Association Of Transcranial Stimulation By Continuous Current (Tdcs) To March Training In Parkinson's Disease: Systematic Review With Meta-Analysis.

Willian Assis do Carmo 1, Gabriela Pinto de Oliveira 1, Augusto Boening 1, Fernando Zanela da Silva Arêas 1, Fernanda Moura Vargas Dias 1, Lucas Rodrigues Nascimento  1.

1. Universidade Federal do Espírito Santo

OBJECTIVE: To investigate whether gait training associated with tDCS is more effective than gait training alone in people with PD

METHODS: A systematic RCT review was carried out (PROSPERO CRD42020162908). The searches were performed in MEDLINE, AMED, EMBASE, Cochrane, PsycINFO and PEDro. The terms were: Parkinson, tDCS and gait. Adult participants with clinical diagnosis of PD and able to walk. The intervention was gait training associated with tDCS compared to gait training associated with tDCS-placebo. The results were extracted and combined in meta-analyzes using the RevMan software. The PEDro scale and the quality of the evidence were assessed using the GRADE system (Cochrane).

RESULTS: Five studies (average PEDro: 8 points), involving 117 participants, were included. The stimulation was eminently applied to the primary motor cortex for 13 to 30 minutes, with an intensity of 2mA. The participants had an average walking speed between 0.6 m / s and 1.4 m / s and a classification between 1 and 3 on the Hoehn and Yahr scale. The training was carried out, on average, for 30-60 minutes, 2-3 times a week, on average, for 4 weeks (NEUROFUNCIONAL SD - 31 - 1.5). The addition of tDCS did not show any significant additional effects to gait training on the variables walking speed (MD -0.01 m / s; 95% CI -0.05 to 0.04; I2 = 8%), step length (2.5 cm MD; 95% CI -0.6 to 5.6; I2 = 72%) or cadence (MD -7 steps / min; 95% CI -6 to 0.4; I2 = 10%). The quality of the evidence was moderate.

CONCLUSIONS: Use of tDCS associated with gait training did not promote additional benefits in people with mild or moderate PD involvement. Future studies should investigate the use of tDCS in multiple brain regions or in individuals with severe impairment.