Objective: 1. To assess brain network dysfunction of Huntington disease (HD). 2. To evaluate the effectiveness of 2-week home-based chronic non-invasive transcranial brain stimulation to modify the network dysfunction and treat motor symptoms and depression.

Background: Therapeutic trials in HD have failed to show promising results with pharmacotherapy. Thus, there is an unmet treatment need. Current studies have shown multilevel network dysfunction in neurodegenerative movement disorders. Targeting network level dysfunction by non-invasive electromagnetic stimulation is a novel therapeutic option. In this pilot study, we have investigated the efficacy of 2-week home-based non-invasive transcranial pulse current stimulation (tPCS) in patients with HD.

Method: fifteen patients with HD were assessed for the following parameters:

– Quantitative EEG (qEEG).

– Unified Huntington disease rating scale (UHDRS).

– Beck Depression Inventory (BDI).

– Upper limb movements using KinArm with a validated recording protocol.

– Gait using ZenoWalkway gait carpet.

tPCS was delivered through a pair of saline-soaked surface sponge electrodes with the anode (active electrode) placed on the scalp over the dysfunctional brain region (evidenced by qEEG). Each patient received active and sham stimulation with a 1-month gap in between, in a randomized blinded fashion. Patients were assessed before and after stimulation (20 min per day). Analysis compared pre and post stimulation data in clinical scores.

Results: So far, we have analyzed the clinical data of 6 patients. Others are still under analysis. In qEEG, most of HD patients displayed an abnormality in the supplementary motor area. There was a decrease in the percentage of the total UHDRS in each patient after sham and active stimulation. However, this decrease was greater during the active stimulation (80% to 90% compared to 20% to 40%). Regarding BDI, no difference was seen in total score.

Conclusion: This is the first study to begin a detailed characterization of HD. EEG evaluation showed predominantly a motor dysfunction, that improves after active stimulation. UHDRS helped to identify a variation after sham and active stimulation, being the later, the one that improved motor symptoms of HD. No stimulation proved a change of the BDI. tPCS seems to be a promising treatment for HD, although there is a need of trials with more patient population.

References: 1. Gatto EM, et al. Huntington disease: Advances in the understanding of its mechanisms. Clin Park Relat Disord. 2020 May 6;3:100056
2. Blumenstock S, Dudanova I. Cortical and Striatal Circuits in Huntington’s Disease. Front Neurosci. 2020 Feb 6;14:82
3. Lane, R.M. et al. (2018). Translating Antisense Technology into a Treatment for Huntington’s Disease. In: Precious, S., Rosser, A., Dunnett, S. (eds) Huntington’s Disease. Methods in Molecular Biology, vol 1780. Humana Press, New York, NY.
4. Bocci T, et al. Cerebellar Direct Current Stimulation (ctDCS) in the Treatment of Huntington’s Disease: A Pilot Study and a Short Review of the Literature. Front Neurol. 2020 Dec 3;11:614717

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MDS Abstracts - https://www.mdsabstracts.org/abstract/modifying-clinical-and-electrophysiological-parameters-through-transcranial-pulsed-current-stimulation-tpcs-in-huntington-disease/