• Brain Stimul · Mar 2018

    Effects of cerebellar neuromodulation in movement disorders: A systematic review.

    • Carina França, de Andrade Daniel Ciampi DC Transcranial Magnetic Stimulation Laboratories, Psychiatry Institute, University of São Paulo, São Paulo, Brazil; Pain Center, Department of N, Manoel Jacobsen Teixeira, Ricardo Galhardoni, Valquiria Silva, Egberto Reis Barbosa, and Rubens Gisbert Cury.
    • Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Transcranial Magnetic Stimulation Laboratories, Psychiatry Institute, University of São Paulo, São Paulo, Brazil. Electronic address: franca.carina@gmail.com.
    • Brain Stimul. 2018 Mar 1; 11 (2): 249-260.

    BackgroundThe cerebellum is involved in the pathophysiology of many movement disorders and its importance in the field of neuromodulation is growing.ObjectivesTo review the current evidence for cerebellar modulation in movement disorders and its safety profile.MethodsEligible studies were identified after a systematic literature review of the effects of cerebellar modulation in cerebellar ataxia, Parkinson's disease (PD), essential tremor (ET), dystonia and progressive supranuclear palsy (PSP). Neuromodulation techniques included transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). The changes in motor scores and the incidence of adverse events after the stimulation were reviewed.ResultsThirty-four studies were included in the systematic review, comprising 431 patients. The evaluation after stimulation ranged from immediately after to 12 months after. Neuromodulation techniques improved cerebellar ataxia due to vascular or degenerative etiologies (TMS, tDCS and DBS), dyskinesias in PD patients (TMS), gross upper limb movement in PD patients (tDCS), tremor in ET (TMS and tDCS), cervical dystonia (TMS and tDCS) and dysarthria in PSP patients (TMS). All the neuromodulation techniques were safe, since only three studies reported the existence of side effects (slight headache after TMS, local skin erythema after tDCS and infectious complication after DBS). Eleven studies did not mention if adverse events occurred.ConclusionsCerebellar modulation can improve specific symptoms in some movement disorders and is a safe and well-tolerated procedure. Further studies are needed to lay the groundwork for new researches in this promising target.Copyright © 2017 Elsevier Inc. All rights reserved.

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