Effects of vestibular rehabilitation combined with transcranial cerebellar direct current stimulation in patients with chronic dizziness: An exploratory study
Introduction
Vestibular rehabilitation is used for managing chronic vestibular dysfunction [1], [2]. It aims to induce neuroplastic changes to compensate for vestibular impairment in the central nervous system, wherein the cerebellum readjusts the central processing of vestibular inputs [3]. Transcranial cerebellar direct current stimulation (tcDCS) can enhance cerebellar function and motor learning [4], [5], [6]. Here we investigated whether vestibular rehabilitation in combination with tcDCS could be more effective than using rehabilitation alone.
Section snippets
Methods
In this exploratory, single-blind, randomized controlled study, 30 patients recruited at the Department of Ear Nose and Throat at the Tokyo National Medical Center were randomly assigned to tcDCS (n = 15) or sham (n = 15) groups. Six patients in the tcDCS group and 8 in the sham group were lost to follow-up. Therefore, 16 patients (10 women; mean age ± SD: 62.7 ± 9.0 years; range, 41–73) were included. All patients had chronic dizziness for at least 6 months (mean ± SD: 92.0 ± 73.8 months) due
Results
None of the patients reported skin irritation and other adverse effect of the stimulation.
Baseline scores in the tcDCS and sham groups (respectively) were as follows: DHI physical, 16.2 ± 5.7 and 14.6 ± 6.4; DHI emotional, 19.6 ± 8.7 and 18.0 ± 6.1; DHI functional, 19.1 ± 11.4 and 17.1 ± 7.4; DHI total, 54.9 ± 22.3 and 49.7 ± 11.9; STAI state anxiety, 52.7 ± 12.1 and 51.0 ± 11.0; STAI trait anxiety, 50.6 ± 12.6 and 45.3 ± 9.4; SDS, 49.0 ± 10.5 and 43.9 ± 9.5; TUG, 7.5 ± 1.2 and 9.8 ± 6.0 s;
Discussion
We found that vestibular rehabilitation partially combined with tcDCS had a greater effect than rehabilitation alone on the reduction of dizziness in daily life of patients with chronic unilateral vestibular dysfunction. To our knowledge, this is the first report that describes vestibular rehabilitation using brain stimulation.
In the present study, the DHI physical and functional scores were significantly reduced in the tcDCS group. Patient handicap is linked to both scores and less to the
Conflicts of interest
None.
Acknowledgements
This study was partly supported by a Grant-in-Aid for JSPS Fellows (16J40201), a Grant-in-Aid for Young Scientists (B) (26870321) from the Japan Society for the Promotion of Science, a research grant (2015) from the Nakatomi Foundation (203150700073) (to S.K.), a Grant-in-Aid for Scientific Research (B) 15H03044, a Grant-in-Aid for Scientific Research on Innovative Areas (15H05880, 15H05871) from the Japan Society for the Promotion of Science, STEP2(27280201) and 2736040 from the Japan Agency
References (28)
- et al.
Outcomes after rehabilitation for adults with balance dysfunction
Arch Phys Med Rehabil
(2004) - et al.
Transcranial cerebellar direct current stimulation (tcDCS): motor control, cognition, learning and emotions
Neuroimage
(2014) - et al.
Cerebellar direct current stimulation enhances motor learning in older adults
Neurobiol Aging
(2014) - et al.
The role of the human cerebellum in performance monitoring
Curr Opin Neurobiol
(2016) - et al.
Contributions of the cerebellum and the motor cortex to acquisition and retention of motor memories
Neuroimage
(2014) - et al.
Cerebellum estimates the sensory state of the body
Trends Cogn Sci
(2014) - et al.
High-resolution modeling assisted design of customized and individualized transcranial direct current stimulation protocols
Neuromodulation
(2012) - et al.
Vestibular rehabilitation for unilateral peripheral vestibular dysfunction
Cochrane Database Syst Rev
(2015) Neurophysiology of vestibular rehabilitation
NeuroRehabilitation
(2011)- et al.
Modulating human procedural learning by cerebellar transcranial direct current stimulation
Cerebellum
(2013)
Cerebellar tDCS: how to do it
Cerebellum
The development of the dizziness handicap inventory
Arch Otolaryngol Head Neck Surg
Discussion of the dizziness handicap inventory
J Vestib Res
Manual for the state-trait anxiety inventory
Cited by (9)
Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial
2022, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :It seems that tDCS stimulation over the DLPFC area may prime the central vestibular system during therapeutic intervention, providing the potential to enhance synaptic plasticity and alleviate the chronic vestibular symptoms. In a similar study, Koganemaru et al.17 investigated the treatment outcomes of VRT combined with transcranial cerebellar Direct Current Stimulation (tcDCS) in patients (n = 16) with chronic dizziness due to vestibular dysfunction. However, contrary to our study they used tDCS over the cerebellum, which was partially combined with VRT in which the patients received VRT concurrently with either 20-min real tDCS (2 mA) or sham stimulation for 5 days.
Non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD)
2023, Cochrane Database of Systematic ReviewsEffects of non-invasive brain stimulation (NIBS) on vestibulopathy disorders: a systematic review
2023, Hearing, Balance and Communication