Over the last three decades, measuring and modulating cerebellar activity and its connectivity with other brain regions has become an emerging research topic in clinical neuroscience. The most important connection is the cerebellothalamocortical pathway, which can be functionally interrogated using a paired‐pulse transcranial magnetic stimulation paradigm. Cerebellar brain inhibition reflects the magnitude of suppression of motor cortex excitability after stimulating the contralateral cerebellar hemisphere and therefore represents a neurophysiological marker of the integrity of the efferent cerebellar tract. Observations that cerebellar noninvasive stimulation techniques enhanced performance of certain motor and cognitive tasks in healthy individuals have inspired attempts to modulate cerebellar activity and connectivity in patients with cerebellar diseases in order to achieve clinical benefit. We here comprehensively explore the therapeutic potential of these techniques in two movement disorders characterized by prominent cerebellar involvement, namely the degenerative ataxias and essential tremor. The article aims to illustrate the (patho)physiological insights obtained from these studies and how these translate into clinical practice, where possible by addressing the association with cerebellar brain inhibition. Finally, possible explanations for some discordant interstudy findings, shortcomings in our current understanding, and recommendations for future research will be provided. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

中文翻译：

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小脑在退行性共济失调和特发性震颤中的作用：对小脑活动无创调节的见解

在过去的三年中，测量和调节小脑活动及其与其他大脑区域的连接已成为临床神经科学的新兴研究课题。最重要的连接是小脑丘脑皮层通路，可以使用成对脉冲经颅磁刺激范式对其进行功能询问。小脑脑抑制反映了刺激对侧小脑半球后运动皮层兴奋性的抑制程度，因此代表了小脑传出束完整性的神经生理学标志。观察到小脑无创刺激技术增强了健康个体某些运动和认知任务的表现，这激发了尝试调节小脑疾病患者的小脑活动和连通性以实现临床益处的尝试。我们在这里全面探讨了这些技术在两种以小脑受累为特征的运动障碍中的治疗潜力，即退行性共济失调和特发性震颤。本文旨在说明从这些研究中获得的（病理）生理学见解以及这些见解如何转化为临床实践，在可能的情况下，通过解决与小脑抑制的关联。最后，对一些不一致的研究结果的可能解释，我们目前理解的缺陷，并对未来的研究提出建议。© 2019 作者。运动障碍由 Wiley Periodicals, Inc. 代表国际帕金森和运动障碍协会出版。