http://nnr.sagepub.com/content/27/7/592.abstract
- Eman M. Khedr, MD1
- Ola A. Shawky, MD1
- Dina H. El-Hammady, MD2
- John C. Rothwell, MD3
- Essam S. Darwish, MD1
- Omar M. Mostafa, MD4
- Amal M. Tohamy, MD1
- 1Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
- 2Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
- 3UCL Institute of Neurology, London, UK
- 4Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Eman M. Khedr, Department of Neurology, Assiut University Hospital, Assiut 15117, Egypt. Email: emankhedr99@yahoo.com
Abstract
Objective. We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery
in patients after subacute stroke. Methods.
Forty patients with ischemic stroke undergoing rehabilitation were
randomly assigned to 1 of 3 groups: Anodal, Cathodal
(over-affected and unaffected hemisphere,
respectively), and Sham. Each group received tDCS at an intensity of 2
mA for 25
minutes daily for 6 consecutive days over of the
motor cortex hand area. Patients were assessed with the National
Institutes
of Health Stroke Scale (NIHSS), Orgogozo’s MCA
scale (OMCASS), the Barthel index (BI), and the Medical Research Council
(MRC)
muscle strength scale at baseline, after the sixth
tDCS session and then 1, 2, and 3 months later. Motor cortical
excitability
was measured with transcranial magnetic stimulation
(TMS) at baseline and after the sixth session. Results. By the 3-month follow-up, all groups had improved on all scales with P
values ranging from .01 to .0001. Improvement was equal in the Anodal
and Cathodal groups. When these treated groups were
combined and compared with Sham, significant
interactions were seen for the OMCASS and BI scales of functional
ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being
greater in the real versus sham groups. There were borderline significant improvements in muscle strength. Conclusion. A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation
training to improve motor recovery after stroke.
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