{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:12:45Z","timestamp":1790770365658,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Transcranial Direct Current Stimulation (tDCS) of the cerebellum shows promise for the treatment of dystonia. Specific motor rehabilitation programs have also been developed in this context. However, the combination of these two approaches has not yet been evaluated to determine their therapeutic potential.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report a series of 5 patients with cervical dystonia (CD) poorly controlled by botulinum toxin injections. They were initially treated by a protocol of repeated daily sessions (for 3 or 5\u2009days) of cerebellar anodal tDCS (cer-atDCS) applied alone. In a second time, additional protocols of cer-atDCS were performed in combination with a program of goal-oriented motor training exercises (Mot-Training), specifically developed for the treatment of CD. The clinical impact of the procedures was assessed on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to baseline, the maximum percentage of TWSTRS total score improvement was 37% on average after cer-atDCS performed alone (<jats:italic>p<\/jats:italic>\u2009=\u20090.147, not significant) and 53% on average after cer-atDCS combined with Mot-Training (<jats:italic>p<\/jats:italic>\u2009=\u20090.014, significant). The TWSTRS pain and functional handicap subscores also improved after the combined protocol. A score of (+3) to (+5) was rated on the TWSTRS response scale after cer-atDCS performed alone or the combined protocol, corresponding to a moderate to striking improvement on dystonia and pain. This improvement lasted longer after the combined protocol than after cer-atDCS alone (3.4 vs. 1.4\u2009months on average, <jats:italic>p<\/jats:italic>\u2009=\u20090.011).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of cer-atDCS with Mot-Training produced a greater and more prolonged improvement than the application of cer-atDCS alone. Such a combined therapeutic procedure is easy to perform and opens important perspectives in the long-term treatment of CD. These results remain to be confirmed by a randomized sham-controlled trial on a larger sample.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1381390","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T04:42:16Z","timestamp":1714452136000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Combination of anodal tDCS of the cerebellum with a goal-oriented motor training to treat cervical dystonia: a pilot case series"],"prefix":"10.3389","volume":"15","author":[{"given":"Jean-Pierre","family":"Bleton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Coss\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiphanie","family":"Caloc\u2019h","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alcira","family":"Suarez Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Diverres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Derkinderen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Nizard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pascal","family":"Lefaucheur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1007\/s00415-014-7586-2","article-title":"An international survey of patients with cervical dystonia","volume":"262","author":"Comella","year":"2015","journal-title":"J Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1002\/mds.10252","article-title":"Long-term efficacy of botulinum toxin a in treatment of various movement disorders over a 10-year period","volume":"17","author":"Hsiung","year":"2002","journal-title":"Mov Disord"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1468-1331.2010.03061.x","article-title":"Physiotherapy of focal dystonia: a physiotherapist\u2019s personal experience","volume":"17","author":"Bleton","year":"2010","journal-title":"Eur J Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1177\/0269215512456221","article-title":"Active exercise for individuals with cervical dystonia: a pilot randomized controlled trial","volume":"27","author":"Boyce","year":"2013","journal-title":"Clin Rehabil"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/1471-2377-13-85","article-title":"Cervical dystonia: effectiveness of a standardized physical therapy program; 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