Dopamine-independent effects of combining transcranial direct current stimulation with cued gait training on cortical excitability and functional mobility in Parkinson's disease.
OBJECTIVE
To investigate the dopamine-dependent effect of combining transcranial direct current stimulation (tDCS) with visually cued gait training on cortical excitability and functional mobility in individuals with Parkinson's disease.


METHODS
A pilot, randomized, double-blind, controlled trial.


METHODS
Twenty-two patients with Parkinson's disease were randomly assigned to 2 groups: (i) active anodal tDCS over the supplementary motor area (experimental group), or (ii) sham tDCS (control group). After tDCS, both groups participated in a visually cued gait training. Functional mobility was evaluated with the Timed Up and Go test (TUG). Cortical excitability was assessed by active motor threshold and motor-evoked potential amplitudes elicited by transcranial magnetic stimulation in patients in on and off medication states.


RESULTS
In the TUG test both groups achieved improvements either in on or off medication condition compared with baseline. However, for both medication conditions, these gains were maintained only in the experimental group during 1-month follow-up, compared with baseline. In the experimental group, enhancement of cortical excitability was observed at post-intervention and 1-month follow-up (both only for the "on" phase) compared with baseline.


CONCLUSIONS
These findings suggest that tDCS, independent of dopaminergic medication state, might prolong the positive effect induced by cued gait training on functional mobility.
Department of Physical Therapy, Applied Neuroscience Laboratory, Universidade Federal de Pernambuco - UFPE. Av. Jornalista Anibal Fernandes, s/n, Cidade Universitária, Recife, Pernambuco, Brazil. E-mail: monte.silvakk@gmail.com.
Adriana
A
Costa-Ribeiro
Ariadne
A
Maux
Thamyris
T
Bosford
Yumi
Y
Tenório
Déborah
D
Marques
Maíra
M
Carneiro
Michael A
MA
Nitsche
Alberto Moura
AM
Filho
Kátia
K
Monte-Silva
D000328:Adult; D000368:Aged; D000071080:Cortical Excitability; D004298:Dopamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology / Q000534:rehabilitation*; D010865:Pilot Projects; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
D004298:Dopamine