentate nucleus TMS (DN-TMS). This same patient was then offered a dentate DBS implant, with also good response. Inspired by the results in this case, we expanded the TMS trials to a larger number of patients. We included, in addition to other stroke patients, patients with ataxia of degenerative causes in order to shed a light in which types of ataxia would perhaps benefit from this approach.

Methods: Six patients with cerebellar ataxia refractory to clinical treatment were screened for DN-TMS (patient 1, ischemic cerebellar stroke; patient 2, Multiple System Atrophy; patient 3, Spino-cerebellar Ataxia; patient 4, ischemic cerebellar stroke; patient 5, Ataxia with Vitamin E Deficiency); Patient 6, hemorrhagic cerebellar stroke. All patients were evaluated before and after 5 sections of DN-TMS with the following scales: Scale for the Assessment and Rating of Ataxia (SARA) and Fahn Tolosa Martin Tremor Rating Scale (FTMTRS). Patient 2 was not evaluated with FTMTRS. Deep brain stimulation to the left dentate nucleus was performed in patient 1.

Results: Four out of six patients had an improvement in the ataxia according to the SARA (range: 25% – 34%; patients 1, 2, 3 and 4). All patients that presented a tremor at baseline (patients 1, 4 and 5) improved according to the FTMTRS (range: 23% – 70%). Only Patient 6 didn’t show any sign of improvement in his symptoms.

Conclusions: This was the first controlled, neuronavigation-guided TMS study aiming at cerebellar ataxia and tremor control. All our patients improved ataxia or tremor due to the treatment. In the patient submitted to the DBS implant, the clinical improvement remained until the last evaluation (one year). The study protocol was safe and well tolerated. As one patient did not improve in the present series, further studies (including our ongoing study) are needed to provide larger evidence on the best target population for cerebellum neuromodulation.

References: 1. Cury et al. Neuronavigation-guided transcranial magnetic stimulation of the dentate nucleus improves cerebellar ataxia: a sham-controlled, double-blind n=1 study,

Parkinsonism and Related Disorders (2015), Aug;21(8):999–1001 .

2. Teixeira et al. Deep Brain Stimulation of the dentate nucleus improves cerebellar ataxia after cerebellar stroke, Neurology (2015) Dec 8;85(23):2075–6 

« Back to 2017 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/is-the-cerebellum-a-good-target-for-neuromodulation-in-movement-disorders/