MovDisordV3, Main, Curation, bibRecord, 003312

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease

Identifieur interne : 003312 ( Main/Curation ); précédent : 003311; suivant : 003313

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease

Auteurs : Felipe Fregni [États-Unis] ; Paulo S. Boggio [Brésil] ; Marcelo C. Santos [Brésil] ; Moises Lima [Brésil] ; Adriana L. Vieira [Brésil] ; Sergio P. Rigonatti [Brésil] ; M. Teresa A. Silva [Brésil] ; Egberto R. Barbosa [Brésil] ; Michael A. Nitsche [Allemagne] ; Alvaro Pascual-Leone [États-Unis]

Source :

Movement Disorders [ 0885-3185 ] ; 2006-10.

RBID : ISTEX:8E9F0F54FAEB6C66A66CC89C72020DE06A096B6B

Descripteurs français

Pascal (Inist)
- Courant continu, Parkinson maladie, Système nerveux pathologie.

English descriptors

KwdEn :
- Aged, Antiparkinson Agents (therapeutic use), Brain Mapping, Deep Brain Stimulation (methods), Direct current, Dominance, Cerebral (physiology), Double-Blind Method, Electrodes, Evoked Potentials, Motor (physiology), Female, Humans, Levodopa (therapeutic use), Male, Middle Aged, Motor Activity (physiology), Motor Cortex (physiopathology), Motor Skills (physiology), Nervous system diseases, Neurologic Examination, Parkinson Disease (physiopathology), Parkinson Disease (therapy), Parkinson disease, Parkinson's disease, Prefrontal Cortex (physiopathology), Statistics as Topic, brain DC polarization, cortical stimulation, motor function, transcranial direct current stimulation.
MESH :
- chemical , therapeutic use : Antiparkinson Agents, Levodopa.
- methods : Deep Brain Stimulation.
- physiology : Dominance, Cerebral, Evoked Potentials, Motor, Motor Activity, Motor Skills.
- physiopathology : Motor Cortex, Parkinson Disease, Prefrontal Cortex.
- therapy : Parkinson Disease.
- Aged, Brain Mapping, Double-Blind Method, Electrodes, Female, Humans, Male, Middle Aged, Neurologic Examination, Statistics as Topic.

Abstract

Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor‐evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham‐stimulation] and evaluated the effects on motor function—as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test—and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double‐blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham‐stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal–tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD. © 2006 Movement Disorder Society

Url:

https://api.istex.fr/document/8E9F0F54FAEB6C66A66CC89C72020DE06A096B6B/fulltext/pdf

DOI: 10.1002/mds.21012

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ISTEX:8E9F0F54FAEB6C66A66CC89C72020DE06A096B6B

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<term>Antiparkinson Agents (therapeutic use)</term>
<term>Brain Mapping</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Direct current</term>
<term>Dominance, Cerebral (physiology)</term>
<term>Double-Blind Method</term>
<term>Electrodes</term>
<term>Evoked Potentials, Motor (physiology)</term>
<term>Female</term>
<term>Humans</term>
<term>Levodopa (therapeutic use)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Motor Activity (physiology)</term>
<term>Motor Cortex (physiopathology)</term>
<term>Motor Skills (physiology)</term>
<term>Nervous system diseases</term>
<term>Neurologic Examination</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson disease</term>
<term>Parkinson's disease</term>
<term>Prefrontal Cortex (physiopathology)</term>
<term>Statistics as Topic</term>
<term>brain DC polarization</term>
<term>cortical stimulation</term>
<term>motor function</term>
<term>transcranial direct current stimulation</term>
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<term>Motor Activity</term>
<term>Motor Skills</term>
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<term>Parkinson Disease</term>
<term>Prefrontal Cortex</term>
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<term>Brain Mapping</term>
<term>Double-Blind Method</term>
<term>Electrodes</term>
<term>Female</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en">Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor‐evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham‐stimulation] and evaluated the effects on motor function—as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test—and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double‐blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham‐stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal–tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD. © 2006 Movement Disorder Society</div>
</front>
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<author><name sortKey="Pascual Leone, Alvaro" sort="Pascual Leone, Alvaro" uniqKey="Pascual Leone A" first="Alvaro" last="Pascual-Leone">Alvaro Pascual-Leone</name>
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<country>États-Unis</country>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease</title>
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<s2>Boston, Massachusetts</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Boggio, Paulo S" sort="Boggio, Paulo S" uniqKey="Boggio P" first="Paulo S." last="Boggio">Paulo S. Boggio</name>
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</placeName>
<orgName type="university">Université de São Paulo</orgName>
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</author>
<author><name sortKey="Santos, Marcelo C" sort="Santos, Marcelo C" uniqKey="Santos M" first="Marcelo C." last="Santos">Marcelo C. Santos</name>
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</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Lima, Moises" sort="Lima, Moises" uniqKey="Lima M" first="Moises" last="Lima">Moises Lima</name>
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<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Vieira, Adriana L" sort="Vieira, Adriana L" uniqKey="Vieira A" first="Adriana L." last="Vieira">Adriana L. Vieira</name>
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<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
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<author><name sortKey="Rigonatti, Sergio P" sort="Rigonatti, Sergio P" uniqKey="Rigonatti S" first="Sergio P." last="Rigonatti">Sergio P. Rigonatti</name>
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<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Silva, M Teresa A" sort="Silva, M Teresa A" uniqKey="Silva M" first="M. Teresa A." last="Silva">M. Teresa A. Silva</name>
<affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Departments of Experimental Psychology (Institute of Psychology), Psychiatry, and Neurology, University of Sao Paulo</s1>
<s2>Sao Paulo</s2>
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<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Barbosa, Egberto R" sort="Barbosa, Egberto R" uniqKey="Barbosa E" first="Egberto R." last="Barbosa">Egberto R. Barbosa</name>
<affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Departments of Experimental Psychology (Institute of Psychology), Psychiatry, and Neurology, University of Sao Paulo</s1>
<s2>Sao Paulo</s2>
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<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Nitsche, Michael A" sort="Nitsche, Michael A" uniqKey="Nitsche M" first="Michael A." last="Nitsche">Michael A. Nitsche</name>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Clinical Neurophysiology, Georg August University</s1>
<s2>Goettingen</s2>
<s3>DEU</s3>
<sZ>9 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>Goettingen</wicri:noRegion>
<wicri:noRegion>Georg August University</wicri:noRegion>
<wicri:noRegion>Goettingen</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pascual Leone, Alvaro" sort="Pascual Leone, Alvaro" uniqKey="Pascual Leone A" first="Alvaro" last="Pascual-Leone">Alvaro Pascual-Leone</name>
<affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Harvard Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School</s1>
<s2>Boston, Massachusetts</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
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</analytic>
<series><title level="j" type="main">Movement disorders</title>
<title level="j" type="abbreviated">Mov. disord.</title>
<idno type="ISSN">0885-3185</idno>
<imprint><date when="2006">2006</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Movement disorders</title>
<title level="j" type="abbreviated">Mov. disord.</title>
<idno type="ISSN">0885-3185</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Direct current</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term>
<term>Parkinson maladie</term>
<term>Courant continu</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor-evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of Ml, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham-stimulation] and evaluated the effects on motor function-as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test-and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double-blinded manner. Anodal stimulation of Ml was associated with a significant improvement of motor function compared to sham-stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of Ml or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of Ml significantly increased MEP amplitude and area, cathodal stimulation of Ml significantly decreased them. There was a trend toward a significant correlation between motor function improvement after Ml anodal-tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD.</div>
</front>
</TEI>
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<author><name sortKey="Boggio, Paulo S" sort="Boggio, Paulo S" uniqKey="Boggio P" first="Paulo S." last="Boggio">Paulo S. Boggio</name>
</author>
<author><name sortKey="Santos, Marcelo C" sort="Santos, Marcelo C" uniqKey="Santos M" first="Marcelo C." last="Santos">Marcelo C. Santos</name>
</author>
<author><name sortKey="Lima, Moises" sort="Lima, Moises" uniqKey="Lima M" first="Moises" last="Lima">Moises Lima</name>
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<author><name sortKey="Vieira, Adriana L" sort="Vieira, Adriana L" uniqKey="Vieira A" first="Adriana L." last="Vieira">Adriana L. Vieira</name>
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<author><name sortKey="Rigonatti, Sergio P" sort="Rigonatti, Sergio P" uniqKey="Rigonatti S" first="Sergio P." last="Rigonatti">Sergio P. Rigonatti</name>
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<author><name sortKey="Silva, M Teresa A" sort="Silva, M Teresa A" uniqKey="Silva M" first="M. Teresa A." last="Silva">M. Teresa A. Silva</name>
</author>
<author><name sortKey="Barbosa, Egberto R" sort="Barbosa, Egberto R" uniqKey="Barbosa E" first="Egberto R." last="Barbosa">Egberto R. Barbosa</name>
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<author><name sortKey="Pascual Eone, Alvaro" sort="Pascual Eone, Alvaro" uniqKey="Pascual Eone A" first="Alvaro" last="Pascual-Leone">Alvaro Pascual-Leone</name>
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<author><name sortKey="Boggio, Paulo S" sort="Boggio, Paulo S" uniqKey="Boggio P" first="Paulo S." last="Boggio">Paulo S. Boggio</name>
<affiliation wicri:level="4"><country xml:lang="fr">Brésil</country>
<wicri:regionArea>Departments of Experimental Psychology (Institute of Psychology), Psychiatry, and Neurology, University of Sao Paulo, Sao Paulo</wicri:regionArea>
<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
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<affiliation wicri:level="3"><country xml:lang="fr">Brésil</country>
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<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
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<author><name sortKey="Santos, Marcelo C" sort="Santos, Marcelo C" uniqKey="Santos M" first="Marcelo C." last="Santos">Marcelo C. Santos</name>
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<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
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<author><name sortKey="Lima, Moises" sort="Lima, Moises" uniqKey="Lima M" first="Moises" last="Lima">Moises Lima</name>
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<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
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<author><name sortKey="Vieira, Adriana L" sort="Vieira, Adriana L" uniqKey="Vieira A" first="Adriana L." last="Vieira">Adriana L. Vieira</name>
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<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
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<author><name sortKey="Rigonatti, Sergio P" sort="Rigonatti, Sergio P" uniqKey="Rigonatti S" first="Sergio P." last="Rigonatti">Sergio P. Rigonatti</name>
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<region type="state">État de São Paulo</region>
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<orgName type="university">Université de São Paulo</orgName>
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<placeName><settlement type="city">São Paulo</settlement>
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<orgName type="university">Université de São Paulo</orgName>
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</author>
<author><name sortKey="Barbosa, Egberto R" sort="Barbosa, Egberto R" uniqKey="Barbosa E" first="Egberto R." last="Barbosa">Egberto R. Barbosa</name>
<affiliation wicri:level="4"><country xml:lang="fr">Brésil</country>
<wicri:regionArea>Departments of Experimental Psychology (Institute of Psychology), Psychiatry, and Neurology, University of Sao Paulo, Sao Paulo</wicri:regionArea>
<placeName><settlement type="city">São Paulo</settlement>
<region type="state">État de São Paulo</region>
</placeName>
<orgName type="university">Université de São Paulo</orgName>
</affiliation>
</author>
<author><name sortKey="Nitsche, Michael A" sort="Nitsche, Michael A" uniqKey="Nitsche M" first="Michael A." last="Nitsche">Michael A. Nitsche</name>
<affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Department of Clinical Neurophysiology, Georg August University, Goettingen</wicri:regionArea>
<wicri:noRegion>Goettingen</wicri:noRegion>
<wicri:noRegion>Goettingen</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pascual Eone, Alvaro" sort="Pascual Eone, Alvaro" uniqKey="Pascual Eone A" first="Alvaro" last="Pascual-Leone">Alvaro Pascual-Leone</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Harvard Center for Non‐Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts</wicri:regionArea>
<placeName><region type="state">Massachusetts</region>
</placeName>
</affiliation>
</author>
</analytic>
<monogr></monogr>
<series><title level="j">Movement Disorders</title>
<title level="j" type="abbrev">Mov. Disord.</title>
<idno type="ISSN">0885-3185</idno>
<idno type="eISSN">1531-8257</idno>
<imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher>
<pubPlace>Hoboken</pubPlace>
<date type="published" when="2006-10">2006-10</date>
<biblScope unit="vol">21</biblScope>
<biblScope unit="issue">10</biblScope>
<biblScope unit="page" from="1693">1693</biblScope>
<biblScope unit="page" to="1702">1702</biblScope>
</imprint>
<idno type="ISSN">0885-3185</idno>
</series>
<idno type="istex">8E9F0F54FAEB6C66A66CC89C72020DE06A096B6B</idno>
<idno type="DOI">10.1002/mds.21012</idno>
<idno type="ArticleID">MDS21012</idno>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Antiparkinson Agents (therapeutic use)</term>
<term>Brain Mapping</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Dominance, Cerebral (physiology)</term>
<term>Double-Blind Method</term>
<term>Electrodes</term>
<term>Evoked Potentials, Motor (physiology)</term>
<term>Female</term>
<term>Humans</term>
<term>Levodopa (therapeutic use)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Motor Activity (physiology)</term>
<term>Motor Cortex (physiopathology)</term>
<term>Motor Skills (physiology)</term>
<term>Neurologic Examination</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson's disease</term>
<term>Prefrontal Cortex (physiopathology)</term>
<term>Statistics as Topic</term>
<term>brain DC polarization</term>
<term>cortical stimulation</term>
<term>motor function</term>
<term>transcranial direct current stimulation</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term>
<term>Levodopa</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Dominance, Cerebral</term>
<term>Evoked Potentials, Motor</term>
<term>Motor Activity</term>
<term>Motor Skills</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Motor Cortex</term>
<term>Parkinson Disease</term>
<term>Prefrontal Cortex</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Brain Mapping</term>
<term>Double-Blind Method</term>
<term>Electrodes</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Neurologic Examination</term>
<term>Statistics as Topic</term>
</keywords>
</textClass>
<langUsage><language ident="en">en</language>
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<front><div type="abstract" xml:lang="en">Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor‐evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham‐stimulation] and evaluated the effects on motor function—as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test—and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double‐blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham‐stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal–tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD. © 2006 Movement Disorder Society</div>
</front>
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</ISTEX>
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	Movement Disorders (revue)
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Movement Disorders (revue)

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease

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