Transcranial Direct Current Stimulation (tDCS) to Improve Gait in Multiple Sclerosis: A Timing Window Comparison

Craig D Workman, John Kamholz, Thorsten Rudroff, Craig D Workman, John Kamholz, Thorsten Rudroff

Abstract

Unilateral weakness of the lower limb is a hallmark of multiple sclerosis (MS) and a significant contributor to the progressive worsening of walking ability. There are currently no effective rehabilitation strategies targeting strength asymmetries and/or gait impairments in people with MS (PwMS). Transcranial direct current stimulation (tDCS) has improved motor outcomes in various populations, but the effect of tDCS on gait in PwMS and the ideal timing window of tDCS application are still unknown. This study investigated the effects of tDCS, either before or during a 6 min walk test (6MWT), on the distance walked and gait characteristics in PwMS. Twelve participants were recruited and randomly assigned into BEFORE or DURING groups (both n = 6). The BEFORE group received stimulation before performing a 6MWT (sham/2 mA, 13 min). The DURING group received stimulation only during a 6MWT (sham/2 mA, 6 min). Stimulation was over the more MS-affected primary motor cortex (M1). Distance walked and gait characteristics of the walk were the primary and secondary outcomes. The results indicated a significant decrease in distance walked in the DURING group (p = 0.026) and a significant increase in gait velocity in the BEFORE group (p = 0.04). These changes were accompanied by trends (p < 0.1) in distance walked, gait velocity, and stride length. Overall, the results of this study suggest that tDCS performed before a 6MWT might be more effective than tDCS during a 6MWT and that a single session of tDCS may not be sufficient to influence gait. Clinical Trial Registration: www.ClinicalTrials.gov, identifier #NCT03757819.

Keywords: 6-min walk test; gait; multiple sclerosis; neuromodulation; transcranial direct current stimulation (tDCS).

Copyright © 2019 Workman, Kamholz and Rudroff.

Figures

Figure 1
Figure 1
Distance walked in the 6-min walk test. Data are mean ± SEM. *Indicates significantly different from sham.
Figure 2
Figure 2
Gait velocity in the 6-min walk test. Data are mean ± SEM. *Indicates significantly different from sham.

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