Методы нейромодуляции в лечении мышечных дистоний

Бордовский С.П., Варфоломеева А.В., Кожина А.А., Меинова Т.О., Ервандян А.С., Шевцова К.В. Методы нейромодуляции в лечении мышечных дистоний. Consilium Medicum. 2026;28(2):93–101. DOI: 10.26442/20751753.2026.2.203594

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Bordovsky SP, Varfolomeeva AV, Kozhina AA, Meinova TO, Ervandyan AS, Shevtsova KV. Neuromodulation for muscle dystonia management: A review. Consilium Medicum. 2026;28(2):93–101. DOI: 10.26442/20751753.2026.2.203594

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Аннотация

Мышечная дистония представляет собой группу хронических неврологических расстройств, характеризующихся патологическими мышечными сокращениями, формированием аномальных поз и выраженным снижением качества жизни пациентов. Стандартные подходы к лечению включают ботулинотерапию и хирургические методы, однако у части больных эффект терапии остается недостаточным или нестабильным. В связи с этим в последние годы возрастает интерес к неинвазивным методам нейромодуляции, таким как транскраниальная магнитная стимуляция и транскраниальная стимуляция постоянным током (ТСПТ), рассматриваемым в качестве потенциальных вспомогательных терапевтических инструментов. В статье обобщены и критически проанализированы данные современных клинических исследований, включая пилотные работы, систематические обзоры и метаанализы, посвященные применению нейромодуляции при различных формах мышечной дистонии, в частности при фокальной и цервикальной дистонии. Особое внимание уделено параметрам стимуляции, выбору зон воздействия и полярности тока, включая анодную и катодную стимуляцию. Обзорный анализ опубликованных данных показал, что транскраниальная магнитная стимуляция демонстрирует умеренный терапевтический потенциал при отдельных формах дистонии, однако полученные результаты остаются неоднородными. В то же время в большинстве исследований, посвященных ТСПТ, не выявлено статистически и клинически значимого улучшения моторных симптомов при фокальных дистониях, включая писчий спазм и блефароспазм, что подтверждают результаты систематических обзоров и метаанализов. Вместе с тем наиболее обнадеживающие результаты получены при цервикальной дистонии, особенно в исследованиях с применением билатеральной анодной стимуляции мозжечка в сочетании с двигательным тренингом. Несмотря на отдельные положительные данные, существующая доказательная база не позволяет рекомендовать ТСПТ в качестве стандартного метода лечения мышечной дистонии. Таким образом, перспективы нейромодуляции связаны с оптимизацией протоколов стимуляции, персонализацией подходов и интеграцией метода в комплексные реабилитационные программы, направленные на улучшение функциональных исходов и долгосрочного контроля симптомов у пациентов.

Ключевые слова: транскраниальная магнитная стимуляция, транскраниальная стимуляция постоянным током, мышечная дистония, цервикальная дистония, фокальная дистония, нейромодуляция, анодная стимуляция, катодная стимуляция, писчий спазм, блефароспазм

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Muscle dystonia represents a group of chronic neurological disorders characterized by pathological muscle contractions, the formation of abnormal postures, and a pronounced reduction in patients’ quality of life. Standard treatment approaches include botulinum toxin therapy and surgical interventions; however, in a subset of patients, therapeutic effects remain insufficient or unstable. Consequently, recent years have seen growing interest in non-invasive neuromodulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation, which are considered potential adjunctive therapeutic tools. This review summarizes and critically analyses data from contemporary clinical studies, pilot trials, systematic reviews, and meta-analyses addressing the use of neuromodulation in various forms of muscle dystonia, including focal dystonia and cervical dystonia. Particular attention is paid to stimulation parameters, target regions, and current polarity, including anodal stimulation and cathodal stimulation. Analysis of the available evidence indicates that transcranial magnetic stimulation demonstrates a moderate therapeutic potential in certain forms of dystonia; however, reported outcomes remain heterogeneous. At the same time, most studies investigating transcranial direct current stimulation fail to demonstrate statistically or clinically significant improvement in motor symptoms in focal dystonias, including writer’s cramp and blepharospasm, a finding consistently supported by systematic reviews and meta-analyses. However, the most encouraging results have been observed in cervical dystonia, particularly in studies employing bilateral anodal cerebellar stimulation in combination with motor training. Despite isolated positive findings, the current evidence base does not support the recommendation of transcranial direct current stimulation as a standard treatment for muscle dystonia. Thus, future perspectives of neuromodulation are associated with optimization of stimulation protocols, personalization of therapeutic approaches, and integration of these methods into comprehensive rehabilitation programs aimed at improving functional outcomes and long-term symptom control in patients.

Keywords: transcranial magnetic stimulation, transcranial direct current stimulation, muscle dystonia, cervical dystonia, focal dystonia, neuromodulation, anodal stimulation, cathodal stimulation, writer’s cramp, blepharospasm

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Список литературы

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1. Albanese A, Asmus F, Bhatia KP, et al. EFNS guidelines on diagnosis and treatment of primary dystonias. Eur J Neurol. 2011;18(1):5-18. DOI:10.1111/j.1468-1331.2010.03042.x
2. Steeves TD, Day L, Dykeman J, et al. The prevalence of primary dystonia: a systematic review and meta-analysis. Mov Disord. 2012;27(14):1789-96. DOI:10.1002/mds.25244
3. NORD review. Dystonia – Symptoms, Causes, Treatment. What is Dystonia? Available at: https://rarediseases.org/rare-diseases/dystonia. Accessed: 28.11.2025.
4. Dressler D, Altenmüller E, Giess R, et al. The epidemiology of dystonia: the Hannover epidemiology study. J Neurol. 2022;269(12):6483-93. DOI:10.1007/s00415-022-11310-9
5. Junker J, Berman BD, Hall J, et al. Quality of life in isolated dystonia: non-motor manifestations matter. J Neurol Neurosurg Psychiatry. 2021;:jnnp-2020-325193. DOI:10.1136/jnnp-2020-325193
6. Balint B, Mencacci NE, Valente EM, et al. Dystonia. Nat Rev Dis Primers. 2018;4(1):25. DOI:10.1038/s41572-018-0023-6
7. Conte A, Defazio G, Hallett M, et al. The role of sensory information in the pathophysiology of focal dystonias. Nat Rev Neurol. 2019;15(4):224-33. DOI:10.1038/s41582-019-0137-9
8. Pana A, Saggu BM. Dystonia. StatPearls. 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448144. Accessed: 28.11.2025.
9. Rajan S, Kaas B, Moukheiber E. Movement Disorders Emergencies. Semin Neurol. 2019;39(1):125-36. DOI:10.1055/s-0038-1677050
10. Elshebawy H, Ramzy GM, Salama M, El-Jaafary S. Assessment of quality of life in patients with cervical dystonia and hemifacial spasm after botulinum toxin injections. Acta Neurol Belg. 2025;125(3):707-16. DOI:10.1007/s13760-025-02742-x
11. Wagle Shukla A. Basis of movement control in dystonia and why botulinum toxin should influence it? Toxicon. 2024;237:107251. DOI:10.1016/j.toxicon.2023.107251
12. Castelão M, Marques RE, Duarte GS, et al. Botulinum toxin type A therapy for cervical dystonia. Cochrane Database Syst Rev. 2017;12(12):CD003633. DOI:10.1002/14651858.CD003633.pub3
13. Zoons E, Dijkgraaf MG, Dijk JM, et al. Botulinum toxin as treatment for focal dystonia: a systematic review of the pharmaco-therapeutic and pharmaco-economic value. J Neurol. 2012;259(12):2519-26. DOI:10.1007/s00415-012-6510-x
14. Hok P, Veverka T, Hluštík P, et al. The Central Effects of Botulinum Toxin in Dystonia and Spasticity. Toxins (Basel). 2021;13(2):155. DOI:10.3390/toxins13020155
15. Sławek J, Bogucki A, Bonikowski M, et al. Botulinum toxin type-A preparations are not the same medications – clinical studies (Part 2). Neurol Neurochir Pol. 2021;55(2):141-57. DOI:10.5603/PJNNS.a2021.0028
16. Adam OR, Jankovic J. Treatment of dystonia. Parkinsonism Relat Disord. 2007;13(Suppl. 3):S362-8. DOI:10.1016/S1353-8020(08)70031-2
17. Dressler D, Adib Saberi F, Rosales RL. Botulinum toxin therapy of dystonia. J Neural Transm (Vienna). 2021;128(4):531-7. DOI:10.1007/s00702-020-02266-z
18. Jinnah HA. Medical and Surgical Treatments for Dystonia. Neurol Clin. 2020;38(2):325-48. DOI:10.1016/j.ncl.2020.01.003
19. Tierney TS, Lozano AM. Surgical treatment for secondary dystonia. Mov Disord. 2012;27(13):1598-605. DOI:10.1002/mds.25204
20. Momin SMB, Aquilina K, Bulstrode H, et al. MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review. Cureus. 2024;16(2):e54284. DOI:10.7759/cureus.54284
21. Menon V, Varadharajan N, Bascarane S, Andrade C. Efficacy of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in focal hand dystonia: Systematic review of intervention trials. Asian J Psychiatr. 2023;80:103437. DOI:10.1016/j.ajp.2022.103437
22. Ganguly J, Murgai A, Sharma S, et al. Non-invasive Transcranial Electrical Stimulation in Movement Disorders. Front Neurosci. 2020;14:522. DOI:10.3389/fnins.2020.00522
23. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(Pt 3):633-9. DOI:10.1111/j.1469-7793.2000.t01-1-00633.x
24. Yamada Y, Sumiyoshi T. Neurobiological Mechanisms of Transcranial Direct Current Stimulation for Psychiatric Disorders; Neurophysiological, Chemical, and Anatomical Considerations. Front Hum Neurosci. 2021;15:631838. DOI:10.3389/fnhum.2021.631838
25. Lefaucheur JP, Moro E, Shirota Y, et al. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol. 2024;164:57-99. DOI:10.1016/j.clinph.2024.05.007
26. Woods AJ, Antal A, Bikson M, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol. 2016;127(2):1031-48. DOI:10.1016/j.clinph.2015.11.012
27. Bordovsky SP, Andreev SS, Murtazina RТ, et al. Transcranial direct current stimulation in Parkinson’s disease management. Consilium Medicum. 2025;27(11):659-64 (in Russian). DOI:10.26442/20751753.2025.11.203455
28. Lozeron P, Poujois A, Richard A, et al. Contribution of TMS and rTMS in the Understanding of the Pathophysiology and in the Treatment of Dystonia. Front Neural Circuits. 2016;10:90. DOI:10.3389/fncir.2016.00090
29. Schrader LM, Stern JM, Koski L, et al. Seizure incidence during single- and paired-pulse transcranial magnetic stimulation (TMS) in individuals with epilepsy. Clin Neurophysiol. 2004;115(12):2728-37. DOI:10.1016/j.clinph.2004.06.018
30. Rossi S, Antal A, Bestmann S, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol. 2021;132(1):269-306. DOI:10.1016/j.clinph.2020.10.003
31. Oyama G, Hattori N. New modalities and directions for dystonia care. J Neural Transm (Vienna). 2021;128(4):559-65. DOI:10.1007/s00702-020-02278-9
32. Qiu X, He Z, Cao X, Zhang D. Transcranial magnetic stimulation and transcranial direct current stimulation affect explicit but not implicit emotion regulation: a meta-analysis. Behav Brain Funct. 2023;19(1):15. DOI:10.1186/s12993-023-00217-8
33. Grimm K, Prilop L, Schön G, et al. Cerebellar Modulation of Sensorimotor Associative Plasticity Is Impaired in Cervical Dystonia. Mov Disord. 2023;38(11):2084-93. DOI:10.1002/mds.29586
34. Buttkus F, Weidenmüller M, Schneider S, et al. Failure of cathodal direct current stimulation to improve fine motor control in musician's dystonia. Mov Disord. 2010;25(3):389-94. DOI:10.1002/mds.22938
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Авторы

С.П. Бордовский*, А.В. Варфоломеева, А.А. Кожина, Т.О. Меинова, А.С. Ервандян, К.В. Шевцова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Российская Федерация
*sbordoche@gmail.com

________________________________________________

Sergey P. Bordovsky*, Arina V. Varfolomeeva, Anastasiia A. Kozhina, Taisiya O. Meinova, Arakel S. Ervandyan, Kseniya V. Shevtsova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
*sbordoche@gmail.com

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