scholarly journals Contralesional Cathodal Transcranial Direct Current Stimulation Does Not Enhance Upper Limb Function in Subacute Stroke: A Pilot Randomized Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Danielle De S. Boasquevisque ◽  
Larissa Servinsckins ◽  
Joselisa P. Q. de Paiva ◽  
Daniel G. dos Santos ◽  
Priscila Soares ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Sham Group ◽  
Motor Recovery ◽  
Active Group ◽  
Group Differences ◽  
Direct Current Stimulation ◽  
Cathodal Tdcs

Transcranial direct current stimulation (tDCS) has the potential to improve upper limb motor outcomes after stroke. According to the assumption of interhemispheric inhibition, excessive inhibition from the motor cortex of the unaffected hemisphere to the motor cortex of the affected hemisphere may worsen upper limb motor recovery after stroke. We evaluated the effects of active cathodal tDCS of the primary motor cortex of the unaffected hemisphere (ctDCSM1UH) compared to sham, in subjects within 72 hours to 6 weeks post ischemic stroke. Cathodal tDCS was intended to inhibit the motor cortex of the unaffected hemisphere and hence decrease the inhibition from the unaffected to the affected hemisphere and enhance motor recovery. We hypothesized that motor recovery would be greater in the active than in the sham group. In addition, greater motor recovery in the active group might be associated with bigger improvements in measures in activity and participation in the active than in the sham group. We also explored, for the first time, changes in cognition and sleep after ctDCSM1UH. Thirty subjects were randomized to six sessions of either active or sham ctDCSM1UH as add-on interventions to rehabilitation. The NIH Stroke Scale (NIHSS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Barthel Index (BI), Stroke Impact Scale (SIS), and Montreal Cognitive Assessment (MoCA) were assessed before, after treatment, and three months later. In the intent-to-treat (ITT) analysis, there were significant GROUP*TIME interactions reflecting stronger gains in the sham group for scores in NIHSS, FMA, BI, MoCA, and four SIS domains. At three months post intervention, the sham group improved significantly compared to posttreatment in FMA, NIHSS, BI, and three SIS domains while no significant changes occurred in the active group. Also at three months, NIHSS improved significantly in the sham group and worsened significantly in the active group. FMA scores at baseline were higher in the active than in the sham group. After adjustment of analysis according to baseline scores, the between-group differences in FMA changes were no longer statistically significant. Finally, none of the between-group differences in changes in outcomes after treatment were considered clinically relevant. In conclusion, active CtDCSM1UH did not have beneficial effects, compared to sham. These results were consistent with other studies that applied comparable tDCS intensities/current densities or treated subjects with severe upper limb motor impairments during the first weeks post stroke. Dose-finding studies early after stroke are necessary before planning larger clinical trials.

scholarly journals Effect of transcranial direct current stimulation in the first weeks after stroke: a preliminary study

2021 ◽  
Author(s):  
Marcela Tengler Carvalho Takahashi ◽  
Paulo Rodrigo Bázan ◽  
Joana Bisol Balardin ◽  
Danielle de Sá Boasquevisque ◽  
Edson Amaro Júnior ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Motor Performance ◽  
Sham Group ◽  
Primary Motor Cortex ◽  
Premotor Cortex ◽  
Group Differences ◽  
Direct Current Stimulation ◽  
Cathodal Tdcs

Background: There is limited information about effects of transcranial Direct Current Stimulation(tDCS), delivered within the first weeks post-stroke, on performance of the paretic upper limb and on connectivity between motor areas in the affected and unaffected hemispheres. Objectives: We compared changes in Fugl-Meyer Assessment of Motor Recovery(FMA) scores, connectivity between the primary motor cortex of the unaffected(M1UH) and the affected hemisphere(M1AH), as well as between M1UH and the premotor cortex of the unaffected hemisphere(PMUH) before and after 6 sessions of cathodal tDCS targeting the primary motor cortex of the unaffected hemisphere(M1UH) early after stroke in 13 patients. Methods: This hypothesis-generating substudy was a randomized parallel, two-arm, double-blind, sham-controlled clinical trial performed at the Albert Einstein Hospital. Subjects were randomized active(N=6) or sham(N=7) groups. Results: Clinically relevant differences in FMA scores(≥ 9 points) were observed more often in the sham than in the active group. Between-group differences in changes in FMA scores were not statistically significant(Mann-Whitney test, p=0.133) but the effect size was -0.619(rank biserial correlation). Connectivity measures(Fisher’s z- transform of ROI-to-ROI correlations) between M1AH-M1UH increased in 5/6 participants in the active, and in 2/7 in the sham group after treatment. Between-group differences in changes in connectivity(M1UH-M1AH or PMUH-M1AH) were not statistically significant. In contrast with M1AH-M1UH connectivity, improvements in motor performance were more frequent in the active than in the sham group. Conclusions: Effects of cathodal tDCS on motor performance and on Resting-state Functional Magnetic Resonance Imaging may have distinct underpinnings in subjects at an early stage after stroke.

Cathodal transcranial direct current stimulation of the primary motor cortex improves selective muscle activation in the ipsilateral arm

2011 ◽  
Vol 105 (6) ◽  
pp. 2937-2942 ◽  
Author(s):  
Alana B. McCambridge ◽  
Lynley V. Bradnam ◽  
Cathy M. Stinear ◽  
Winston D. Byblow
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Muscle Activation ◽  
Primary Motor Cortex ◽  
Selectivity Ratio ◽  
Direct Current Stimulation ◽  
Antagonist Muscles ◽  
Stimulation Of

Proximal upper limb muscles are represented bilaterally in primary motor cortex. Goal-directed upper limb movement requires precise control of proximal and distal agonist and antagonist muscles. Failure to suppress antagonist muscles can lead to abnormal movement patterns, such as those commonly experienced in the proximal upper limb after stroke. We examined whether noninvasive brain stimulation of primary motor cortex could be used to improve selective control of the ipsilateral proximal upper limb. Thirteen healthy participants performed isometric left elbow flexion by contracting biceps brachii (BB; agonist) and left forearm pronation (BB antagonist) before and after 20 min of cathodal transcranial direct current stimulation (c-tDCS) or sham tDCS of left M1. During the tasks, motor evoked potentials (MEPs) in left BB were acquired using single-pulse transcranial magnetic stimulation of right M1 150–270 ms before muscle contraction. As expected, left BB MEPs were facilitated before flexion and suppressed before pronation. After c-tDCS, left BB MEP amplitudes were reduced compared with sham stimulation, before pronation but not flexion, indicating that c-tDCS enhanced selective muscle activation of the ipsilateral BB in a task-specific manner. The potential for c-tDCS to improve BB antagonist control correlated with BB MEP amplitude for pronation relative to flexion, expressed as a selectivity ratio. This is the first demonstration that selective muscle activation in the proximal upper limb can be improved after c-tDCS of ipsilateral M1 and that the benefits of c-tDCS for selective muscle activation may be most effective in cases where activation strategies are already suboptimal. These findings may have relevance for the use of tDCS in rehabilitation after stroke.

Transcranial direct current stimulation for motor recovery of upper limb function after stroke

2014 ◽  
Vol 47 ◽  
pp. 245-259 ◽  
Author(s):  
Jitka Lüdemann-Podubecká ◽  
Kathrin Bösl ◽  
Sandra Rothhardt ◽  
Geert Verheyden ◽  
Dennis Alexander Nowak
Keyword(s):  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Motor Recovery ◽  
Limb Function ◽  
Direct Current Stimulation ◽  
Upper Limb Function

scholarly journals Does Cathodal vs. Sham Transcranial Direct Current Stimulation Over Contralesional Motor Cortex Enhance Upper Limb Motor Recovery Post-stroke? A Systematic Review and Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Joyce L. Chen ◽  
Ashley Schipani ◽  
Clarissa Pedrini Schuch ◽  
Henry Lam ◽  
Walter Swardfager ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Post Stroke ◽  
Cathodal Tdcs

Background: During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery.Objective: The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS.Methods: We searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for participants with stroke (>1 week post-onset) with motor impairment and who received cathodal or sham tDCS to contralesional M1 for one or more sessions. The outcomes included a change in any clinically validated assessment of physical function, activity, or participation, or a change in a movement performance variable (e.g., time, accuracy). A meta-analysis was performed by pooling five randomized controlled trials (RCTs) and comparing the change in Fugl–Meyer upper extremity scores between cathodal and sham tDCS groups.Results: Eleven studies met the inclusion criteria. Qualitatively, four out of five cross-over design studies and three out of six RCTs reported a significant effect of cathodal vs. sham tDCS. In the quantitative synthesis, cathodal tDCS (n = 65) did not significantly reduce motor impairment compared to sham tDCS (n = 67; standardized mean difference = 0.33, z = 1.79, p = 0.07) with a little observed heterogeneity (I2 = 5%).Conclusions: The effects of cathodal tDCS to contralesional M1 on motor recovery are small and consistent. There may be sub-populations that may respond to this approach; however, further research with larger cohorts is required.

scholarly journals Longitudinal Clinical Trial Recruitment and Retention Challenges in the Burn Population: Lessons Learned From a Trial Examining a Novel Intervention for Chronic Neuropathic Symptoms

2019 ◽  
Vol 40 (6) ◽  
pp. 792-795 ◽  
Author(s):  
Emily A Ohrtman ◽  
Ana Luiza Zaninotto ◽  
Sandra Carvalho ◽  
Vivian L Shie ◽  
Jorge Leite ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Sham Group ◽  
Burn Injury ◽  
Group Analysis ◽  
Dropout Rate ◽  
Lessons Learned ◽  
Active Group ◽  
Direct Current Stimulation

Abstract Long-term trials are key to understanding chronic symptoms such as pain and itch. However, challenges such as high attrition rates and poor recruitment are common when conducting research. The aim of this work was to explore these issues within a long-term randomized control trial using transcranial direct current stimulation to treat pain and itch. This parallel double blinded, placebo-controlled randomized trial was comprised of 15 transcranial direct current stimulation visits and 7 follow-up visits. Participants were over the age of 18, had a burn injury that occurred at least 3 weeks before enrollment, and reported having pain and/or itch that was moderate to severe in intensity. A total of 31 subjects were randomized into either an active or sham transcranial direct current stimulation groups. There were no significant differences between the groups in terms of age, race, education, baseline depression, or anxiety. The median dropout time was at visit 19 (visit 16 [SE = 1.98] for the sham group and visit 19 [SE = 1.98] for the active group). Analysis showed no differences in the dropout rate between groups [χ2(1) = 0.003, P = .954]. The dropout rate was 46.7% for the sham group and 43.8% for the active group. Overall, 45.2% of the subjects dropped out of the trial. Long-term clinical trials are an essential part of evaluating interventions for symptoms such as chronic pain and itch. However, as seen in this trial, long-term studies in the burn population often face recruitment and adherence challenges.

Transcranial direct current stimulation effects on I-wave activity in humans

2011 ◽  
Vol 105 (6) ◽  
pp. 2802-2810 ◽  
Author(s):  
Nicolas Lang ◽  
Michael A. Nitsche ◽  
Michele Dileone ◽  
Paolo Mazzone ◽  
Javier De Andrés-Arés ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Cortical Neurons ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
Anodal Tdcs ◽  
Direct Current Stimulation ◽  
Cathodal Tdcs ◽  
Motor Cortex Excitability

Transcranial direct current stimulation (tDCS) of the human cerebral cortex modulates cortical excitability noninvasively in a polarity-specific manner: anodal tDCS leads to lasting facilitation and cathodal tDCS to inhibition of motor cortex excitability. To further elucidate the underlying physiological mechanisms, we recorded corticospinal volleys evoked by single-pulse transcranial magnetic stimulation of the primary motor cortex before and after a 5-min period of anodal or cathodal tDCS in eight conscious patients who had electrodes implanted in the cervical epidural space for the control of pain. The effects of anodal tDCS were evaluated in six subjects and the effects of cathodal tDCS in five subjects. Three subjects were studied with both polarities. Anodal tDCS increased the excitability of cortical circuits generating I waves in the corticospinal system, including the earliest wave (I1 wave), whereas cathodal tDCS suppressed later I waves. The motor evoked potential (MEP) amplitude changes immediately following tDCS periods were in agreement with the effects produced on intracortical circuitry. The results deliver additional evidence that tDCS changes the excitability of cortical neurons.

scholarly journals Modulation of human trigeminal and extracranial nociceptive processing by transcranial direct current stimulation of the motor cortex

Cephalalgia ◽  
2011 ◽  
Vol 31 (6) ◽  
pp. 661-670 ◽  
Author(s):  
Niels Hansen ◽  
Mark Obermann ◽  
Franziska Poitz ◽  
Dagny Holle ◽  
Hans-Christoph Diener ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Pain Processing ◽  
Direct Current Stimulation ◽  
Cathodal Tdcs ◽  
Nociceptive Processing ◽  
After Effect ◽  
Stimulation Of

Objective: The study was conducted to investigate the after-effect of transcranial direct current stimulation (tDCS) applied over the human primary motor cortex (M1) on trigeminal and extracranial nociceptive processing. Basic procedures: Nineteen healthy volunteers were stimulated using cathodal, anodal (both 1 mA) or sham tDCS for 20 minutes. Pain processing was assessed by recording trigeminal and extracranial pain-related evoked potentials (PREPs) following electrical stimulation of the contralateral forehead and hand at baseline, 0, 20 and 50 minutes post-tDCS. Main findings: Cathodal tDCS resulted in decreased peak-to-peak amplitudes (PPAs) by 18% while anodal tDCS lead to increased PPAs of PREPs by 35% ( p < .05). Principal conclusions: The decreased PPAs suggest an inhibition and the increased PPAs of PREPs suggest an excitation of trigeminal and extracranial pain processing induced by tDCS of the M1. These results may provide evidence for the effectiveness of tDCS as a therapeutic instrument in treating headache disorders.

Time course of the induction of homeostatic plasticity generated by repeated transcranial direct current stimulation of the human motor cortex

2011 ◽  
Vol 105 (3) ◽  
pp. 1141-1149 ◽  
Author(s):  
K. Fricke ◽  
A. A. Seeber ◽  
N. Thirugnanasambandam ◽  
W. Paulus ◽  
M. A. Nitsche ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Homeostatic Plasticity ◽  
Network Activity ◽  
Time Interval ◽  
Human Motor Cortex ◽  
Direct Current Stimulation ◽  
Cathodal Tdcs ◽  
Human Motor

Several mechanisms have been proposed that control the amount of plasticity in neuronal circuits and guarantee dynamic stability of neuronal networks. Homeostatic plasticity suggests that the ease with which a synaptic connection is facilitated/suppressed depends on the previous amount of network activity. We describe how such homeostatic-like interactions depend on the time interval between two conditioning protocols and on the duration of the preconditioning protocol. We used transcranial direct current stimulation (tDCS) to produce short-lasting plasticity in the motor cortex of healthy humans. In the main experiment, we compared the aftereffect of a single 5-min session of anodal or cathodal tDCS with the effect of a 5-min tDCS session preceded by an identical 5-min conditioning session administered 30, 3, or 0 min beforehand. Five-minute anodal tDCS increases excitability for about 5 min. The same duration of cathodal tDCS reduces excitability. Increasing the duration of tDCS to 10 min prolongs the duration of the effects. If two 5-min periods of tDCS are applied with a 30-min break between them, the effect of the second period of tDCS is identical to that of 5-min stimulation alone. If the break is only 3 min, then the second session has the opposite effect to 5-min tDCS given alone. Control experiments show that these shifts in the direction of plasticity evolve during the 10 min after the first tDCS session and depend on the duration of the first tDCS but not on intracortical inhibition and facilitation. The results are compatible with a time-dependent “homeostatic-like” rule governing the response of the human motor cortex to plasticity probing protocols.

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