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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(07): 630-646
DOI: 10.1590/0004-282X-ANP-2020-0381
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Use of non-invasive stimulation in movement disorders: a critical review

O uso da estimulação não-invasiva em distúrbios do movimento: uma revisão crítica
Clecio Godeiro 
1   Universidade Federal do Rio Grande do Norte, Departamento de Medicina Integrada, Natal RN, Brazil.
,
Carina França 
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
Rafael Bernhart Carra 
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
Felipe Saba 
3   Universidade Estadual de Campinas, São Paulo SP, Brazil.
,
Roberta Saba 
4   Hospital do Servidor Público Estadual, São Paulo SP, Brazil.
5   Universidade Federal de São Paulo, São Paulo SP, Brazil.
,
Débora Maia 
6   Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil.
,
Pedro Brandão 
7   Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil.
,
Nasser Allam 
7   Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil.
,
Carlos R. M. Rieder 
8   Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre RS, Brazil.
,
Fernando Cini Freitas 
9   Hospital Governador Celso Ramos, Serviço de Neurologia, Florianópolis SC, Brazil.
,
Tamine Capato 
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
10   Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, Netherlands.
,
Mariana Spitz 
11   Universidade do Estado do Rio de Janeiro, Unidade de Distúrbios do Movimento, Rio de Janeiro RJ, Brazil.
,
Danilo Donizete de Faria 
4   Hospital do Servidor Público Estadual, São Paulo SP, Brazil.
5   Universidade Federal de São Paulo, São Paulo SP, Brazil.
,
Marcela Cordellini 
12   Instituto de Neurologia de Curitiba, Curitiba PR, Brazil.
,
Beatriz A. A. G. Veiga 
5   Universidade Federal de São Paulo, São Paulo SP, Brazil.
,
Maria Sheila G. Rocha 
13   Hospital Santa Marcelina, Departamento de Neurologia e Neurocirurgia Funcional, São Paulo SP, Brazil.
,
Ricardo Maciel 
6   Universidade Federal de Minas Gerais, Departamento de Medicina Interna, Unidade de Distúrbios do Movimento, Belo Horizonte MG, Brazil.
,
Lucio B. De Melo 
14   Universidade Estadual de Londrina, Serviço de Neurologia, Londrina PR, Brazil.
,
Patricia D. S. Möller 
15   Hospital da Criança de Brasília José Alencar, Unidade Pediátrica de Distúrbios do Movimento, Brasília DF, Brazil.
,
R.R. Magno  Júnior
16   Universidade Federal do Maranhão, Hospital Universitário, São Luís MA, Brazil.
,
Luís H. T. Fornari 
17   Santa Casa de Misericórdia de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil.
,
Carlos E. Mantese 
18   Hospital Mãe de Deus, Serviço de Neurologia, Porto Alegre RS, Brazil.
,
Egberto Reis Barbosa 
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
Renato P. Munhoz 
19   University of Toronto, Toronto Western Hospital - UHN, Division of Neurology, Morton and Gloria Shulman Movement Disorders Centre and Edmond J. Safra Program in Parkinson’s Disease, Toronto ON, Canada.
20   Krembil Brain Institute, Toronto ON, Canada.
,
Marcus Vinicius Della Coletta 
21   Universidade do Estado do Amazonas, Manaus AM, Brazil.
,
Rubens Gisbert Cury 
2   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
on behalf of Neuromodulation for Movement Disorders Study Group, Brazilian Academy of Neurology › Author Affiliations
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Abstract

Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson’s disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

Resumo

Introdução: A estimulação não-invasiva tem sido amplamente utilizada nos últimos 30 anos no estudo e no tratamento de um grande número de doenças neurológicas, incluindo distúrbios do movimento. Objetivos: Nesta revisão crítica, discutimos o embasamento científico do uso da estimulação não-invasiva em distúrbios do movimento e as evidências científicas dos principais ensaios clínicos realizados. Métodos: Um grupo de especialistas realizou uma revisão crítica abrangente da literatura a fim de analisar as principais aplicações da estimulação magnética transcraniana (EMT) e da estimulação transcraniana por corrente contínua (ETCC) em distúrbios do movimento. As classes de evidência e de recomendação foram descritas para cada doença. Resultados: Apesar da grande variabilidade da metodologia e baixo efeito clínico, a EMT é provavelmente eficaz para o tratamento dos sintomas motores e da depressão na doença de Parkinson. A eficácia em outros distúrbios do movimento ainda é incerta. A EMT é possivelmente eficaz para o tratamento da distonia focal da mão, do tremor essencial e da ataxia cerebelar. No entanto, é provavelmente ineficaz na redução dos tiques na síndrome de Tourette. Finalmente, a ETCC é provavelmente eficaz na melhora da marcha na doença de Parkinson. Conclusões: As evidências até o momento sugerem que a estimulação não-invasiva pode ser benéfica para o alívio de alguns sintomas em determinados distúrbios do movimento como a doença de Parkinson, o tremor essencial, a distonia e a ataxia. Os protocolos de aplicação e paradigmas de estimulação ainda precisam ser investigados em ensaios clínicos maiores, assim como os seus efeitos a longo prazo.

Keywords:

Parkinson’s Disease - Movement Disorders - Transcranial Direct Current Stimulation - Transcranial Magnetic Stimulation

Palavras-chave:

Doença de Parkinson - Distúrbios do Movimento - Estimulação Transcraniana por Corrente Direta - Estimulação Magnética Transcraniana

Authors’ contributions:

CG, RGC: conceptualization, validation, writing - original draft; RBC, CF: writing - original draft; FS, RS, DM, PB, NA, CRMR, FCF, TC, MS, DDF, MC, BAAGV, MSGR, RM, LBM, PDSM, MRRJ, LHTF, CEM, ERB, RPM, MVDC: conceptualization, review and editing.


Supplementary Files



Publication History

Received: 13 August 2020

Accepted: 21 October 2020

Article published online:
10 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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