Effects of transcranial direct current stimulation (tDCS) and concurrent cognitive training on episodic memory in patients with traumatic brain injury: a double-blind, randomised, placebo-controlled study

Abstract

IntroductionDeficits in episodic memory following traumatic brain injury (TBI) are common and affect independence in activities of daily living. Transcranial direct current stimulation (tDCS) and concurrent cognitive training may contribute to improve episodic memory in patients with TBI. Although previous studies have shown the potential of tDCS to improve cognition, the benefits of the tDCS applied simultaneously to cognitive training in participants with neurological disorders are inconsistent. This study aims to (1) investigate whether active tDCS combined with computer-assisted cognitive training enhances episodic memory compared with sham tDCS; (2) compare the differences between active tDCS applied over the left dorsolateral prefrontal cortex (lDLPFC) and bilateral temporal cortex (BTC) on episodic memory and; (3) investigate inter and intragroup changes on cortical activity measured by quantitative electroencephalogram (qEEG).Methods and analysisA randomised, parallel-group, double-blind placebo-controlled study is conducted. Thirty-six participants with chronic, moderate and severe closed TBI are being recruited and randomised into three groups (1:1:1) based on the placement of tDCS sponges and electrode activation (active or sham). TDCS is applied for 10 consecutive days for 20 min, combined with a computer-based cognitive training. Cognitive scores and qEEG are collected at baseline, on the last day of the stimulation session, and 3 months after the last tDCS session. We hypothesise that (1) the active tDCS group will improve episodic memory scores compared with the sham group; (2) differences on episodic memory scores will be shown between active BTC and lDLPFC and; (3) there will be significant delta reduction and an increase in alpha waves close to the location of the active electrodes compared with the sham group.Ethics and disseminationThis study was approved by Hospital das Clínicas, University of São Paulo Ethical Institutional Review Border (CAAE: 87954518.0.0000.0068).Trial registration numberNCT04540783.

Noninvasive neuromodulatory effect on cognition in individuals with traumatic brain injury: A single-blinded, two-arm parallel randomized clinical trial

“…It also has been shown to improve neuroplasticity and cognitive outcomes in neurological conditions, including TBI. [ 22 ] Cranial electrical stimulation transcutaneously applies a pulsed, alternating microcurrent (1000 µA) to the head via electrodes placed on the earlobes, mastoid processes, zygomatic arches, or the maxillo-occipital junction[ 23 ] and has few side effects (≤1%). [ 14 ] Stimulation alters intrinsic connectivity networks, such as dorsal fronto-parietal network and the sensorimotor network.…”

Functional Neurological Disorders

“…Noninvasive brain stimulation using transcranial magnetic stimulation and transcranial direct current stimulation is well-tolerated, do not require general anaesthesia, and both have fewer potential side effects when compared with ECT 206. Both these therapies have demonstrated modulation of brain networks and have been shown to bring about good change in clinical and behavioural domains relevant to FND, in both healthy controls and patients with neuropsychiatric disorders 207–215…”

“…206 Both these therapies have demonstrated modulation of brain networks and have been shown to bring about good change in clinical and behavioural domains relevant to FND, in both healthy controls and patients with neuropsychiatric disorders. [207][208][209][210][211][212][213][214][215]…”

Computer-aided Cognitive Training Combined with tDCS Can Improve Cognitive Function and Cerebrovascular Reactivity After Ischemic Stroke: A Randomized Controlled Trial

“…Many studies have shown that tDCS combined with conventional arti cial cognitive training can improve the cognitive and learning abilities of patients with cognitive dysfunction, and the e cacy is better than that of single therapy, which has been veri ed [30][31][32][33][34] . Nevertheless, there is a lack of substantial scienti c evidence to support the combination of tDCS and CACT for the treatment of PSCI.…”