Non-invasive brain stimulation in Stroke patients (NIBS): A prospective randomized open blinded end-point (PROBE) feasibility trial using transcranial direct current stimulation (tDCS) in post-stroke hemispatial neglect (original) (raw)
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Brain Stimulation, 2018
Visuospatial neglect remains a relatively misunderstood complication of stroke. Up to 72% of right hemispheric strokes present neglect symptoms, and up to 75% of those patients still suffer at the 3-month mark [1]. This leads to marked increases in dependency, and lower functional outcomes [2]. Transcranial Direct Current Stimulation is a new rehabilitation tool that has been gaining popularity in the last two decades [3]. Current research focuses on subacute or chronic strokes, while stimulating the posterior parietal cortex (PPC), and seems to have positive effects on visuospatial neglect [4]. Four patients were included in this case report: patient 1, a 74year-old right-handed male patient was admitted at the University hospital's stroke unit with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. Patient 2: a 69-year-old right-handed male patient with right-sided middle cerebral artery (MCA) infarction and presented left visuo-spatial neglect. Patient 3: a 73-year-old right-handed male patient with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. Patient 4: a 59-year-old right-handed male patient with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. The patients understood the study, and gave written and oral consent according to the Declaration of Helsinki (1964). The protocol was approved by the University Hospital's ethics committee. Transcranial direct current stimulation (tDCS) was delivered using standard equipment (Starstim TCS, Barcelona, Spain) following a protocol in which sham and active stimulation sessions were administered in randomized order and double-blind conditions. Treatment began 48h after stroke, following the hospital's protocol to keep patients prone during that time. The patients received 20 minutes of anodal stimulation (anode placed on C4, cathode on FP1 based on the international EEG 10e20 system), using two electrodes covered by saline soaked 25cm 2 sponges, at 2mA daily. For patients 1 and 2, during weeks 1 and 3 patient received 20 minutes of tDCS, whilst during weeks 2 and 4, patient received 20 minutes of placebo (ramping up the current to 2mA over 15 seconds then the device automatically switches off). For patients 3 and 4, during weeks 1 and 3 patient received 20 minutes of placebo, whilst during weeks 2 and 4, patient received 20 minutes of tDCS. During stimulation, the patient was seated in a comfortable position in a calm, quiet and isolated room, and was instructed not perform any activity. In addition to the tDCS or placebo, the patient received 60 minutes of physical therapy (30 minutes of conventional therapy and 30 minutes peddling on a stationary bike), 30 minutes of
Archives of physical medicine and rehabilitation, 2017
To evaluate the effectiveness of noninvasive brain stimulation (NIBS) - repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) - on hemispatial neglect and performance in activities of daily living (ADL) after stroke. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, SCOPUS, Scielo and Physiotherapy Evidence Database (PEDro) were searched from database inception to December 2016. Randomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke. Methodological characteristics of the studies, number of participants, comparison groups, interventions and outcomes were extracted. Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with another therapy significantly improves hemispatial neglect [SMD -1.91 (95% CI, -2.57 to -1.25; I(2) 71%)]. A sensitivity...
Neural plasticity, 2018
Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. To assess the impact of NIBS on USN after stroke. An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.6...
Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients
Brain Stimulation, 2008
Stroke is the leading cause of disability in the adult population of western industrialized countries. Despite significant improvements of acute stroke care, two thirds of stroke survivors have to cope with persisting neurologic deficits. Adjuvant brain stimulation is a novel approach to improving the treatment of residual deficits after stroke. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and epidural electrical stimulation have been used in first trials on small cohorts of stroke patients. Effect sizes in the order of 8% to 30% of functional improvement have been reported, but a publication bias toward presenting ''promising'' but not negative results is likely. Many questions regarding underlying mechanisms, optimal stimulation parameters, combination with other types of interventions, among others, are open. This review addresses six controversies related to the experimental application of brain stimulation techniques to stroke patients. Cortical stimulation after stroke will need to be individually tailored and a thorough patient stratification according to type and extent of clinical deficit, lesion location, lesion size, comorbidities, time in the recovery process, and perhaps also age and gender will be necessary. There is consensus that cortical stimulation in stroke patients is still experimental and should only be applied in the frame of scientific studies.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients' tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
The Effect of Transcranial Direct Current Stimulation on Neglect Syndrome in Stroke Patients
Annals of rehabilitation medicine, 2016
To examine whether transcranial direct current stimulation (tDCS) applied over the posterior parietal cortex (PPC) improves visuospatial attention in stroke patients with left visuospatial neglect. Patients were randomly assigned to 1 of 3 treatment groups: anodal tDCS over the right PPC, cathodal tDCS over the left PPC, or sham tDCS. Each patient underwent 15 sessions of tDCS (5 sessions per week for 3 weeks; 2 mA for 30 minutes in each session). Outcome measures were assessed before treatment and 1 week after completing the treatment. From pre- to post-treatment, there was an improvement in the motor-free visual perception test (MVPT), line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), Korean version of Modified Barthel Index (K-MBI), and Functional Ambulation Classification in all 3 groups. Improvements in the MVPT, SCT, and LBT were greater in the anodal and cathodal groups than in the sham group. However, improvements in other outcomes were ...
Application Value of Transcranial Direct Current Stimulation in Stroke Patients
Objectives: The main objective of the study is to analyze the application value of transcranial direct current Stimulation (TDCS) in stroke patients. Material and Methods: This pilot study was conducted in Rawal Institute of Health Sciences during June 2019 to June 2020. The components required for TDCS include a Constant Current Stimulator and surface electrodes soaked in normal saline. A Constant Current Stimulator provides a steady flow of direct current (e.g., 0-4mA) while constantly monitoring the resistance in the system. Results: The study was completed by 136 patients. Their mean age was 53.2 ± 8.4 years (range: 36-61 years). There were more males than females (60% vs. 40%). Their demographic and clinical characteristics are summarized in table 1. Conclusion: It is concluded that TDCS combined with VR can reduce motor impairment, improve function, increase ADL in the affected upper limb in patients with subacute or chronic ischemic stroke than VR alone.
Non-invasive brain stimulation in early rehabilitation after stroke
Journal of Medicine and Life, 2015
The new tendency in rehabilitation involves non-invasive tools that, if applied early after stroke, promote neurorecovery. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may correct the disruption of cortical excitability and effectively contribute to the restoration of movement and speech. The present paper analyses the results of non-invasive brain stimulation (NIBS) trials, highlighting different aspects related to the repetitive transcranial magnetic stimulation frequency, transcranial direct current stimulation polarity, the period and stimulation places in acute and subacute ischemic strokes. The risk of adverse events, the association with motor or language recovery specific training, and the cumulative positive effect evaluation are also discussed. Abbreviations: AAT = Aachen Aphasia Test, BDNF = brain-derived neurotrophic factor, IFG = inferior frontal gyrus, M1 = primary motor cortex, MRI = magnetic resonance imaging, NIBS = non-in...