http://nnr.sagepub.com/content/29/8/743?etoc
- Virginie Sattler, MD1,2,3
- Blandine Acket, MD1,2,3
- Nicolas Raposo, MD1,2
- Jean-François Albucher, MD1,2
- Claire Thalamas, MD4
- Isabelle Loubinoux, PhD2
- François Chollet, MD, PhD1,2,3
- Marion Simonetta-Moreau, MD, PhD1,2,3
- 1Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- 2Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, Toulouse, France
- 3Université de Toulouse, Toulouse, France
- 4Centre d’Investigation Clinique, CHU Purpan, Toulouse, France
- Marion Simonetta-Moreau, Service de Neurologie, CHU Purpan, place du Dr Baylac, 31059 Toulouse cedex TSA40031, France. Email: simonetta.m@chu-toulouse.fr
Abstract
Background and Objective. The
question of the best therapeutic window in which noninvasive brain
stimulation (NIBS) could potentiate the plastic changes
for motor recovery after a stroke is still
unresolved. Most of the previous NIBS studies included patients in the
chronic
phase of recovery and very few in the subacute or
acute phase. We investigated the effect of transcranial direct current
stimulation
(tDCS) combined with repetitive peripheral nerve
stimulation (rPNS) on the time course of motor recovery in the acute
phase
after a stroke.
Methods. Twenty patients
enrolled within the first few days after a stroke were randomized in 2
parallel groups: one receiving 5
consecutive daily sessions of anodal tDCS over the
ipsilesional motor cortex in association with rPNS and the other
receiving
the same rPNS combined with sham tDCS. Motor
performance (primary endpoint: Jebsen and Taylor Hand Function Test
[JHFT]) and
transcranial magnetic stimulation cortical
excitability measures were obtained at baseline (D1), at the end of the
treatment
(D5), and at 2 and 4 weeks’ follow-up (D15 and
D30).
Results. The time course of motor recovery of the 2 groups of patients was different and positively influenced by the intervention
(Group × Time interaction P = .01). The amount of improvement on the JHFT was greater at D15 and D30 in the anodal tDCS group than in the sham group.
Conclusion. 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.
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