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Transcranial stimulation — a noninvasive technique that delivers low electrical currents to the brain to fine-tune nerve cell activity — improved muscle strength and quality of life in people with <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS) in a small clinical trial.
Researchers also found that a two-week course of transcranial direct current stimulation (tDCS) restored electrical activity through certain neuronal circuits, and that each additional treatment course significantly lowered the risk of death by 71%.
“Our study provides compelling evidence for the potential benefits of cortico-spinal tDCS as a therapeutic and rehabilitative approach for patients with ALS,” the scientists wrote. Still, “larger and more comprehensive clinical trials are necessary to confirm these results and further investigate the mechanisms underlying these effects.”
The study, “<a href="https://www.sciencedirect.com/science/article/pii/S1935861X23019514">Cortico-spinal tDCS in amyotrophic lateral sclerosis: A randomized, double-blind, sham-controlled trial followed by an open-label phase</a>,” was published in <a href="https://www.sciencedirect.com/journal/brain-stimulation">Brain Stimulation</a>.
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<h3>Transcranial stimulation allows neurons to fine-tune responses to stimuli</h3>
ALS is a progressive disease that damages motor neurons, the nerve cells that control voluntary muscles in the body. Without motor neurons, the brain is no longer able to control movement, causing muscle weakness and a range of other <a href="https://alsnewstoday.com/symptoms-of-als/">disease symptoms</a>.
<a href="https://alsnewstoday.com/what-is-als/#Life_expectancy">Life expectancy with ALS</a> varies depending on which symptoms appear first and how rapidly the disease progresses. While medications can slow disease progression and extend survival, not every patient responds well to current <a href="https://alsnewstoday.com/als-treatment/">disease treatment options</a>.
Transcranial direct current stimulation is a noninvasive approach that uses constant, low-intensity electrical currents, passed through small electrodes applied to the scalp, to stimulate certain regions of the brain.
It aims to fine-tune neuronal responses to stimuli, allowing the brain to rewire itself in a way that differs from how it previously functioned. This has been shown to slow progression in neurodegenerative diseases such as <a href="https://parkinsonsnewstoday.com/what-is-parkinsons-disease/">Parkinson’s</a>, and it is thought to hold promise in ALS.
Researchers in Italy conducted a two-part <a href="https://clinicaltrials.gov/study/NCT04293484">clinical trial (NCT04293484)</a> to assess tDCS in 31 adults, all with a <a href="https://alsnewstoday.com/als-diagnosis/">disease diagnosis</a> of early to moderate stage ALS, at a single site in Brescia. Patients in its first part were randomly assigned to either sham (placebo) stimulation or tDCS for five days each week over two weeks.
Using a so-called cortico-spinal approach, scientists stimulated both the motor cortex — a brain region involved in controlling voluntary muscle movement — and the spinal cord at the same time.
&#8220;In ALS, cortical hyperexcitability has emerged as a key factor contributing to the degeneration of motor neurons,&#8221; the researchers wrote.
In the study&#8217;s second part, both patient groups received tDCS about six months after the first course. Follow-up evaluations were done up to 48 weeks from baseline (the study’s start).
<h3>Significant gains in muscle strength seen, starting with two weeks of treatment</h3>
The trial&#8217;s main goal was to determine whether tDCS could increase muscle strength, as assessed with the Medical Research Council (MRC) scale, which ranges from 0 (no movement) to 5 (normal contraction). This score is the sum of scores for each muscle group, like shoulder abductors and knee flexors, with total scores ranging from 100 (no impairment) to 0 (most severe impairment).
Compared with trial&#8217;s sham stimulation, tDCS use resulted in significant improvements in muscle strength at week 24 (about six months), with most improvements seen during the two weeks of treatment. While scores rose by an average of 0.9 points on the MRC scale for people on tDCS, these scores dropped by 6.6 points on average in the sham group.
Treatment also resulted in a better quality of life for patients and a lower burden for caregivers over the 24 weeks.
Nineteen patients had data on intracortical connectivity, or how neurons communicate with each other through circuits within the brain’s cortex. tDCS significantly improved connectivity processes known to be disturbed in people with ALS.
The treatment also appeared to lessen neuronal damage in patients, as assessed by changes in the levels of neurofilament light chain (NfL), a nerve damage biomarker.
While NfL levels peaked about eight weeks after the start of tDCS, they markedly dropped after that, reaching the lowest levels at the 48-week assessment. For initial sham group patients who began tDCS treatment at study week 24, reductions in NfL levels started to become evident between 26 and 32 weeks.
By the study&#8217;s end, 15 patients had died. Bulbar-onset disease, which initially affects the muscles around the face and throat, causing <a href="https://alsnewstoday.com/speech-problems/">slurred speech</a> and <a href="https://alsnewstoday.com/als-symptoms/difficulty-swallowing/">difficulty swallowing</a>, linked with a nearly five times higher risk of death.
In turn, for each tDCS course, there was a 71% lower risk of death, “suggesting that the number of completed tDCS treatments significantly reduced the risk of death and increased survival,” the researchers wrote.
“Our study presents several encouraging findings regarding the therapeutic potential of cortico-spinal tDCS for patients with ALS, comprehensively encompassing highly relevant aspects of ALS: global muscle strength, patient-rated quality of life, caregiver burden and survival,” the researchers concluded.
Despite its small number of patients, “the promising results from our study highlight the potential of cortico-spinal tDCS as a therapeutic intervention for ALS patients, and they open up several avenues for future research,” they added.

Transcranial stimulation seen to boost muscle strength, life quality

People with <a href="https://alsnewstoday.com/what-is-als/">amyotrophic lateral sclerosis</a> (ALS) report significant changes in lifestyle after their diagnosis, but still have an acceptable quality of life and low stress levels, according to a survey conducted across nine European countries.
When asked about new drug development, participants most commonly prioritized <a href="https://alsnewstoday.com/approved-treatments-for-als/">treatments</a> that slow disease progression or help with breathing or mobility. Also, there may be a need to better educate patients about the scales used to monitor disease progression or certain <a href="https://alsnewstoday.com/symptoms-of-als/">symptoms</a>.
The study, “<a href="https://www.tandfonline.com/doi/abs/10.1080/21678421.2023.2249515">IMPACT-ALS: summary of results from a European survey of people living with ALS</a>,” was published in the journal <a href="https://www.tandfonline.com/journals/iafd20">Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration</a>.
The majority of scales used to monitor people with ALS tend to focus more on the clinical aspect of the disease, such as the motor symptoms it causes and how fast the disease is progressing. But the actual patient experience is often left out.
Thus, to better understand the functional burden of ALS and ensure that patient experiences contribute to the development of novel therapies, researchers developed the IMPACT-ALS European survey.
The survey collected the experiences of people <a href="https://alsnewstoday.com/living-with-als-2/">living with ALS</a> across nine European countries participating in the <a href="https://www.encals.eu/">European Network to Cure of ALS</a>: United Kingdom, Ireland, Germany, France, Spain, Italy, Belgium, Netherlands, and Sweden.
It involved similar questions from a previous U.S. IMPACT-ALS survey, which were adapted and translated into the main languages of the participating countries.
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<h3>Questionnaire covered demographics, treatments, living with ALS</h3>
The questionnaire included 36 questions grouped in four sections. The first group of questions collected data regarding demographics such as age, gender, employment, marital status, education, and country of residence. The second and third collected information about the disease and treatments, and the fourth was focused on living with ALS, including recent symptoms, fears, and stress levels.
A total of 857 patients, mostly men (57%), responded to the survey. The majority of responses were from Italy, and participation rates ranged from 0.2%-6.3% based on ALS prevalence in each country. About two-thirds of patients were in the 55-74 age range.
In total, 91% of participants answered questions regarding their symptoms and <a href="https://alsnewstoday.com/als-diagnosis/">ALS diagnosis</a>. In half, the first symptoms had appeared two to three years before the survey and the formal diagnosis had been issued 1.5-2 years earlier. The most common first symptom was weakness in the arms or legs (60%), followed by falling and speech problems.
About two-thirds knew which <a href="https://alsnewstoday.com/forms-of-als/">ALS type</a> they had: 58% of patients had <a href="https://alsnewstoday.com/sporadic-als/">sporadic ALS</a> and 6.4% <a href="https://alsnewstoday.com/forms-of-als-familial-als/">familial ALS</a>, while 35% who did not know their disease form.
Also, while genetic testing <a href="https://alsnewstoday.com/news/genetic-test-als-all-patients-guidelines/">is now recommended</a> for all with the neurodegenerative condition, less than half of the respondents underwent such testing. The most frequent mutations were detected in the SOD1 (15%) and C9orf72 (24%) genes.
More than half of patients did not know about the ALS Functional Rating Scale &#8211; Revised (ALSFRS-R), the researchers noted. This is a validated measure of disease progression that essentially assesses a person&#8217;s ability to perform activities of daily living such as buttoning a shirt, grabbing a pen, turning in bed, or speaking clearly.
For the patients who knew their ALSFRS-R score, the median score was higher — indicating less severe disease and a greater ability to perform daily functions — among patients with the most recent diagnosis than in those with a longer-established diagnosis (37 vs. 31).
<h3>ALS symptoms included fatigue, speech issues, depression</h3>
In the two weeks preceding the survey, the most common symptoms were limb weakness, fatigue, and <a href="https://alsnewstoday.com/speech-problems/">speech problems</a>. Other symptoms such as pain, <a href="https://alsnewstoday.com/als-mental-health/">depression or mood changes</a>, apathy, and thinking difficulties were also present in at least 1 in 10 patients.
Patients also often reported issues with physical activities in that period, such as trouble walking (67%), difficulty managing buttons or keys (64%), or problems rising from a chair (62%).
Still, most patients reported low to medium levels of stress in the two weeks prior to the survey and moderate quality of life in the two days prior.
There were certain fears related to the future in about 82% of patients, although fear was less common in people diagnosed for longer (75.3%). The most common fears were leaving family too soon, dying from respiratory failure, having an injury, needing invasive ventilation, or experiencing social isolation due to communication impairments.
Participants also reported changes in their life since the diagnosis. In general, they spent less time on most daily activities, and more on the internet, reading, and communicating with family and friends.
<h3>Treatment options detailed</h3>
In terms of treatment, 12% required a feeding tube and 22% needed noninvasive ventilatory support. For mobility, more than half attended physical therapy, about one-third did regular exercise, and some required manual or motorized wheelchairs or wheeled walkers.
When asked about what they valued more about current and new treatments, most patients wanted therapies that could stop disease progression. Other treatments that were highly sought were those that could improve breathing and mobility.
“To enable the delivery of care that meets the needs of [people with ALS], further work is required to focus on commonly reported symptoms as well as those symptoms which patients want treating the most,” the researchers wrote. “The findings we report from this survey support the increased use of [patient-reported outcome measures] in clinical trials to promote the development of patient focused interventions to improve quality of life.”

Tag: Quality of Life

Transcranial stimulation seen to boost muscle strength, life quality

Survey offers look at life, treatment priorities of those living with ALS