Non-Invasive Neuromodulation Therapies for Parkinson’s Disease

Noninvasive brain stimulation (NIBS) technologies have been applied to study brain physiology and, more recently, have been recognized for their therapeutic potential as an adjunctive treatment for various neurologic and psychiatric disorders. Transcranial magnetic stimulation (TMS) and transcranial electric stimulation (tES) are two of the most studied NIBS modalities in Parkinson’s disease. They are non-systemic and relatively safe. Most therapeutic trials have been conducted to ameliorate motor symptoms of Parkinson’s disease (PD) with overall positive results using various stimulation modalities and methods. Notwithstanding significant results, evidence has not yet been compelling mainly due to small-size studies, lack of standardization of methodologies and other study design limitations. NIBS hold promise for treatment of PD symptoms and PD related complications. Large, well designed clinical trials are needed to corroborate these positive findings and inform its durability and the overall clinical relevance for the treatment of PD

Art therapy for Parkinson's disease.

Abstract Objective To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). Methods Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. Results At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. Interpretation Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks