Abstract
It has been demonstrated that intrinsic auricular muscles zone stimulation (IAMZS) can improve the motor symptoms of Parkinson's disease (PD) patients who are examined with the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores. In the present pilot study, using motion capture technology, we aimed to investigate the efficacy of IAMZS compared to medication alone or in combination with medication. Ten PD patients (mean age: 54.8 ± 10.1 years) were enrolled. Each participant participated in three different sessions: sole medication, sole stimulation-20 min of IAMZS, and combined IAMZS (20 min) and medication. Each session was performed on different days but at the same time to be aligned with patients' drug intake. Motion capture recording sessions took place at baseline, 20, 40, and 60 min. Statistical analysis was conducted using one-way repeated measures ANOVA. Bonferroni correction was implemented for pairwise comparisons. The sole medication was ineffective to improve gait-related parameters of stride length, stride velocity, stance, swing, and turning speed. In the sole-stimulation group, pace-related gait parameters were significantly increased at 20 and 40 min. These improvements were observed in stride length at 20 (p = 0.0498) and 40 (p = 0.03) min, and also in the normalized stride velocity at 40 min (p-value = 0.02). Stride velocity also tended to be significant at 20 min (p = 0.06) in the sole-stimulation group. Combined IAMZS and medication demonstrated significant improvements in all the time segments for pace-related gait parameters [stride length: 20 min (p = 0.04), 40 min (p = 0.01), and 60 min (p < 0.01); stride velocity: 20 min (p < 0.01), 40 min (p = 0.01), and 60 min (p < 0.01)]. These findings demonstrated the fast action of the IAMZS on PD motor symptoms. Moreover, following the termination of IAMZS, a prolonged improvement in symptoms was observed at 40 min. The combined use of IAMZS with medication showed the most profound improvements. The IAMZS may be particularly useful during medication off periods and may also postpone the long-term side effects of high-dose levodopa. A large scale multicentric trial is required to validate the results obtained from this pilot study.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03907007.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder due to dopaminergic neuronal loss at substantia nigra
It should be noted that criteria for normality of data distribution were found to be valid for all dataset
Levodopa medication is the gold standard therapeutic modality in PD, the beneficial effects of oral levodopa on the motor symptoms can appear 1 h after the levodopa intake [(4) and it is confirmed in the present study motion capture results]
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder due to dopaminergic neuronal loss at substantia nigra. PD motor symptoms respond well to levodopa medication, levodopa dosages need to be increased gradually as the disease progresses to achieve the same beneficial effects [1,2,3]. Around the tenth year of the disease, the benefits of levodopa for motor symptoms reduce dramatically even with increased dosages, while side effects like dyskinesia become more prominent [1,2,3]. Invasive approaches, like deep brain stimulation, as well as transcranial direct current stimulation, transcranial magnetic stimulation and focused ultrasound-like non-invasive approaches have been used as neuromodulation treatment modalities [5,6,7,8] Each of these approaches has its advantages, disadvantages, and limitations. In the context of non-invasive and wearable neuromodulation approaches, the options are limited; more research is needed
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