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Citation
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Wuehr M, Schmidmeier F, Katzdobler S, Fietzek UM, Levin J, Zwergal A. J. Parkinsons Dis. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Postural instability is a major disabling factor in patients with advanced Parkinson's disease (PD) and often resistant to treatment. Previous studies indicated that imbalance in PD may be reduced by low-intensity noisy galvanic vestibular stimulation (nGVS).
OBJECTIVE: To investigate the potential mode of action of this therapeutic effect. In particular, we examined whether nGVS-induced reductions of body sway in PD are compatible with stochastic resonance (SR), a mechanism by which weak sensory noise stimulation can paradoxically enhance sensory information transfer.
METHODS: Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 15 patients with PD standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal reductions of sway at intermediate nGVS intensities to be indicative of SR. An established SR-curve model was fitted on individual patient outcomes and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR.
RESULTS: nGVS-induced reductions of body sway compatible with SR were found in 10 patients (67%) with optimal improvements of 23±13%. In 7 patients (47% ), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 30±10% ), indicative of strong SR. This beneficial effect was more likely in patients with advanced PD (R = 0.45; p = 0.045).
CONCLUSIONS: At least half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with low-intensity nGVS. In particular, patients with more advanced disease stages and imbalance may benefit from the non-invasive and well-tolerated treatment with nGVS.
Language: en |