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

Autor: da Silva TR; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., de Carvalho Nunes HR; Department of Public Health, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Martins LG; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., da Costa RDM; Department of Rehabilitation, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., de Souza JT; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Winckler FC; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Sartor LCA; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Modolo GP; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Ferreira NC; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., da Silva Rodrigues JC; Department of Rehabilitation, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Kanda R; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Fogarolli MO; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Borges GF; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Rizzatti GRS; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Ribeiro PW; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Favoretto DB; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil., Dos Santos LRA; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil., Bazan SGZ; Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Betting LE; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., de Oliveira Antunes LC; Department of Rehabilitation, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Pereira VM; Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Edwards TGS; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil., Pontes-Neto OM; Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, Brazil., Conforto AB; Clinical Hospital, São Paulo University (USP) and Hospital Israelita Albert Einstein, São Paulo, Brazil., Bazan R; Department of Neurology, Department of Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Luvizutto GJ; Department of Applied Physical Therapy, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil.
Jazyk: angličtina
Zdroj: Annals of neurology [Ann Neurol] 2022 Sep; Vol. 92 (3), pp. 400-410. Date of Electronic Publication: 2022 Jun 28.
DOI: 10.1002/ana.26430
Abstrakt: Objective: 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.
Methods: 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.
Results: 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.
Interpretation: 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.
(© 2022 American Neurological Association.)
Databáze: MEDLINE
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