Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke

Sattler, Virginie; Acket, Blandine; Raposo, Nicolas; Albucher, Jean‐François; Thalamas, Claire; Loubinoux, Isabelle; Chollet, François; Simonetta‐Moreau, Marion

doi:10.1177/1545968314565465

Cited by 74 publications

(49 citation statements)

References 58 publications

(86 reference statements)

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“…We used random-effects model to account for this duplication (between-study variance τ 2 = 0.46; heterogeneity index I 2 = 71%). We grouped individual studies based on tDCS montage as anodal [24,25,28], cathodal [23–25,27] or bihemispheric [22,26,29] (Fig. 2A) as well as based on the mean post-stroke duration as acute stroke [23–25,28] or chronic stroke [22,26,27,29] (mean time post-stroke ≤1 month or ≥2.5 years, respectively; Fig.…”

Section: Resultsmentioning

confidence: 99%

Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose–Response Relationship

et al. 2016

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Background and purpose Transcranial direct current stimulation (tDCS) has shown mixed results in post-stroke motor recovery, possibly because of tDCS dose differences. The purpose of this meta-analysis was to explore whether the outcome has a dose–response relationship with various dose-related parameters. Methods The literature was searched for double-blind, randomized, sham-controlled clinical trials investigating the role of tDCS (≥5 sessions) in post-stroke motor recovery as measured by the Fugl-Meyer Upper Extremity (FM-UE) scale. Improvements in FM-UE scores were compared between active and sham groups by calculating standardized mean differences (Hedge’s g) to derive a summary effect size. Inverse-variance-weighted linear meta-regression across individual studies was performed between various tDCS parameters and Hedge’s g to test for dose–response relationships. Results Eight studies with total of 213 stroke subjects were included. Summary Hedge’s g was statistically significant in favor of the active group (Hedge’s g = 0.61, p = 0.02) suggesting moderate effect. Specifically, studies that used bihemispheric tDCS montage (Hedge’s g = 1.30, p = 0.08) or that recruited chronic stroke patients (Hedge’s g = 1.23, p = 0.02) showed large improvements in the active group. A positive dose–response relationship was found with current density (p = 0.017) and charge density (p = 0.004), but not with current amplitude. Moreover, a negative dose–response relationship was found with electrode size (p < 0.001, smaller electrodes were more effective). Conclusions Our meta-analysis and meta-regression results suggest superior motor recovery in the active group when compared to the sham group and dose–response relationships relating to electrode size, charge density and current density. These results need to be confirmed in future dedicated studies.

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Section: Resultsmentioning

confidence: 99%

Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose–Response Relationship

et al. 2016

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“…Importantly, decreased mouse head volume compared to the rat suggests a further scaling factor – which if ≥ 2 brings this result in line with those in healthy rats. However, it is important to note that several studies in the acute and subacute phase of recovery have been successfully conducted in humans (see above) without reported serious adverse events [186], [152], [153], [187], [188]. …”

Section: Dcs Safety Data From Animal Lesion Studies and Translationalmentioning

confidence: 99%

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

et al. 2016

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This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3–13 A/m2) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 mA, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1,000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.

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“…A 2015 trial by Sattler et al recruited 20 mild-to-moderately impaired patients at mean 5.5 days after ischemic stroke, and compared ipsilesional anodal tDCS versus sham tDCS, each paired with radial repetitive peripheral nerve stimulation (rPNS) [62]. The primary outcome measure was Jepsen Taylor Hand Function Test (JHFT), and secondary outcome was cortical excitability measured via TMS.…”

Section: Human Trialsmentioning

confidence: 99%

Early Rehabilitation After Stroke: a Narrative Review

Coleman

Moudgal

Lang

et al. 2017

Curr Atheroscler Rep

260

188

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Purpose of Review Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain’s dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. Recent Findings Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. Summary The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.

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Anodal tDCS Combined With Radial Nerve Stimulation Promotes Hand Motor Recovery in the Acute Phase After Ischemic Stroke

Abstract: These results show that early cortical neuromodulation with anodal tDCS combined with rPNS can promote motor hand recovery and that the benefit is still present 1 month after the stroke.

Cited by 74 publications

References 58 publications

Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose–Response Relationship

Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose–Response Relationship

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

Early Rehabilitation After Stroke: a Narrative Review

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