THE IMPACT OF NON-INVASIVE BRAIN STIMULATION ON POSTURAL DISORDERS IN PATIENTS WITH PARKINSON’S DISEASE: A SYSTEMATIC REVIEW

Autori

Martina Ceriani (1Bachelor degree Physiotherapy, School of Medicine, University of Insubria, Varese, Italy 2 Division of Physiotherapy, IRCCS Istituto Auxologico Italiano, Piancavallo (Verbania), Italy.)

Elisa Ravizzotti (Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy. 4 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.)

Background and aims

Axial postural disorders, as camptocormia, Pisa syndrome, scoliosis and anterocollis, are frequently observed in individuals with Parkinson’s disease. These symptoms worsen with disease progression and are poorly responsive to standard pharmacological treatments, leading to a greater functional impairment and a significant decline in quality of life. NIBS techniques, including tDCS and  rTMS, have emerged as potential therapeutic tools for improving motor function.The main purpose of this systematic review was to synthesize current evidence on the effectiveness of NIBS in managing axial postural disorders in patients with PD.

Methods

The literature search for this review was conducted across five major bibliographic databases: PubMed, the Cochrane Library, Scopus, Web of Science, and CINAHL. The search strategy, from inception to April 2024, was structured using the Problem-Intervention-Outcome. The selection process followed a structured approach: initial removal of duplicates, title and abstract screened by 2 independent reviewers, and full-text selection with data extraction. The review included trials involving adult patients with PD who underwent rehabilitation interventions based on NIBS techniques. To be eligible, studies had to assess at least one outcome related to postural alignment or postural control, in static or dynamic condition. Studies were excluded if they involved patients with a DBS implant.The risk of bias of the included clinical trial studies was assessed using the Cochrane RoB 2, the  version for crossover studies, and ROBINS-I.

Results

From 1.018 records, a total of four RCTs, one cross-over study and one non-randomized clinical trial study, met the inclusion criteria, involving 157 participants with PD at a mild to moderate stage. Five studies investigated the effects of tDCS, only one utilized rTMS. In all studies the target of the intervention was M1, with unilateral or bilateral application and administration in an online setting. The control interventions showed a sham stimulation. Improvements in postural control measures reported as changes in Centre of Pressure, Limits of Stability and Range of Motion of the trunk were found in all studies. Risk of bias assessment revealed high risk in four studies, moderate in one, and some concerns in another one.

Conclusion

The findings from this review support the potential role of NIBS techniques in managing postural disorders in individuals with PD. In particular, tDCS appears to be a promising intervention, showing short-term effectiveness in enhancing postural stability. There were limitations such as small sample sizes and short follow-up periods. Future RCTs with larger patient samples, standardized protocols, and longer follow-up are needed.

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