The Efficacy and Safety of Transcranial Direct Current Stimulation for Cerebellar Ataxia: a Systematic Review and Meta-Analysis

Abstract

A promising new approach, transcranial direct current stimulation (tDCS) has recently been used as a therapeutic modality for cerebellar ataxia. However, the strength of the conclusions drawn from individual studies in the current literature may be constrained by the small sample size of each trial. Following a systematic literature retrieval of studies, meta-analyses were conducted by pooling the standardized mean differences (SMDs) using random-effects models to assess the efficacy of tDCS on cerebellar ataxia, measured by standard clinical rating scales. Domain-specific effects of tDCS on gait and hand function were further evaluated based on 8-m walk and 9-hole peg test performance times, respectively. To determine the safety of tDCS, the incidences of adverse effects were analyzed using risk differences. Out of 293 citations, 5 randomized controlled trials involving a total of 72 participants with cerebellar ataxia were included. Meta-analysis indicated a 26.1% (p = 0.003) improvement in ataxia immediately after tDCS with sustained efficacy over months (28.2% improvement after 3 months, p = 0.04) when compared with sham stimulation. tDCS seems to be domain-specific as the current analysis suggested a positive effect on gait (16.3% improvement, p = 0.04) and failed to reveal differences for hand function (p = 0.10) with respect to sham. The incidence of adverse events in tDCS and sham groups was similar. tDCS is an effective intervention for mitigating ataxia symptoms with lasting results that can be sustained for months. This treatment shows preferential effects on gait ataxia and is relatively safe.

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Abbreviations

ICARS:

International Cooperative Ataxia Rating Scale

SARA:

Scale for the assessment and rating of ataxia

SCA:

Spinocerebellar ataxia

SMD:

Standardized mean difference

RCT:

Randomized controlled trial

tACS:

Transcranial alternating current stimulation

tDCS:

Transcranial direct current stimulation

TMS:

Transcranial magnetic stimulation

95% CI:

95% confidence interval

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Funding

Dr. Kuo is supported by the NINDS R01NS104423, R01NS118179, R03NS114871, K08NS083738, Louis V. Gerstner Jr. Scholarship, National Ataxia Foundation, Parkinson’s Foundation, Brain Research Foundation, and International Essential Tremor Foundation.

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Correspondence to Sheng-Han Kuo.

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Supplementary Fig. 1

Assessment of the quality of included randomized controlled trials with the Cochrane Risk of Bias (RoB2) tool. The following domains of potential bias were considered: (D1) randomization process, (D2) deviations from the intended interventions, (D3) missing outcome data, (D4) measurement of the outcome, and (D5) selection of the reported result (JPEG 1349 kb).

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Chen, T.X., Yang, CY., Willson, G. et al. The Efficacy and Safety of Transcranial Direct Current Stimulation for Cerebellar Ataxia: a Systematic Review and Meta-Analysis. Cerebellum 20, 124–133 (2021). https://doi.org/10.1007/s12311-020-01181-z

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Keywords

  • Transcranial direct current stimulation
  • Electric stimulation
  • Ataxia
  • Cerebellum
  • Gait