Affiliations: [a] German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| [b] Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| [c] Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich, Germany
| [d] Department of Neurology and Clinical Neurophysiology, Schön Klinik München Schwabing, Munich, Germany
| [e]
Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
Correspondence:
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Correspondence to: Max Wuehr, German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Marchioninistrasse 15, 81377 Munich, Germany. Tel.: +49 89 4400 77823; E-mail: max.wuehr@med.uni-muenchen.de.
Note: [1] These authors contributed equally to this work.
Abstract: Background:Postural instability is a major disabling factor in patients with advanced Parkinson’s disease (PD) and often resistant to treatment. Previous studies indicated that imbalance in PD may be reduced by low-intensity noisy galvanic vestibular stimulation (nGVS). Objective:To investigate the potential mode of action of this therapeutic effect. In particular, we examined whether nGVS-induced reductions of body sway in PD are compatible with stochastic resonance (SR), a mechanism by which weak sensory noise stimulation can paradoxically enhance sensory information transfer. Methods:Effects of nGVS of varying intensities (0–0.7 mA) on body sway were examined in 15 patients with PD standing with eye closed on a posturographic force plate. We assumed a bell-shaped response curve with maximal reductions of sway at intermediate nGVS intensities to be indicative of SR. An established SR-curve model was fitted on individual patient outcomes and three experienced human raters had to judge whether responses to nGVS were consistent with the exhibition of SR. Results:nGVS-induced reductions of body sway compatible with SR were found in 10 patients (67%) with optimal improvements of 23±13%. In 7 patients (47%), nGVS-induced sway reductions exceeded the minimally important clinical difference (optimal improvement: 30±10%), indicative of strong SR. This beneficial effect was more likely in patients with advanced PD (R = 0.45; p = 0.045). Conclusions:At least half of the assessed patients showed robust improvements in postural balance compatible with SR when treated with low-intensity nGVS. In particular, patients with more advanced disease stages and imbalance may benefit from the non-invasive and well-tolerated treatment with nGVS.
