Can transcranial Direct Current Stimulation enhance the efficacy of a rehabilitative intervention for the treatment of Freezing of Gait in Parkinson's disease? A double-blind, randomized controlled study

Background Freezing of gait (FOG) in Parkinson's disease (PD) is a major cause of disability and falls and often responds incompletely to conventional therapy. Rehabilitative interventions including cognitive strategies and sensory cueing are efficacious, but difficulties in learning impair executing these strategies. Transcranial direct current stimulation (tDCS) enhances motor task learning and might enhance the efficacy of rehabilitative interventions. Objective We assessed whether tDCS can enhance the efficacy of physiotherapy for FOG in PD. Methods In a randomized, double-blind, controlled study, anodal tDCS (pre-/motor cortex) or sham-tDCS were delivered combined with a standardized rehabilitative intervention in 24 PD patients with FOG for eight sessions within four weeks. Clinical assessment included walking a Parcourse, timed gait tests, FOG questionary, and clinical scales at baseline, across the interventions with a follow-up 3-months after the last intervention. Results Nineteen PD patients with FOG completed the study. TDCS combined with physiotherapy reduced FOG, but not more than physiotherapy alone Conclusion Combining tDCS with physiotherapy did not enhance its efficacy in reducing FOG.