Abstract
Objective
To investigate the effects of cathodal transcranial direct current stimulation (tDCS)
and continuous theta burst stimulation (cTBS) on neural network connectivity and motor
recovery in individuals with subacute stroke.
Design
Double-blinded, randomized, placebo-controlled study.
Setting
University hospital rehabilitation unit.
Participants
Inpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke,
5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score,
14; range, 3–48).
Interventions
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal
tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional
primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks,
combined with physical therapy.
Main Outcome Measures
Brain function was assessed with directed and nondirected functional connectivity
based on high-density electroencephalography before and after stimulation sessions.
Primary clinical end point was the change in slope of the multifaceted motor score
composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score,
9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and
the treatment time.
Results
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS
induced different neural effects. Only cTBS was able to reduce transcallosal influences
from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced
perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation
analyses indicated that the modulation of interhemispheric driving and perilesional
beta-band connectivity were not independent mediators for functional recovery across
all patients. However, exploratory subgroup analyses suggest that the enhancement
of perilesional beta-band connectivity through tDCS might have more robust clinical
gains if started within the first 4 weeks after stroke.
Conclusions
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions
was not clinically useful in the heterogeneous group of subjects with subacute stroke.
An early modulation of perilesional oscillation coherence seems to be a more promising
strategy for brain stimulation interventions.
Keywords
List of abbreviations:
CI (confidence interval), cTBS (continuous theta burst stimulation), FC (functional connectivity), FMA (Fugl-Meyer Assessment), M1 (primary motor cortex), NIBS (noninvasive brain stimulation), PDC (partial directed coherence), rTMS (repetitive transcranial magnetic stimulation), tDCS (transcranial direct current stimulation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 06, 2017
Footnotes
Supported by the Swiss National Science Foundation (grant no. 320030_146639).
Clinical Trial Registration No.: NCT02031107.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
