神经退行性病

    Vibrotactile coordinated reset stimulation for the treatment of Parkinson’s disease
  • Figure 1|Acute, cumulative and long-lasting off medication clinical and EEG effects of VCR stimulation.

    In the feasibility pilot study (Pfeifer et al., 2021), six patients with clinically diagnosed mild to moderate idiopathic PD, further classified as tremor-dominant (n = 4), postural instability/gait difficulty (n = 1), and intermediate (n = 1), received noisy vCR stimulation for 3 months. To assess acute vCR effects at the outset of treatment, on the first vCR treatment day, patients received twice 2 hours of vCR. MDS-UPDRS III scores were taken before and after the in total four hours of vCR. Patients remained off medication until after the second MDS-UPDRS III exam. MDS-UPDRS III scores were significantly reduced after the four hours of vCR (paired-samples t-test, N = 6, t(5) = 4.297, P = 0.008, SD = 4.56). By the same token, axial symptom subscores also showed a significant acute effect (t(5) = 4.719, P = 0.005, SD = 1.211). To assess whether the acute vCR effects were clinically significant, acute reduction of MDS-UPDRS III scores were compared with the minimal clinically important differences (MCID) of the MDS-UPDRS III. Although patients remained off medication, five out of six patients showed a clinically significant acute reduction of MDS-UPDRS III scores exceeding the MCID (3.25) (green bars, Figure 1A). Cumulative vCR effects were studied by comparing off medication MDS-UPDRS III scores before and after the 3-month vCR therapy, revealing a significant reduction of MDS-UPDRS III scores (paired-samples t-test, N = 6, t(5) = 2.890, P = 0.034, SD = 5.93). In particular, all patients showed a clinically significant cumulative reduction of MDS-UPDRS III scores after three months of vCR treatment (orange bars, Figure 1A). EEG recordings performed off medication before (Figure 1B) and after (Figure 1C) the 3-month noisy vCR therapy revealed a significant decrease in cortical sensorimotor high beta power (21–30 Hz) at rest (paired-samples t-test, t(4) = 3.012, P = 0.030, SD = 0.015). In addition, Levodopa equivalent daily dose was reduced on average by 7.82% after the 3-month vCR therapy. 
    The 6+ months feasibility case series study in three patients with idiopathic PD was performed to investigate the long-term cumulative effects of vCR (Pfeifer et al., 2021). Off medication MDS-UPDRS III scores were obtained before vCR therapy and approx. every 3 months for 1–3 days during each follow-up visit. Patients 1 and 2 received regular vCR, while patient 3 (recruited from study 1, which had to be terminated after three months because of COVID-19) received noisy vCR. All three patients showed sustained cumulative therapeutic effect as demonstrated by a significant linear decrease of the off medication MDS-UPDRS III scores (two-tailed Pearson’s correlation, Figure 1D–F) as well as off medication tremor subscores. In addition, in patient 1 the off medication subscore for bradykinesia and rigidity displayed a significant linear decrease. The Hohn and Yahr (HY) scales remained at HY2 on medication for patient 1, went from HY4 on medication (pre-vCR) to HY2 on medication (with vCR) for patient 2, decreased from HY3 (pre-vCR) off medication to HY2 (with vCR) off medication for patient 3. In patient 2, gait improved from consistent use of cane and occasional use of wheelchair to walking without assistance. Medication levels (assessed by Levodopa equivalent daily dose) stably remained on a pre-vCR level in patient 1, decreased from 2700 mg/d to 900 mg/d in patient 2 and from 920 mg/d to 820 mg/d in patient 3 in the course of the vCR therapy. Patient videos can be downloaded as supplementary material (Pfeifer et al., 2021).

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  • 发布日期: 2022-01-12  浏览: 364
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