Well, duh! If you want to vastly improve stroke recovery, you're going to have to save hundreds of millions to billions of neurons by stopping the 5 causes of the neuronal cascade of death in the first week!
I lost 5.4 billion neurons that first week. If I'd only lost 177 million neurons in the 90 minutes it took to get tPA I'd easily be recovered by now.
Stroke rehab is a complete fucking failure as proven by this!
Only 10% get to full recovery.
The latest here:
Electric Stimulation Comes Up Short for Motor Recovery After Stroke
— Transcranial direct current stimulation fails at high and low doses in a randomized trial
LOS ANGELES -- A course of transcranial direct current stimulation (tDCS) did not help with post-stroke motor recovery when tested in a larger multicenter randomized trial.
Among stroke survivors 1-6 months out from their index stroke in the phase II TRANSPORT2 trial, Fugl-Meyer Upper Extremity (FM-UE) scores increased to a similar degree -- a handful of points over 15 days -- among groups randomly assigned to near-daily tDCS 4 mA, tDCS 2 mA, both with modified constraint-induced movement therapy (mCIMT), or mCIMT alone.
All groups had started from a baseline FM-UE of around 40 on the 66-point scale. Their FM-UE scores continued to drift upward through day 105 post-intervention, suggesting similar improvements across tDCS and sham groups alike, according to Wayne Feng, MD, MS, of Duke University School of Medicine in Durham, North Carolina.
As the tDCS intervention was at least safe and tolerated by patients in TRANSPORT2, "in the future we should consider a higher dose, probably do a better job with outcome assessment, and put more efforts in trial enrollment," Feng told the audience here at the International Stroke Conference.
He acknowledged that some patients had been mislabeled in the study, resulting in unbalanced groups despite randomization. There was also some variability in patient eligibility and outcomes reported between site and central raters.
The full manuscript of the 129-person TRANSPORT2 is expected to appear in Lancet Neurology next week, Feng said.
For cognitive and motor recovery after stroke, tDCS had shown promise in several proof-of-concept studies and a phase I study.
TRANSPORT2 co-author Gottfried Schlaug, MD, PhD, of UMass Chan Medical School-Baystate in Springfield, noted that the technology consists of a portable device, strapped over one's head, that sends weak currents to the brain. The system is designed to modulate interactions between the two brain hemispheres and to enhance synaptic plasticity of brain cells.
Outside of stroke, tDCS has had major setbacks in recent years. The DepressionDC study found it to be no better than sham as an adjunct to selective serotonin reuptake inhibitor therapy for major depressive disorder, and an at-home strategy of tDCS also failed in a later trial.
In TRANSPORT2, tDCS had its lack of efficacy reinforced by secondary assessments per the Wolf Motor Function Test and Stroke Impact Scale hand scale.
The trial had been conducted in 15 U.S. sites. People were enrolled in the 1-6 months after their first-ever unihemispheric ischemic stroke. Participants had to be adults up to 80 years of age and had to pass a screening period during which they demonstrated stable motor impairment (no spontaneous improvements).
Exclusion criteria included use of medications that may interfere with tDCS, moderate to severe cognitive impairment, and recent receipt of botulinum toxin injections (Botox) to the affected upper extremity.
Study authors randomized people to tDCS 4 mA plus mCIMT (n=43), tDCS 2 mA plus mCIMT (n=43), or sham stimulation plus mCIMT (n=43). Those receiving tDCS underwent 10 sessions over 2 weeks, each session involving 30 minutes of tDCS with 2 hours mCIMT and 6 hours of wearing a mitten after the session.
The overall cohort was fairly diverse as it included 42% women and 47% non-Caucasians. The baseline NIH Stroke Scale score was a median 3.0. Over 70% of participants had been randomized on the later end of the eligibility window, in the 3-6 months after their index stroke.
Those assigned the lower-dose tDCS had disproportionately more men and had more left brains affected by stroke. They also tended to have 1-cc greater lesion volumes on the affected side.
Feng and Schlaug reported no safety signals for tDCS as there were few serious adverse events in the trial.
They said their TRANSPORT2 group was notable for retaining a high proportion of patients despite disruptions during the COVID-19 pandemic.
![author['full_name']](https://clf1.medpagetoday.com/media/images/author/nicoleLou_188.jpg)
Disclosures
TRANSPORT2 was funded through the NIH StrokeNet.
Feng disclosed relationships with the NIH, American Heart Association, NAMSA, AHA, CIRM, and Burke Rehabilitation Institute.
Schlaug reported NIH and NSF grants, as well as an institutional research award.
Primary Source
International Stroke Conference
Source Reference: opens in a new tab or windowSchlaug G, Feng W "Transcranial direct current stimulation for post-stroke motor recovery - a phase II study (TRANSPORT2)" ISC 2025.
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