Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke

Abstract

Anodal transcranial direct current stimulation (tDCS) can boost the effects of motor training and facilitate plasticity in the healthy brain. Motor rehabilitation depends on learning and plasticity, and motor learning can occur after stroke. Here, we tested whether brain stimulation using anodal tDCS added to motor training could improve rehabilitation outcomes in patients after stroke. We performed a randomized, controlled trial in 24 patients at least 6 months after a first unilateral stroke not directly involving the primary motor cortex. Patients received either anodal tDCS (n=11) or sham treatment (n=13) paired with daily motor training for 9 days. We observed improvements that persisted for at least 3 months post-intervention after anodal tDCS but not sham treatment on the Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) but not on the Fugl-Meyer upper extremity score (UEFM). Functional MRI showed increased activity during movement of the affected hand in the ipsilesional motor and premotor cortex in the anodal tDCS group compared to the sham treatment group. Structural MRI revealed intervention-related increases in gray matter volume in cortical areas including ipsilesional motor and premotor cortex after anodal tDCS but not sham treatment. The addition of ipsilesional anodal tDCS to a 9-day motor training program improved long-term clinical outcomes relative to sham treatment in patients after stroke.

Visual training in hemianopia alters neural activity in the absence of behavioural improvement: a pilot study

“…Non‐invasive direct current stimulation has been shown to lead to additional improvement in motor performance both in healthy participants and when used as an adjunct to physiotherapy in stroke rehabilitation . However, the effects of tDCS on visual performance appear to be considerably less clear.…”

Commentary: Systematic assessment of duration and intensity of anodal transcranial direct current stimulation on primary motor cortex excitability

“…To do so would be to discredit a technique with vast potential and disregard the emerging evidence regarding sustained benefits in clinical populations (Khedr et al, 2014; Allman et al, 2016). That is not to say that these non-significant results should be overlooked.…”

Functional relevance of stroke‐related losses in GABAB‐mediated interhemispheric inhibition for alternative modes of stroke recovery

“…In the context of stroke in humans, decreased GABA in the ipsilesonal cortex through anodal transcranial direct current stimulation (tDCS) has been shown to improve functional recovery (Allman et al . ). As highlighted in the article by Kokinovic & Medini (), an adaptation observed in mice recovering from a stroke is the loss of transcallosal pathway‐specific IHI.…”