Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial

Abstract

BackgroundMild traumatic brain injury (MTBI) represents 70–80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI.Methods/designThis is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement.DiscussionThere is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction.Clinical Trial Registration, identifier NCT02292589 ().

A scientometrics analysis of physical activity and transcranial stimulation research

“…The most frequently used keyword concept was "TMS" (80 occurrences) plus 18 more occurrences with its acronym "TMS." "tDCS" (24 occurrences) or its acronym "tDCS" (36 occurrences) were also among the most used keywords together with "PA" (21 occurrences), "motor cortex" (20), "exercise" (15), "corticospinal excitability" (14), "sport" (13), neuromodulation" (11), "athletes" (11) or "concussion" (11). The most used keywords in the fractionalization analysis were grouped into the 2 largest thematic categories around the concepts: TMS and tDCS, and a third with the terms exercise, stroke and neuroplasticity (Fig.…”

“…The 2 most commonly used techniques are transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES). [5,6] TMS and tES are considered effective in disorders such as depression, [7] pain [8,9] or Parkinson disease [10] among others, Although their efficacy in concussion [11] or stroke [12] is not yet well established. However, TMS and tES should be considered as support in the rehabilitation protocols (e.g., reinforcing improvements in the patients´ recovery) rather than the main approach.…”

Neurostimulation, doping, and the spirit of sport

“…When we turn to the non-ideal question, a number of further concrete facts about tDCS become more salient than abstract discussions of the spirit of sport. First, it is currently extremely difficult to accurately test whether an individual has undergone tDCS [10]; this problem might also be compounded by legitimate potential future therapeutic uses of neuro-stimulation, particularly to treat mild traumatic brain injuries and concussion that may result from participation in certain sports [85][86][87][88] .…”