International Journal of Neuroscience

ISSN: 0020-7454 (Print) 1543-5245 (Online) Journal homepage: https://www.tandfonline.com/loi/ines20

The clinical application of Transcranial Direct

Current Stimulation in patients with cerebellar
ataxia: a systematic review

Graziella Orrù, Valentina Cesari, Ciro Conversano & Angelo Gemignani

To cite this article: Graziella Orrù, Valentina Cesari, Ciro Conversano & Angelo Gemignani (2020):
The clinical application of Transcranial Direct Current Stimulation in patients with cerebellar ataxia:
a systematic review, International Journal of Neuroscience, DOI: 10.1080/00207454.2020.1750399

To link to this article: https://doi.org/10.1080/00207454.2020.1750399

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The clinical application of Transcranial Direct Current
Stimulation in patients with cerebellar ataxia: a systematic
review
Graziella Orrù, Valentina Cesari, Ciro Conversano, Angelo Gemignani

Department of Surgical, Medical, Molecular & Critical Area Pathology, University of Pisa, via Savi,
10, 56126, Pisa, Italy

* Corresponding author: Dr. Graziella Orrù Department of Surgical, Medical, Molecular &
Critical Area Pathology, University of Pisa, via Savi, 10, 56126, Pisa, Italy Tel.: +39 050993654.
Fax: 050 993325. E-mail address: graziella.orru@unipi.it

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Abstract

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Aim: the aim of this review was to investigate the effects of transcranial direct current stimulation (tDCS) on motor
function in patients with cerebellar ataxia.

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Materials and Methods: our systematic review has been performed by searching full-text articles on
Pubmed and Scopus. Only studies investigating the motor effects of tDCS in patients with cerebellar
ataxias were considered. A qualitative analysis of data was performed, as the methodology of the
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selected studies was highly heterogeneous.

Results: our search yielded a total of twenty-seven hits. Based on the inclusion criteria, 19 of these
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were excluded and 9 were retained (number of patients = 81).The results reviewed so far suggest that
tDCS over cerebellum combined or not with extra-cerebellar areas might be promising approach to
improve motor outcomes, with a greater success in patients less impaired. In particular, it is been
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shown an improvement in both clinical measures assessing cerebellar deficits (i.e., gait, stance and
oculomotor disorders) and performance measures (finger dexterity, upper limb coordination and gait
speed). Some of the assessed investigations highlighted a restore effect of cerebellar brain inhibition
pathway and resting motor threshold after tDCS.
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Conclusions: tDCS could be considered an effective approach to promote plasticity in patient with
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cerebellar ataxia with significant motor effects. Future studies, with larger sample sizes are needed in
order to evaluate the effective tDCS benefits on motor functionality. Due to the limited number of
studies available so far, conclusions on the effectiveness of the reported approaches are premature.
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Keywords: Ataxia Recovery; Cerebellar Ataxias; Non-Invasive Brain Stimulation; Rehabilitation;

Systematic Review; Transcranial Direct Current Stimulation.

1. Introduction

The cerebellum is a brain structure located at the base of the skull, forming complex largescale
connections, where integrative functions are still poorly understood [1]. A damage originating in the
cerebellum is associated with cerebellar disorders. Specific cerebellum disorders refer to cerebellar
ataxias (CAs) and a significant percentage of CAs is hereditary and the indications can be disclosed
taking into account different parameters on investigation (i.e., age of onset, chronic progression,
family history and lack of acquired causes) [2]. CAs refer to conditions highly heterogeneous,
belonging to a group of genetic disorders distinguished by: lack of coordination (dysmetria),
instability of gait, kinetic tremor, gait and limb ataxia, impairment of articulation, oculomotor
abnormalities (nystagmus or saccadic dysmetria), speech difficulties (dysarthria) and impaired
swallowing (dysphagia) [3, 4]. The reported motor deficits are clinically characterized by impairment
of rate, rhythm, and force of contraction [3].

As result of genetic progresses, the number of defined cerebellar ataxias is growing (i.e., Autosomal-
Dominant CAs, Polyglutamine Expansion Spinocerebellar Ataxias, Intronic Repeat Diseases and
subtypes) [2]. There are multiple modes of inheritance of hereditary ataxia such as: autosomal
recessive, autosomal dominant, X-linked (paternal), mitochondrial forms (maternal), and incomplete
penetrance [5]. The category of inherited ataxias comprises disorders with autosomal dominant (i.e.,
Episodic Ataxias and Spinocerebellar Ataxia), autosomal recessive (i.e., identified gene-defects and
identified gene-locus) and X-linked inheritance (i.e., Fragile-X tremor ataxia syndrome) and
disorders related to mitochondrial DNA mutations [6]. The genetic forms of ataxia are diagnosed by
family history, physical examination, -neuroimaging, and molecular genetic testing. The clinical
manifestations may result from one or a combination of dysfunction of the cerebellar systems,
lesions in the spinal cord, and peripheral sensory loss [7].

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Sporadic or acquired ataxias may be attributed to various heterogeneous group of conditions or
events such as intoxication, inflammation, paraneoplastic, metabolic, endocrinal or malabsorption

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conditions. The remaining ataxia’s of unknown cause are referred to as idiopathic sporadic category
of CA. [6].

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Efficient symptomatic treatment is currently missing for the majority of CAs, therefore a great need
to identify effective medication, novel therapies and strategies is required indeed [8-12]. In this
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regard, the literature has shown a growing interest in the clinical application of transcranial direct
current stimulation (tDCS), in order to modulate cerebellar functions [11-13]. tDCS has been applied
in several neurological conditions including stroke [review, 14], Parkinson’s disease [review, 15],
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amongst others. tDCS is a widely-used non-invasive brain stimulation technique (NIBS) which
employs electrical current (typically 1 to 2 mA) to stimulate the brain through the electrodes scalp
(anode and cathode), temporarily inducing cortical excitability (anodal stimulation) or inhibition
(cathodal stimulation), thereby modulating cortical functions. The main advantage of tDCS is its
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safety as evidence of adverse side effects is quite rare [16]. Emerging researches suggest that tDCS,
in association or not with additional interventions, may reflect improvement on clinical symptoms,
inducing plasticity in cerebellar ataxia as well as other motor symptoms such as dystonia and
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essential tremor [17]. Studies have shown that, in acute and degenerative cerebellar disease, the
excitability of cortical motor areas is severely depressed functionally [18]. In this regard, it has been
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hypothesized that tDCS has the potential to modulate the excitability of the hypoexcitable motor
cortex after acute cerebellar dysfunction, suggesting a role in reversing this condition to a
physiological level of excitability [19].
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Based on the effectiveness of tDCS stimulation on a wide range of motor ataxic symptoms, we first
aim to investigate its effect in patients with CA, comparing different tDCS montages in order to
establish the most effective one for the therapeutic implications.

2. MATERIAL AND METHODS

2.1 Protocol

This review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis
(PRISMA) [20].
We included published reports of clinical trials which examined the clinical efficacy of tDCS on
motor rehabilitation (lack of coordination instability of gait, kinetic tremor, gait and limb ataxia)
using the following protocols of stimulation: a) cerebellar; b) cerebello-spinal; c) cerebello-cerebral;
d) primary motor cortex. No publication status restrictions were imposed.

2.2 Participants

We included a total of 81 patients with an age ≥ 14 with cerebellar ataxia (inherited or acquired). Of
them, 37 patients received a diagnosis of sporadic ataxia.

2.3 Types of intervention

Trials examining the clinical effectiveness and safety of neuromodulation in patients with inherited
or acquired cerebellar ataxia were included. The only neuromodulation technique included was the
tDCS.

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2.4 Outcome measures

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Only studies employing measures of clinical and motor outcomes were included. The primary
outcome was the clinical effectiveness of the intervention measured by movement disorder scales or

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related measures.

2.5 Literature Search

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Studies were identified on April 17 2019 and December 2019 by searching Medline (Pubmed) and
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Scopus electronic databases and scanning the reference list of articles employing the following
search terms: (“transcranial direct current stimulation”[MeSH Terms] OR (“transcranial”[All Fields]
AND “direct”[All Fields] AND “current”[All Fields] AND “stimulation”[All Fields]) OR
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“transcranial direct current stimulation”[All Fields] OR “tdcs”[All Fields]) AND (“ataxia”[MeSH

Terms] OR “ataxia”[All Fields]). The last search was performed on August 2019. A total of 27 hits
were returned of which we included 9 studies.
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2.6 Inclusion and exclusion criteria

Studies were included if the following inclusion criteria were met: (a) application of tDCS; (b)
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patients with cerebellar ataxias; (c) volunteer over 14 years old. We excluded from the study all
researches involving non-human subjects, duplicates and irrelevant studies (after titles and abstracts
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reading). We also excluded studies which used transcranial alternating current stimulation,
transcranial random noise stimulation and transcranial magnetic stimulation and home-based tDCS.
Furthermore, studies investigating neurological conditions other than cerebellar ataxias, were
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excluded. According to these criteria, we retained a total 9 studies.

2.7 Grouping of Studies

As stated above, studies were classified based on tDCS protocols: a) cerebellar; b) cerebello-spinal;
c) cerebello-cerebral; d) primary motor cortex. In what follows, we present the main findings of
these studies, before discussing the main results and potential limitations of the review.

3. RESULTS

3.1 Study selection

The database search provided 64 studies. Based on title and abstract reading, 31 studies were
excluded. The full texts of the remaining 33 articles were examined. Irrelevant neurological
conditions (n=1), at-home tDCS (n=1), and study involving combined stimulation techniques (n=1)
were excluded. According to the eligibility criteria, a total of 9 studies were selected and included in
the systematic review (Figure 1).

3.2 Studies characteristics

A total of 9 studies were identified through the combined search criteria and found eligible for
inclusion. A total of 81 patients were involved. Inclusion criteria varied among the studies, but all
the patients received a diagnosis related to movement disorders as previously described. All trials
applied unilateral or bilateral tDCS targeting cerebellar cortex and vermis and/or primary motor
cortex. There was a vast variability regarding the number of tDCS sessions and current intensity
used. All the 9 studies included had blinded designs (single or double). In order to evaluate the
effectiveness of tDCS on motor function, measures on motor performance were considered. A
summary of tDCS studies including protocol design, methodology and outcomes are shown in Table
1.

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atDCS, anodal tDCS; CBI, cerebellar brain inhibition; ctDCS, cathodal tDCS; CBI, cerebellar brain
inhibition; eof, end of treatment; FU, follow up; ICARS, International Cooperative Ataxia Rating

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Scale; LT, lokomat training; M1, primary motor cortex; mA, milliampere; PSD, power spectra
density; rMT, resting motor threshold; SARA, Scale for the Assessment and Rating of Ataxia; SF 36,

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Short-Form Health Survey 36; TMS, transcranial magnetic stimulation; SR, stretch reflexes; 8MW, 8-
m walking time; 9HPT, 9-hole peg test.
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3.3 Cerebellar ataxia (inherited and acquired) studies

The 9 studies included patients with cerebellar ataxia due to inherited ] or sporadic condition (total
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patients = 81; sporadic ataxia = 37; hereditary ataxia = 44). Four studies were double-blind designs
and the rest were single-blind or open label. In all studies considered, the time of evaluation after
stimulation (follow-up) varied from the end of treatment to 3 months. Table 1, summarizes the main
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parameters of the analysed studies including protocol design, methodology and motor effect
outcomes.

3.4 Studies investigating anodal tDCS over cerebellum areas

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The effect of tDCS over bilateral cerebellar cortex for the treatment of ataxic symptoms was
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extensively investigated by Benussi and colleagues [21-22]. In one study [21] nineteen patients with
different variants of ataxia underwent anodal tDCS or sham stimulation. The anode electrode was
placed on the scalp over the cerebellum area and the cathode over the right deltoid muscle. The
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investigation demonstrated significant interaction between treatment and time on the Scale for the
Assessment and Rating of Ataxia (SARA), the International Cooperative Ataxia Rating Scale
(ICARS), the 9-Hole Peg Test (9HPT), and the 8-Meter Walking Time (8MW) (p < 0.001). All
performance scores were significantly different in the sham condition, compared to the active one.
Those outcomes suggest that a single session of anodal tDCS applied to the cerebellar cortex may
enhance motor performance, improving motor and upper limb coordination.

In an additional investigation, Benussi et al., [ 22] evaluated whether ten sessions of anodal tDCS
over cerebellar area (2 cm under the inion) could improve symptoms and modulate cerebello-motor
connectivity in patients with neurodegenerative cerebellar ataxia. For this purpose, twenty patients
were recruited, twelve patients received anodal tDCS while eight patients received sham stimulation.
At baseline, the clinical measures scores (SARA, ICARS, 8MWT and 9HPT) did not differ
significantly between groups. Compare to the baseline, significant Time x Treatment interactions in
the anodal tDCS group at different time points (2-week, 1-month and 3-month follow-ups) were
detected for the SARA (partial η2 = 0.70) and ICARS (partial η2 = 0.76) scores. Significant Time x
Treatment interactions were also found in the 8MW (partial η2 =0.50) and the 9HPT (non-dominant
hand) (partial η2 = 0.14). Furthermore, the study highlighted a significant correlation between the
percentage of improvement in clinical scores and the restoration of cerebellar brain inhibition (CBI)
(p = 0.039). All the improvements were maintained for at least three months, especially in those
showing less disabling symptoms.

Grimaldi and Manto [9] performed a single blind, sham-controlled study in order to assess the effect
of anodal tDCS over cerebellar vermis and right cerebellar cortex in 9 patients different types of
cerebellar ataxia. To this purpose, the authors explored the effect of anodal tDCS and sham
stimulation on three different paradigms i) stretch reflexes in upper limbs; ii) upper limb dexterity
and coordination; iii) computerized posturography. The anode was positioned at the level of the
posterior fossa and in front of the vermis (inion level), while cathode was applied over contralateral
supra-orbital area. The results showed that real tDCS reduced the amplitudes of long-lasting latency
stretch reflexes, but no improvement was found in short latency stretch reflexes, coordination and
posture if compared to baseline or sham condition.

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Portaro et al., [23] evaluated the effects of atDCS and ctDCS combined with a robotic gait training
(Lokomat training; LT) in a patient Friedrich ataxia. The patient was provided with 3 weekly

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sessions for two months paired with atDCS combined with robotic gait training. After one month, the
patient underwent to ctDCS using the same combined tDCS-robot gait training protocol. Both atDCS

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and ctDCS combined with LT demonstrated better improvement in functional motor outcomes on the
SARA score and a strengthening of CBI compared to the stand-alone LT.
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3.5 Studies investigating spinal-cerebellar tDCS

More recently, Benussi et al., [24], investigated whether a 2-week treatment with anodal cerebellar
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tDCS and spinal cathodal tDCS could reduce clinical symptoms in patients with neurodegenerative
ataxia. Twenty-one patients were enrolled and randomized to receive sham or active stimulation. The
anode was placed over cerebellar area (anode placed 2 cm under the inion) and the cathode over the
spinal lumbar enlargement. Compared to sham stimulation, cerebello-spinal tDCS showed a
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significant Time × Treatment interactions at different time points (post-stimulation, 1-month and 3-
month follow-ups) in SARA (partial η2 = 0.68), ICARS (partial η2 = 0.64), 9HPT in both dominant
hand (partial η2 = 0.32) and non-dominant hand (partial η2 = 0.208) and 8MW (partial η2 = 0.34).
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Notably, this study suggests that patients who were less impaired showed the greatest improvement
for a long-term period (at least 3 months).
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3.6 Studies investigating cerebello-cerebral tDCS

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Interestingly, Grimaldi et al., [ 25] applied anodal cerebello-cerebral tDCS over right cerebellar
cortex followed by single anodal tDCS over left M1 to study its effect on upper limb tremor and
hypermetria in 2 patients affected with spinocerebellar ataxia type 2. After anodal cerebello-cerebral
tDCS, the following changes were detected: an improvement of postural and action tremor, measured
by spectral analysis; 2) a reduction of the magnitude of low frequency oscillations; 3) a reduction of
the onset latency of hypermetria.

In a case study, Bodranghien et al., [10] tested the effects of cerebello-cerebral tDCS over the right
cerebellar cortex on postural tremor in a patient with a marked postural tremor and an ANO10
mutation (ARCA 3). The results of the study demonstrated a significant reduction of postural tremor.
The quadratical power spectral density (PSD) dropped to 26.12% after tDCS stimulation. On the left
upper limb quadratical PSD remained within the 99% confidence interval of basal values. This case
study suggests that cerebello-cerebral tDCS might be a promising therapeutic protocol in order to
reduce tremor in ARCA3, but further investigation are needed.

3.7 Studies investigating anodal and cathodal tDCS over Motor Cortex

Pozzi and colleagues [ 26] investigated the effect of five sessions of bilateral tDCS over the primary
motor cortex (M1). Anode was placed on the motor cortex contralateral to the most affected side,
while the cathode ipsilateral to the less affected side of the body. SARA and gait measures analysis
were performed. Results showed an improvement of symmetry in steps execution and a reduction of
base-width lasting 30 days after active tDCS compared to sham stimulation.

Barretto and colleagues [27] tested the effects of anodal tDCS over motor cortex (C3 or C4) and
sham stimulation at different times. In this study active tDCS and sham stimulation were applied to
participants for five consecutive days. Results showed improvement in gait parameters, SARA total
score, the Wii Fit platform after active tDCS compared to sham stimulation (p = 0.03).

DISCUSSION

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The aim of this systematic review was to investigate the effects of tDCS in patients with CA, taking
into account the sites of stimulation, tDCS protocols and outcomes measures. To this purpose, eight

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studies were selected and included in the systematic review. As studies varied widely in terms of
methodology and type of stimulation, as well as type of outcome measures, data were not suited for a

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quantitative synthesis. The discussion of tDCS effectiveness on ataxic symptoms will be conducted
according to the sites of stimulation, taking into account the limitations of the studies included in
each category.
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In general terms, anodal tDCS of the cerebellar cortex showed significant improvement related to
performance scores, as measured by SARA, ICARS, 9HPT, 8MW [ 21, 22, 24]. Interestingly,
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Grimaldi et al., [9] suggested that anodal tDCS of the cerebellum might reduce the amplitudes of
long-lasting stretch reflexes “by increasing the inhibitory effect generated by the cerebellar cortex
upon cerebellar nuclei” (p. 2437).
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In regard to the cerebello-cerebral tDCS, Grimaldi et al., [25] applied anodal cerebello-cerebral tDCS
over right cerebellar cortex followed by single anodal tDCS over left M1. The study demonstrated,
for the first time, a reduction of upper limb tremor and hypermetria in dominant spinocerebellar
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ataxia (type 2). Later, Bodriaghien et al., [10] found a significant reduction of postural tremor after
anodal tDCS delivered over right cerebellar cortex and cathodal tDCS over contralateral M1
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compared to the baseline. Despite the uncourageous results about the effectiveness of cerebello-
cerebral tDCS, there is some limitations that preclude robust conclusions: the first is the small
sample size [10, 25]. A second limitation is the lack of investigation of tDCS after-effects [25] the
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lack of successive recordings during repeated administrations over several weeks in order to
characterize the dynamic profile of the response and the impact on daily life [10].

Regarding the stimulation of motor cortex, Pozzi and colleagues [26] suggested that anodal tDCS
targeting the contralateral to most affected side M1 and cathodal tDCS ipsilateral to the most
affected side M1 might improve gait symmetry for a short period of time. However, authors also
explained that a larger sample size is needed in order to establish the best method of stimulation in
terms of timing, amplitude, and area of application to improve the magnitude of efficacy; second,
how to reach a long lasting clinical effect, in order to influence durably the patient's quality of life.

Positive effects on ataxic symptoms were also detected by Barretto and colleagues [27] after anodal
tDCS over motor cortex (C3 or C4 at different times). Results showed improvement in some motor
parameters, therefore it could be considered an effective treatment for CA, even if the authors
highlighted how the small sample size does not allow for identification of differences in specific
parameters.

The involvement of motor cortex in cerebellar dysfunction has been established, as well as the role
of tDCS in modifying excitability of motor cortex [19, 28].

tDCS may exerts a restorative effect over cerebello-thalamo-cortical pathway through the
enhancement of motor cortical activity, resulting in a better motor performance in cerebellar disorder
and a reduction of ataxic symptoms without the direct stimulation of the cerebellum area [24,27].

Benussi et al. [24] shown positive results after cerebello-spinal tDCS suggesting that concurrent
cathodal stimulation over spinal lumbar enlargement can be a more effective protocol compared to
cerebellar tDCS alone. These findings highlight a pivotal role of the cerebello-cerebral tDCS, in
promoting neuromodulation on cerebello-thalamo-cortical pathway, enhancing motor performance in
CA individuals. However, the same authors declared that a clear-cut associations need to be made
with caution their group of patients was relatively small and heterogeneous.

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This review suffers from a number of limitations. The major challenges encountered were the
following: significant heterogeneity in the types of ataxia (inherited vs sporadic), disease stage (mild
vs moderate vs severe), impairment level (mild vs moderate), sample size, tDCS methodology, brain

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site stimulation and stimulation parameters and homogeneity of outcome measures.

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In conclusion, the results reviewed so far suggest that tDCS over cerebellar cortex, cerebellar-spinal
tDCS [29], cerebello-cerebral tDCS might be promising approaches in order to improve motor
function in patients with CA, with a greater success in those individuals less impaired. Due to a
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limited number of studies available so far, conclusions on the effectiveness of the reported
approaches are premature.
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CONCLUSION AND FUTURE PERSPECTIVES

tDCS is a noninvasive brain technique widely used in psychiatric domains [reviews 30, 31], in
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neurological diseases to treat for example motor symptoms in different clinical conditions such as
stroke [14, 32], Parkinson’s disease and other movement disorders [33, 34] amongst others. In this
review, we gathered preliminary evidence that tDCS is able to improve motor ataxic symptoms,
representing an alternative treatment in CA. However, the sole and direct stimulation of the
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cerebellum might not represent the most effective tDCS protocol for the improvement of CA
symptomatology. In particular, it seems reasonable to consider motor cortex as an ideal stimulation
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brain site, due to the important involvement in CA. In conclusion, this systematic review suggests
that an optimal tDCS protocols is not limited to the modulation of cerebellar area, highlighting the
possibility to acts on a more extended circuitry in order to exerts a greater improvement on ataxic
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symptomatology.

However, future studies with larger sample sizes and less homogeneity between outcome measures
are needed to compare tDCS protocols. Moreover, a stratification within the group of patients based
on the severity of ataxia is needed in order to assess the efficacy of tDCS and identify the most
effective parameter to ameliorate the ataxic deficits. As well as the assessment of long lasting effects
of tDCS. Another risk is linked to the high variability within the sample size, in which various forms
of ataxia (inherited and acquired) are present. The latter has to be taking into account for the
evaluation of different level of effectiveness due to different form of ataxia and, moreover, to
establish if varies form of ataxia require a personalized protocol of intervention.

Conflict of interest
The authors of this article have no competing interest to declare.

Funding

The research leading to these results was funded by the Project “Brain Machine Interface in space
manned missions: amplifying Focused attention for error Counterbalancing” (BMI-FOCUS, Tuscany
Region POR CREO 2014/2020)”.

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 Table 1. Detailed intervention parameters of tDCS sessions

Author Sample Trial Polarity Electrod Current/Dura Outcom Results

type e tion/Session/F es
position/ U measure
referenc s
es
Grimaldi N=9 Single- atDCS/s Anode: 1 mA; 20 min; SR; Significant reduction in
and blind, ham right 1; FU: - MCT; amplitude of long-lasting
Manto, 5=spora sham- cerebella computer stretch reflexes
2013 dic; controll r cortex ized
ed and posturog
cerebella raphy
4
r vermis
=heredit
ary
Referenc
e:
contralat
eral

t
supraorbi

ip
tal area
Pozzi et N=3 Single- atDCS/s Anode: 2 mA; 20 min; SARA; Significant improvement in
al., 2013 hereditar blind, ham M1 5; FU: 15 and symmetry of step execution

cr
y sham- contralat 30 days Gait assessed with gait analysis and
controll eral to analysis decrease of base-width lasting
ed the 30 days
affected
side;
us
an
Cathode:
M1
ipsilatera
l to the
M

affected
side

Referenc
ed

es:
contralat
eral
forehead
pt
ce

Grimaldi N= 2 Single- atDCS/s Anode: 1 mA; 20 min; SARA; Significant reduction of: PSD
et al., hereditar blind, ham right 1; FU: - upper peak (by 38.63% and 41.42%
2014 y sham- cerebella limbs in both patients); magnitude of
controll r cortex, tremor; low frequency oscillation (by
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ed left M1 hypermet 46.9% and 62.3%, in both

ria patients); the onset latency of
Referenc the hypermetria (~ 41% and
e: 45%)
contralat
eral
supraorbi
tal area
and right
supraorbi
tal area
Benussi N=19 Random atDCS/s Anode: 2mA; 20 min; SARA; Significant improvement of
et al., ized, ham cerebella 1; FU: - ICARS; SARA, ICARS, 9HPT and
2015 8=spora r Cortex 9HPT; 8MW
dic; double- 8MW
blind, Referenc
11=here cross- es: Right
ditary over deltoid
muscle

Benussi N=20 Random atDCS/s Anode: 2mA; 20 min; SARA; Significant Improvement in
et al., ized, ham Cerebell 20; FU: 4 and ICARS; SARA, ICARS, CBI over time
2017 10=spor double- ar Cortex 12 weeks 9HPT;
adic; blind, 8MW,
10=here sham- Referenc TMS-
ditary controll es: Right CBI
ed deltoid
muscle

t
ip
Bodrang N=1 Single- atDCS/ Anode: 1,5mA; 20 SARA; Significant reduction of the
hien et hereditar blind, sham Right min; 1; FU: - Trace of power spectral density to
al., 2017 y sham- cerebella accelero 26.12% of basal values

cr
controll r cortex metry;
ed spectral

us
Cathode: paramete
Contralat rs of
eral postural
motor tremor
an
cortex
M

Benussi N=19 Random atDCS/ct Anode: 2 mA; 20 min; SARA; Significant improvement on
et al., ized, DCS/sha cerebellu 10; FU: 1 and ICARS; SARA, ICARS, 9HPT, 8MW,
2018 10= double- m m area (2 3 months 9HPT; CBI, rMT, SF 36. Clinical
sporadic blind, cm under 8MW, improvements were maintained
ed

; sham- the TMS- at 3 months FU

controll inion); CBI;
ed, TMS-
9=
crossove Cathode: rMT;
hereditar
pt

y r trial spinal SF36

lumbar
enlargem
ce

ent
Barretto N=7 Double- Bilateral Anode: 2 mA (1 mA SARA; Significant improvement in gait
et al., blind, tDCS/sh C3 and for the first and Analysis parameters and in the total
2019 sham- am C4 last min); 40 of score of the SARA scale and
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3=spora
dic; controll min (20 min posture Wii Fit platform after tDCS
ed Cathode: for C3/C4); 5; and
opposite FU: - balance
4=
supraorbi through
hereditar
y tal the Wii
region Fit
platform
and
CvMob
software
Portaro N=1 Open atDCS Anode: 2 mA; 10 min; SARA; Both atDCS and ctDCS
et al., label over 24; CBI combined with LT
2019 1= both demonstrated better
hereditar lateral FU: eof; 1 improvement in functional
posterior motor outcomes on the SARA
y cerebella month score and a strengthening of
r cortices CBI compared to the stand-
alone LT.
Cathode:
over
both
cheeks

Cathode:
over

t
both
ctDCS

ip
lateral
posterior
cerebella 2 mA; 10 min;

cr
r cortices 24;

FU: eof; 1

us
month
an
M
ed
pt
ce
Ac
 t
ip
cr
us
an
Figure 1. Flow diagram of study selection
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ed
pt
ce
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