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Contralesional Cathodal Transcranial Direct Current Stimulation Does Not Enhance Upper Limb Function in Subacute Stroke: A Pilot Randomized Clinical Trial
Neural Plasticity ( IF 3.1 ) Pub Date : 2021-08-10 , DOI: 10.1155/2021/8858394
Danielle De S Boasquevisque 1, 2 , Larissa Servinsckins 1 , Joselisa P Q de Paiva 1 , Daniel G Dos Santos 1 , Priscila Soares 1 , Danielle S Pires 1 , Jed A Meltzer 3 , Ela B Plow 4 , Paloma F de Freitas 1 , Danielli S Speciali 1 , Priscila Lopes 1 , Mario F P Peres 1 , Gisele S Silva 1, 5 , Shirley Lacerda 1 , Adriana B Conforto 1, 6
Affiliation  

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.

中文翻译:

对侧阴极经颅直流电刺激不会增强亚急性中风的上肢功能:一项初步随机临床试验

经颅直流电刺激 (tDCS) 有可能改善中风后的上肢运动结果。根据大脑半球间抑制的假设,从健侧半球运动皮层到患侧半球运动皮层的过度抑制可能会恶化中风后上肢运动恢复。我们评估了未受影响的半球初级运动皮层的活性阴极 tDCS(ctDCSM1 UH) 与假手术相比,在缺血性卒中后 72 小时至 6 周内的受试者中。阴极 tDCS 旨在抑制未受影响的半球的运动皮层,从而减少从未受影响的半球到受影响的半球的抑制并增强运动恢复。我们假设在活动组中的运动恢复会比在假组中更大。此外,与假手术组相比,与假手术组相比,活动组的运动恢复程度更高可能与活动和参与活动的更大改善有关。我们还首次探索了 ctDCSM1 UH后认知和睡眠的变化。30 名受试者被随机分配到 6 个活动或假 ctDCSM1 UH疗程作为康复的附加干预。在治疗前、治疗后和三个几个月后。在意向治疗 (ITT) 分析中,存在显着的 GROUP*TIME 交互作用,反映出假手术组在 NIHSS、FMA、BI、MoCA 和四个 SIS 领域的得分获得了更强的收益。在干预后三个月,与治疗后相比,假手术组在 FMA、NIHSS、BI 和三个 SIS 领域有显着改善,而在活动组中没有发生显着变化。同样在三个月时,假手术组的 NIHSS 显着改善,而活动组的 NIHSS 显着恶化。活动组的基线 FMA 分数高于假组。根据基线评分调整分析后,FMA 变化的组间差异不再具有统计学意义。最后,治疗后结果变化的组间差异均不被认为具有临床相关性。总之,活性 CtDCSM1与假相比, UH没有有益的影响。这些结果与其他研究一致,这些研究应用可比较的 tDCS 强度/电流密度或在中风后的第一周内治疗患有严重上肢运动障碍的受试者。在计划更大规模的临床试验之前,有必要在中风后早期进行剂量研究。
更新日期:2021-08-10
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