***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Recent findings suggest that transcranial direct current stimulation of the primary motor cortex may ameliorate freezing of gait . However , the effects of multitarget simultaneous stimulation of motor and cognitive networks are mostly unknown . The objective of this study was to evaluate the effects of multitarget transcranial direct current stimulation of the primary motor cortex and left dorsolateral prefrontal cortex on freezing of gait and related outcomes . METHODS Twenty patients with Parkinson 's disease and freezing of gait received 20 minutes of transcranial direct current stimulation on 3 separate visits . Transcranial direct current stimulation targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously , primary motor cortex only , or sham stimulation ( order r and omized and double-blinded assessment s ) . Participants completed a  freezing of gait-provoking test , the Timed Up and Go , and the Stroop test before and after each transcranial direct current stimulation session . RESULTS Performance on the freezing of gait-provoking test ( P = 0.010 ) , Timed Up and Go ( P = 0.006 ) , and the Stroop test ( P = 0.016 ) improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex , but not after primary motor cortex only or sham stimulation . CONCLUSIONS Transcranial direct current stimulation design ed to simultaneously target motor and cognitive regions apparently induces immediate aftereffects in the brain that translate into reduced freezing of gait and improvements in executive function and mobility . © 2018 International Parkinson and Movement Disorder Society OBJECTIVE To investigate the dopamine-dependent effect of combining transcranial direct current stimulation ( tDCS ) with visually cued gait training on cortical excitability and functional mobility in individuals with Parkinson 's disease . DESIGN A pilot , r and omized , double-blind , controlled trial . METHODS Twenty-two patients with Parkinson 's disease were r and omly assigned to 2 groups : ( i ) active anodal tDCS over the supplementary motor area ( experimental group ) , or ( ii ) sham tDCS ( control group ) . After tDCS , both groups participated in a visually cued gait training .  Functional mobility was evaluated with the Timed Up and Go test ( TUG ) . Cortical excitability was assessed by active motor threshold and motor-evoked potential amplitudes elicited by transcranial magnetic stimulation in patients in on and off medication states . RESULTS In the TUG test both groups achieved improvements either in on or off medication condition compared with baseline . However , for both medication conditions , these gains were maintained only in the experimental group during 1-month follow-up , compared with baseline . In the experimental group , enhancement of cortical excitability was observed at post-intervention and 1-month follow-up ( both only for the " on " phase ) compared with baseline . CONCLUSION These findings suggest that tDCS , independent of dopaminergic medication state , might prolong the positive effect induced by cued gait training on functional mobility Objective To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation ( tDCS ) and dual task gait training intervention in people with Parkinson ’s Disease ( PD ) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present . Design A pilot , r and omized , double-blind , sham-controlled parallel group trial with 12 week follow-up . Setting A university physiotherapy department . Interventions Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks . Participants were r and omized to receive either active or sham tDCS applied for the first 20 minutes of each session . Main Measures The primary outcome was gait speed while undertaking concurrent cognitive tasks ( word lists , counting , conversation ) . Secondary measures included step length , cadence , Timed Up and Go , bradykinesia and motor speed . Results Gait speed , step length and cadence improved in both groups , under all dual task conditions . This effect was maintained at follow-up . There was no difference between the active and sham tDCS groups . Time taken to perform the TUGwords also improved , with no difference between groups . The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount . Bradykinesia improved after training in both groups . Conclusion Three weeks of dual task gait training result ed in improved gait under dual task conditions , and bradykinesia , immediately following training and at 12 weeks follow-up . The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG . tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD . Trial Registration Australia-New Zeal and Clinical Trials Registry Transcranial direct current stimulation ( tDCS ) is a noninvasive brain stimulation technique that has potential for clinical utility in neurorehabilitation . However , recent evidence indicates that the responses to tDCS are highly variable . This study investigated whether electroencephalographic ( EEG ) measures of functional connectivity of the target network were associated with the response to ipsilesional anodal tDCS in stroke survivors . Ten chronic stroke patients attended two experimental sessions in a r and omized cross-over trial and received anodal or sham tDCS . Single-pulse transcranial magnetic stimulation was used to quantify change in corticospinal excitability following tDCS . At the beginning of each session , functional connectivity was estimated using the debiased-weighted phase lag index from EEG recordings at rest . Magnetic resonance imaging identified lesion location and lesion volume . Partial least squares regression identified models of connectivity which maximally accounted for variance in anodal tDCS responses . Stronger connectivity of a network with a seed approximating the stimulated ipsilesional motor cortex , and clusters of electrodes approximating the ipsilesional parietal cortex and contralesional frontotemporal cortex in the alpha b and ( 8 - 13 Hz ) was strongly associated with a greater increase of corticospinal excitability following anodal tDCS . This association was not observed following sham stimulation . Addition of a structural measure(s ) of injury ( lesion volume ) provided an improved model fit for connectivity between the seed electrode and ipsilesional parietal cortex , but not the contralesional frontotemporal cortex . TDCS has potential to greatly assist stroke rehabilitation and functional connectivity appears a robust and specific biomarker of response which may assist clinical translation of this therapy Objective The aim of the study was to study the combined effects of transcranial direct current stimulation ( tDCS ) and physical therapy on the walking ability of patients with Parkinson disease ( PD ) . Study Design The study used an experimental , double-blinded , r and omized controlled trial . Results After intervention , group 1 ( only tDCS ) demonstrated a significant increase in gait speed by 0.13 to 0.14 m/sec ( 17.8%–19.2 % ) and an increase in step length by 5.9 to 6.1 cm ( 14.0%–14.5 % ) , whereas group 2 ( tDCS and physical therapy ) revealed a significant increase in gait speed by 0.10 to 0.13 m/sec ( 14.9%–19.4 % ) and step length by 4.5 to 5.4 cm ( 10.6%–12.8 % ) and group 3 ( sham tDCS and physical therapy ) showed a significant increase in gait speed by 0.09 to 0.14 m/sec ( 13.0%–20.3 % ) and step length by 3.0 to 5.4 cm ( 6.8%–12.3 % ) . All these results lasted for at least 8 wks after intervention . Upon comparing the parameters of gait among the three groups at every follow-up visit , no significant difference was observed . Conclusions Anodal tDCS or physical therapy could be used alone or together as a combination treatment to improve the walking speed of patients with Parkinson disease . The effects lasted for approximately 8 wks . The combination treatment was not superior to the use of tDCS or physical therapy alone Background Progression of Parkinson 's disease ( PD ) is characterised by motor deficits which eventually respond less to dopaminergic therapy and thus pose a therapeutic challenge . Deep brain stimulation has proven efficacy but carries risks and is not possible in all patients . Non-invasive brain stimulation has shown promising results and may provide a therapeutic alternative . Objective To investigate the efficacy of transcranial direct current stimulation ( tDCS ) in the treatment of PD . Design R and omised , double blind , sham controlled study . Setting Research institution . Methods The efficacy of anodal tDCS applied to the motor and prefrontal cortices was investigated in eight sessions over 2.5 weeks . Assessment over a 3 month period included timed tests of gait ( primary outcome measure ) and bradykinesia in the upper extremities , Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Serial Reaction Time Task , Beck Depression Inventory , Health Survey and self- assessment of mobility . Results Twenty-five PD patients were investigated , 13 receiving tDCS and 12 sham stimulation . tDCS improved gait by some measures for a short time and improved bradykinesia in both the on and off states for longer than 3 months . Changes in UPDRS , reaction time , physical and mental well being , and self-assessed mobility did not differ between the tDCS and sham interventions . Conclusion tDCS of the motor and prefrontal cortices may have therapeutic potential in PD but better stimulation parameters need to be established to make the technique clinical ly viable . This study was publicly registered ( clinical trials.org : NCT00082342 ) Dopamine is implicated in movement , learning , and motivation , and in illnesses such as Parkinson 's disease , schizophrenia , and drug addiction . Little is known about the control of dopamine release in humans , but research in experimental animals suggests that the prefrontal cortex plays an important role in regulating the release of dopamine in subcortical structures . Here we used [(11)C]raclopride and positron emission tomography to measure changes in extracellular dopamine concentration in vivo after repetitive transcranial magnetic stimulation ( rTMS ) of the dorsolateral prefrontal cortex in healthy human subjects . Repetitive TMS of the left dorsolateral prefrontal cortex caused a reduction in [(11)C]raclopride binding in the left dorsal cau date nucleus compared with rTMS of the left occipital cortex . There were no changes in binding in the putamen , nucleus accumbens , or right cau date . This shows that rTMS of the prefrontal cortex induces the release of endogenous dopamine in the ipsilateral cau date nucleus . This finding has implication s for the therapeutic and research use of rTMS in neurological and psychiatric disorders BACKGROUND Levodopa is the most effective therapy for Parkinson 's disease , but chronic treatment is associated with the development of potentially disabling motor complications . Experimental studies suggest that motor complications are due to non-physiological , intermittent administration of the drug , and can be reduced with continuous delivery . We aim ed to assess efficacy and safety of levodopa-carbidopa intestinal gel delivered continuously through an intrajejunal percutaneous tube . METHODS In our 12-week , r and omised , double-blind , double-dummy , double-titration trial , we enrolled adults ( aged ≥ 30 years ) with advanced Parkinson 's disease and motor complications at 26 centres in Germany , New Zeal and , and the USA . Eligible participants had jejunal placement of a percutaneous gastrojejunostomy tube , and were then r and omly allocated ( 1:1 ) to treatment with immediate-release oral levodopa-carbidopa plus placebo intestinal gel infusion or levodopa-carbidopa intestinal gel infusion plus oral placebo . R and omisation was stratified by site , with a mixed block size of 2 or 4 . The primary endpoint was change from baseline to final visit in motor off-time . We assessed change in motor on-time without troublesome dyskinesia as a prespecified key secondary outcome . We assessed efficacy in a full- analysis set of participants with data for baseline and at least one post-baseline assessment , and imputed missing data with the last observation carried forward approach . We assessed safety in r and omly allocated patients who underwent the percutaneous gastrojejunostomy procedure . This study is registered with Clinical Trials.gov , numbers NCT00660387 and NCT0357994 . FINDINGS From baseline to 12 weeks in the full- analysis set , mean off-time decreased by 4.04 h ( SE 0.65 ) for 35 patients allocated to the levodopa-carbidopa intestinal gel group compared with a decrease of 2.14 h ( 0.66 ) for 31 patients allocated to immediate-release oral levodopa-carbidopa ( difference -1.91 h [ 95 % CI -3.05 to -0.76 ] ; p=0.0015 ) . Mean on-time without troublesome dyskinesia increased by 4.11 h ( SE 0.75 ) in the intestinal gel group and 2.24 h ( 0.76 ) in the immediate-release oral group ( difference 1.86 [ 95 % CI 0.56 to 3.17 ] ; p=0.0059 ) . In the safety analyses 35 ( 95 % ) of 37 patients allocated to the levodopa-carbidopa intestinal gel group had adverse events ( five [ 14 % ] serious ) , as did 34 ( 100 % ) of 34 patients allocated to the immediate-release oral levodopa-car 
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In addition , tDCS protocol s that targeted multiple brain regions showed relatively more positive effects on functional locomotion than protocol s that targeted a single brain region .
Conclusions These meta-analytic findings indicate that tDCS protocol s may show immediate positive effects on functional locomotion in people with PD .