Transcranial direct current stimulation for patients with walking difficulties caused by cerebral small vessel disease: a randomized controlled study

Qiaoqiao Xu; Wenwen Yin; Xia Zhou; Shuo Wang; Sishi Chen; Jiajia Yang; Chunhua Xi; Zhongwu Sun

doi:10.3389/fnagi.2024.1511287

Transcranial direct current stimulation for patients with walking difficulties caused by cerebral small vessel disease: a randomized controlled study

Front Aging Neurosci. 2025 Jan 7:16:1511287. doi: 10.3389/fnagi.2024.1511287. eCollection 2024.

Authors

Qiaoqiao Xu^{1

2}, Wenwen Yin³, Xia Zhou², Shuo Wang¹, Sishi Chen¹, Jiajia Yang⁴, Chunhua Xi¹, Zhongwu Sun²

Affiliations

¹ Department of Neurology, The Third Affiliated Hospital of Anhui Medical University (Hefei City First People's Hospital), Hefei, Anhui, China.
² Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
³ Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
⁴ Department of Burns and Wound Healing, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.

Abstract

Introduction: Cerebral small vessel disease (CSVD) is a chronic systemic degenerative disease affecting small blood vessels in the brain, leading to cognitive impairments. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique that applies low electrical currents to the scalp, shows promise in treating cognitive and movement disorders. However, further clinical evaluation is required to assess the long-term effects of tDCS on neuroplasticity and gait in patients with CSVD. We investigated the effects of long-term, repeated tDCS on local brain perfusion, network connectivity, cognition, and gait in patients with CSVD and gait disorders (CSVD-GD).

Methods: This prospective, single-blind, multicenter, randomized controlled study enrolled 66 patients with CSVD-GD, categorized into the tDCS and Sham groups. Imaging and gait characteristic data were collected over three periods using magnetic resonance imaging and a gait analyzer, along with neuropsychological assessments.

Results: Among 156 volunteers with CSVD-GD, 66 participated in this study, with 60 completing the entire process. Compared to the Sham group, the tDCS group exhibited a more pronounced increase in the cerebral blood flow to the dural cerebrospinal fluid ratio in regions such as the orbitofrontal cortex and cingulate gyrus (P < 0.05, FDR corrected), along with significantly greater improvements in gait speed and stride length. Tolerance to tDCS was good, with no difference in adverse reactions between the groups, except for a scalp burning sensation reported during the 1st week (24.24% and 6.06% in the tDCS and Sham groups, respectively; P = 0.003).

Discussion: Long-term tDCS is effective and safe for improving neuroplasticity and gait cognition in patients with CSVD.

Keywords: cerebral small vessel disease; cognitive impairment; gait analysis; gait disorders; magnetic resonance imaging; neurovascular coupling; transcranial direct current stimulation; walking difficulties.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the National Natural Science Foundation of China (82401420), the Key Research and Development Projects of Anhui Province (202104j07020031), the Traditional Chinese Medicine Inheritance and Innovation Research Project of Anhui Province (2024CCCX230), the Basic and Clinical Cooperative Research Program of Anhui Medical University-incubation project for the Third Affiliated Hospital (2022sfy001), the Clinical Medical Research Transformation Project of the Anhui Provincial Science and Technology Department (202204295107020024), and the Hefei City Health Commission applied medicine project (Hwk2023yb003).