Coordinated Reset Vibrotactile Stimulation Induces Sustained Cumulative Benefits in Parkinson's Disease

Kristina J Pfeifer; Justus A Kromer; Alexander J Cook; Traci Hornbeck; Erika A Lim; Bruce J P Mortimer; Adam S Fogarty; Summer S Han; Rohit Dhall; Casey H Halpern; Peter A Tass

doi:10.3389/fphys.2021.624317

Coordinated Reset Vibrotactile Stimulation Induces Sustained Cumulative Benefits in Parkinson's Disease

Front Physiol. 2021 Apr 6:12:624317. doi: 10.3389/fphys.2021.624317. eCollection 2021.

Authors

Affiliations

¹ Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.
² Engineering Acoustics, Inc., Casselberry, FL, United States.
³ Department of Neurology, Stanford University School of Medicine, Stanford, CA, United States.
⁴ Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States.
⁵ Center for Neurodegenerative Disorders, Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.

Abstract

Background: Abnormal synchronization of neuronal activity in dopaminergic circuits is related to motor impairment in Parkinson's disease (PD). Vibrotactile coordinated reset (vCR) fingertip stimulation aims to counteract excessive synchronization and induce sustained unlearning of pathologic synaptic connectivity and neuronal synchrony. Here, we report two clinical feasibility studies that examine the effect of regular and noisy vCR stimulation on PD motor symptoms. Additionally, in one clinical study (study 1), we examine cortical beta band power changes in the sensorimotor cortex. Lastly, we compare these clinical results in relation to our computational findings.

Methods: Study 1 examines six PD patients receiving noisy vCR stimulation and their cortical beta power changes after 3 months of daily therapy. Motor evaluations and at-rest electroencephalographic (EEG) recordings were assessed off medication pre- and post-noisy vCR. Study 2 follows three patients for 6+ months, two of whom received daily regular vCR and one patient from study 1 who received daily noisy vCR. Motor evaluations were taken at baseline, and follow-up visits were done approximately every 3 months. Computationally, in a network of leaky integrate-and-fire (LIF) neurons with spike timing-dependent plasticity, we study the differences between regular and noisy vCR by using a stimulus model that reproduces experimentally observed central neuronal phase locking.

Results: Clinically, in both studies, we observed significantly improved motor ability. EEG recordings observed from study 1 indicated a significant decrease in off-medication cortical sensorimotor high beta power (21-30 Hz) at rest after 3 months of daily noisy vCR therapy. Computationally, vCR and noisy vCR cause comparable parameter-robust long-lasting synaptic decoupling and neuronal desynchronization.

Conclusion: In these feasibility studies of eight PD patients, regular vCR and noisy vCR were well tolerated, produced no side effects, and delivered sustained cumulative improvement of motor performance, which is congruent with our computational findings. In study 1, reduction of high beta band power over the sensorimotor cortex may suggest noisy vCR is effectively modulating the beta band at the cortical level, which may play a role in improved motor ability. These encouraging therapeutic results enable us to properly plan a proof-of-concept study.

Keywords: Parkinson’s disease; beta band power; coordinated reset; cumulative effects; desynchronization; sensorimotor; vibrotactile stimulation.