Discussion
The rapidly evolving field of cranial nerve stimulation and
neuromodulation techniques has the potential to revolutionize the
management of Parkinson’s disease (PD). In this review, we have
critically assessed the latest advancements in non-invasive and
minimally invasive approaches, their clinical applications, and the
evidence supporting their safety and efficacy. These innovative
techniques offer the possibility of more targeted, less invasive, and
better-tolerated treatment options for patients with this debilitating
disorder [30].
Non-invasive techniques, such as transcranial magnetic stimulation (TMS)
and transcranial direct current stimulation (tDCS), have demonstrated
promising results in alleviating motor and non-motor symptoms of PD
[31, 34]. Repetitive TMS (rTMS), in particular, has shown consistent
improvements in motor function and gait, with some studies also
reporting positive effects on mood and cognition [35]. The advantage
of these non-invasive approaches is the absence of surgical risks and a
relatively low incidence of side effects. However, the long-term
efficacy and optimal stimulation parameters of these techniques are yet
to be determined, and further research is needed to establish their role
in the clinical management of PD [32, 36].
Minimally invasive techniques, such as vagus nerve stimulation (VNS) and
trigeminal nerve stimulation (TNS), have also shown potential benefits
in the treatment of PD. VNS, a well-established treatment for
drug-resistant epilepsy and depression, has been increasingly
investigated for its effects on motor and non-motor symptoms in PD
[25, 37]. Although preliminary studies have suggested a favorable
safety profile, more extensive research is needed to confirm its
efficacy and establish optimal stimulation parameters. Similarly, TNS, a
novel neuromodulation technique, has demonstrated encouraging results in
early studies on motor symptoms, sleep, and cognition in PD patients,
but further investigation is required to validate these findings and
define its role in PD treatment [28, 39].
Despite the promising results of these emerging cranial nerve
stimulation and neuromodulation techniques, several challenges remain to
be addressed before they can be widely adopted in clinical practice. One
critical issue is the need for well-designed, large-scale, randomized
controlled trials to determine the long-term safety, efficacy, and
cost-effectiveness of these approaches, particularly in comparison with
existing treatments [38]. Another challenge is the identification of
optimal stimulation parameters and individualized treatment protocols,
which could maximize the therapeutic benefits and minimize potential
side effects. This will likely require a better understanding of the
underlying neurophysiological mechanisms and the development of advanced
computational models and personalized stimulation algorithms [40].
In conclusion, next-generation cranial nerve stimulation and
neuromodulation techniques hold great promise for the treatment of
Parkinson’s disease, offering the potential for more effective and
better-tolerated alternatives to current pharmacological and surgical
therapies. However, further research is needed to address the existing
challenges, optimize treatment protocols, and validate the long-term
safety and efficacy of these innovative approaches. As our understanding
of the neurophysiological basis of PD continues to evolve, these novel
technologies may pave the way for more targeted, individualized, and
comprehensive treatment strategies, ultimately improving the quality of
life for millions of patients affected by this debilitating disorder.