FYI.
Early Data Mixed for Home-Based Brain Stimulation After Stroke
Certain subgroups may see more cognitive benefit
Adding remotely supervised transcranial direct current stimulation (RS-tDCS) to enhance home-based cognitive rehabilitation appeared feasible, but not particularly effective, for most stroke survivors in a pilot study.
Four weeks of RS-tDCS plus computerized cognitive therapy improved general cognitive function as assessed by the Korean version of the Montreal Cognitive Assessment (K-MoCA), but not significantly more so than computerized cognitive therapy alone, reported Yun-Hee Kim, MD, PhD, of Samsung Medical Center at Sungkyunkwan University School of Medicine in Seoul, Korea, and colleagues.
Only stroke survivors with moderate cognitive impairment and those with left hemispheric lesions showed an improvement in the K-MoCA compared with controls, they noted in Stroke.
These are among the most important findings from the 26-person study, argued Kyrana Tsapkini, PhD, a neurologist at Johns Hopkins School of Medicine in Baltimore, in an accompanying editorial.
"Unfocused populations and confounding patient conditions are among the main reasons that large trials may fail. Therefore, it is imperative to fine-tune the targeted population in clinical trials, and the findings of the present study provide key insights in this direction," she wrote.
"Despite the preliminary nature of this study on the efficacy of home-based tDCS, the present study provides new hope for patients with stroke and their families for accessible and continuous rehabilitation of cognitive symptoms," she concluded.
Kim's group tested a neuromodulation strategy that involves electrodes attached to a soft cap worn on the head. Patients could not control the settings themselves and had to be supported by a remote supervisor who controlled session duration and intensity.
They reported no serious adverse effects of RS-tDCS and no instances of incorrect patient application or inappropriate stimulation.
Two out of the original 28 patients had to be excluded because they did not participate in the required number of neuromodulation sessions, both due to device charging errors. Adherence to RS-tDCS was 98.4% upon successful application.
"RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction," Kim and colleagues maintained.
RS-tDCS has been shown to be effective outside stroke in areas such as Alzheimer's dementia, major depressive disorder, and schizophrenia. Recently, a small randomized trial showed that home-based tDCS improved attention in people with attention deficit-hyperactivity disorder who were not on stimulant medications.
The present pilot study included 26 stroke survivors with cognitive impairment who were randomized to RS-tDCS or sham atop concurrent computerized cognitive therapy that trains people to perform various memory- and attention-related tasks.
There were no significant differences between the neuromodulation and control groups in terms of age (61 vs 57 years), sex (33.3% vs 57.1% men), or other baseline characteristics.
In both protocols, patients and caregivers underwent training for correct tDCS self-application. Patients were treated 5 days a week for 4 weeks.
Chief among the study's limitations were the small sample size and the lack of a control group who did not undergo cognitive therapy, Kim's team acknowledged.
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Disclosures
The study was supported by grants from the Biomedical Research Institute of Jeonbuk National University Hospital, Samsung Medical Center, various Korean government branches, and the National Research Foundation of Korea.
Kim had no disclosures.
Tsapkini reported grants from the NIH, Johns Hopkins University Science of Learning, and Pamela Mars Institute, as well as monetary and equipment donations from private donors.
Primary Source
Stroke
Secondary Source
Stroke
Source Reference: Tsapkini K "Home-based transcranial direct current stimulation: Are we there yet?" Stroke 2022; DOI: 10.1161/STROKEAHA.122.040113.
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