Non‐invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial

经颅直流电刺激 功能独立性测度 物理疗法 冲程(发动机) 医学 析因分析 改良兰金量表 随机对照试验 物理医学与康复 康复 方差分析 重复措施设计 脑刺激 心理学 内科学 刺激 缺血性中风 缺血 机械工程 统计 数学 工程类
作者
Taís Regina da Silva,Hélio Rubens de Carvalho Nunes,Laís Geronutti Martins,Rafael Dalle Molle da Costa,Juli Thomaz de Souza,Fernanda Cristina Winckler,Lorena Cristina Alvarez Sartor,Gabriel Pinheiro Módolo,Natália Cristina Ferreira,Josiela Cristina da Silva Rodrigues,Rafael Guimarães Kanda,Marcelo Ortolani Fogarolli,Guilherme Ferreira Borges,Gabriela Rizzo Soares Rizzatti,Priscila Watson Ribeiro,Diandra B. Favoretto,Luan Rafael Aguiar dos Santos,Silméia Garcia Zanati Bazan,Luiz Eduardo Betting,Letícia Cláudia de Oliveira Antunes
出处
期刊:Annals of Neurology [Wiley]
卷期号:92 (3): 400-410 被引量:12
标识
DOI:10.1002/ana.26430
摘要

Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke.This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test-Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction.In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9-32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = -0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = -9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes.A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400-410.
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