Shiga et al., 200265. Shiga Y, Tsuda T, Itoyama Y, et al. Transcranial magnetic stimulation alleviates truncal ataxia in spinocerebellar degeneration. J Neurol Neurosurg Psychiatry. 2002 Jan;72(1):124-6. https://doi.org/10.1136/jnnp.72.1.124 https://doi.org/10.1136/jnnp.72.1.124...
|
Double-blind sham-controlled |
74 spinocerebellar degeneration cases (cerebellar type x OPCA type): 39 active, 35 placebo |
Single pulse TMS (1 pulse every 6 s, 10 pulses per site, total 30 pulses per session), in 21 sessions with 14 cm circular coil at 250% RMT. |
Cerebellum (over the inion; 4 cm to the left and 4 cm to the right) |
Improvement in 10 m time, 10 m steps, tandem steps and standing capacities, especially regarding cerebellar type. |
7 |
Class III |
Ihara et al., 200566. Ihara Y, Takata H, Tanabe Y, et al. Influence of repetitive transcranial magnetic stimulation on disease severity and oxidative stress markers in the cerebrospinal fluid of patients with spinocerebellar degeneration. Neurol Res. 2005 Apr;27(3):310-3. https://doi.org/10.1179/016164105X39897 https://doi.org/10.1179/016164105X39897...
|
Single-blind, uncontrolled |
20 spinocerebellar degeneration cases (10 OPCA, 6 CCA, 4 SCA6) |
Single-pulse TMS (1 pulse every 5 s, 10 pulses per site, total 30 pulses per session), in 24 sessions with 70 mm figure-of-eight coil at 100% maximum stimulator output. |
Cerebellum (over the inion; 4 cm to the left and 4 cm to the right) |
Improvement in ataxia (ICARS) by 13.5% (38.15 ± 18.43 vs 33.01 ± 17.26, p = 0.003) |
5 |
Class III |
Koch et al., 200862. Koch G, Rossi S, Prosperetti C, et al. Improvement of hand dexterity following motor cortex rTMS in multiple sclerosis patients with cerebellar impairment. Mult Scler. 2008 Aug;14(7):995-8. https://doi.org/10.1177/1352458508088710 https://doi.org/10.1177/1352458508088710...
|
Open-label sham-controlled crossover (one day of washout) |
8 multiple sclerosis cases with cerebellar symptoms + 7 healthy subjects |
5 Hz rTMS (18 trains of 50 stimuli, with 40 s pause, total 900 pulses per session), in one session with 90 mm figure-of-eight coil at 100% RMT. |
M1 (contralateral to the dominant limb) |
Improvement in hand dexterity (9HPT) immediately after and 10 min after. |
4 |
Class IV |
Grimaldi and Manto et al., 201367. Grimaldi G, Manto M. Anodal transcranial direct current stimulation (tDCS) decreases the amplitudes of long-latency stretch reflexes in cerebellar ataxia. Ann Biomed Eng. 2013 Nov;41(11):2437-47. https://doi.org/10.1007/s10439-013-0846-y https://doi.org/10.1007/s10439-013-0846-...
|
Single-blind sham-controlled crossover (> 6 days of washout) |
9 cerebellar ataxia cases (1 immune ataxia; 1 paraneoplastic ataxia; 3 SAOA; 1 autosomal recessive ataxia; 3 dominant ataxia) |
Anodal tDCS, in one session at 1 mA. |
Right cerebellum hemisphere and vermis (over the inion and 3 cm to right) |
No change in posturography and upper limb dexterity. |
4 |
Class III |
Bonnì et al., 201460. Bonnì S, Ponzo V, Caltagirone C, Koch G. Cerebellar theta burst stimulation in stroke patients with ataxia. Funct Neurol. 2014 Jan-Mar;29(1):41-5.
|
Open-label |
6 posterior circulation stroke cases with ataxia |
rTMS (iTBS, 3 pulses at 50 Hz repeated at a rate of 5 Hz; 20 trains of 10 bursts delivered at 8-sec intervals; total duration: 190 sec, 600 pulses), in 10 sessions with 70 mm figure-of-eight coil at 80% RMT + physiotherapy. |
Cerebellar hemisphere (ipsilateral to the lesion) |
Improvement in ataxia (MICARS) by 18%, especially posture and gait subscales. Total score: pre-iTBS = 53.4 ± 13.0 vs post-iTBS = 43.8 ± 12.1 |
5 |
Class IV |
Kim et al., 201461. Kim W-S, Jung SH, Oh MK, et al. Effect of repetitive transcranial magnetic stimulation over the cerebellum on patients with ataxia after posterior circulation stroke: a pilot study. J Rehabil Med. 2014 May;46(5):418-23. https://doi.org/10.2340/16501977-1802 https://doi.org/10.2340/16501977-1802...
|
Double-blind sham-controlled |
32 posterior circulation stroke cases with ataxia |
rTMS (1 Hz, 15 min duration, total 900 pulses per session), in five sessions with 75 mm figure-of-eight coil at 100% RMT. |
Cerebellar hemisphere (2 cm under the inion and 2 cm ipsilateral to the lesion) |
Improvement in the 10 m walk test 1 month afterwards. Balance (BBS) improved after five days and after one month. |
7 |
Class III |
Benussi et al., 201559. Benussi A, Koch G, Cotelli M, et al. Cerebellar transcranial direct current stimulation in patients with ataxia: a double-blind, randomized, sham-controlled study. Mov Disord. 2015 Oct;30(12):1701-5. https://doi.org/10.1002/mds.26356 https://doi.org/10.1002/mds.26356...
|
Double-blind sham-controlled crossover (one week of washout) |
19 cerebellar ataxia cases (5 SCA2; 1 SCA1; 2 SCA 38; 1 Friedreich’s ataxia; 1 AOMA2; 6 MSA-C; 1 FXATAS and 2 SAOA) |
Anode tDCS 1 session with 2 mA. |
Cerebellum |
Improvement in ataxia by 10% (SARA) and 12.2% (ICARS). Hand dexterity also improved by 8% (9HPT) and gait by 10.7% (8MW) |
9 |
Class III |
Grecco et al., 2016 |
Single-blind, sham-controlled, crossover (three months of washout) |
6 ataxic cerebral palsy patients |
Anodal tDCS 20 min duration, in 10 sessions with 1 mA + treadmill training. |
Cerebellum (1 cm under the inion) |
Improvement in hip oscillation during eyes-closed gait (stabilimeter evaluation) |
9 |
Class III |
Benussi et al., 201768. Benussi A, Dell’Era V, Cotelli MS, et al. Long term clinical and neurophysiological effects of cerebellar transcranial direct current stimulation in patients with neurodegenerative ataxia. Brain Stimul. 2017 Mar 1;10(2):242-50. https://doi.org/10.1016/j.brs.2016.11.001 https://doi.org/10.1016/j.brs.2016.11.00...
|
Double-blind sham-controlled |
20 neurodegenerative ataxias (5 SCA 2; 2 SCA 38; 1 SCA 14; 1 Friedreich’s ataxia; 1 AOMA2; 4 MSA-C; 1 FXATAS; 5 SAOA) + 10 healthy controls |
Anodal tDCS, in 10 sessions with 2 mA. |
Cerebellum (2 cm under the inion) |
Improvement lasting at least three months in SARA (17.4%), ICARS (20.2%), gait (27%) and handwriting (8.5%) |
8 |
Class III |
Benussi et al., 201869. Benussi A, Dell’Era V, Cantoni V, et al. Cerebello-spinal tDCS in ataxia: a randomized, double-blind, sham-controlled, crossover trial. Neurology. 2018 Sep 18;91(12):e1090-101. https://doi.org/10.1212/WNL.0000000000006210 https://doi.org/10.1212/WNL.000000000000...
|
Double-blind sham-controlled crossover (three months of washout) |
20 neurodegenerative ataxia cases (7 SCA2; 5 MSA-C; 1 SCA38; 1 SCA14; 1 Friedreich ataxia; 1 AOMA2; 4 SAOA) |
Anodal tDCS (cerebellum) and cathodal tDCS (spinal cord), in 10 sessions with 2 mA. |
Cerebellum (2 cm under the inion) and spinal cord (2 cm under T11) |
Improvement lasting at least 3 months in SARA (20.3%), ICARS (16.6%), 8MW (10.6%), 9HPT (6.6%) and SF-36 (10.5%). |
8 |
Class II |
Manor et al., 201957. Manor B, Greenstein PE, Davila-Perez P, et al. Repetitive transcranial magnetic stimulation in spinocerebellar ataxia: a pilot randomized controlled trial. Front Neurol. 2019 Feb 12;10:73. https://doi.org/10.3389/fneur.2019.00073 https://doi.org/10.3389/fneur.2019.00073...
|
Double-blind sham-controlled |
20 spinocerebellar ataxia cases |
Single pulse TMS (1 pulse every 6 s, 10 pulses per site, total 30 pulses per session), in 20 sessions with 14 cm circular coil at 100% maximum stimulator output. |
Cerebellum (over the inion; 4 cm to the left and 4 cm to the right) |
Improvement only in stance sub-score of SARA and standing postural sway metrics. |
8 |
Class II |