Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship

被引:100
作者
Chhatbar, Pratik Y. [1 ]
Ramakrishnan, Viswanathan [2 ]
Kautz, Steven [3 ,4 ]
George, Mark S. [4 ,5 ]
Adams, Robert J. [1 ]
Feng, Wuwei [1 ,3 ]
机构
[1] Med Univ S Carolina, Coll Med, Dept Neurol, Charleston, SC 29425 USA
[2] Med Univ S Carolina, Coll Med, Dept Publ Hlth Sci, Charleston, SC 29425 USA
[3] Med Univ S Carolina, Coll Hlth Profess, Dept Hlth Sci & Res, Charleston, SC 29425 USA
[4] Ralph H Johnson VA Med Ctr, Charleston, SC USA
[5] Med Univ S Carolina, Coll Med, Brain Stimulat Lab, Dept Psychiat & Behav Sci, Charleston, SC 29425 USA
基金
美国国家卫生研究院;
关键词
Stroke; Transcranial direct current stimulation; tDCS; Motor recovery; Dose-response relationship; Meta-analysis; Meta-regression; Hedge's g; INTERHEMISPHERIC INHIBITION; STROKE; TDCS; THERAPY; EXCITABILITY; METAANALYSIS; MODULATION; CORTEX; PHASE;
D O I
10.1016/j.brs.2015.09.002
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
Background and purpose: Transcranial direct current stimulation (tDCS) has shown mixed results in poststroke motor recovery, possibly because of tDCS dose differences. The purpose of this meta-analysis was to explore whether the outcome has a dose-response relationship with various dose-related parameters. Methods: The literature was searched for double-blind, randomized, sham-controlled clinical trials investigating the role of tDCS (= 5 sessions) in post-stroke motor recovery as measured by the Fugl-Meyer Upper Extremity (FM-UE) scale. Improvements in FM-UE scores were compared between active and sham groups by calculating standardized mean differences (Hedge's g) to derive a summary effect size. Inversevariance- weighted linear meta-regression across individual studies was performed between various tDCS parameters and Hedge's g to test for dose-response relationships. Results: Eight studies with total of 213 stroke subjects were included. Summary Hedge's g was statistically significant in favor of the active group (Hedge's g = 0.61, p = 0.02) suggesting moderate effect. Specifically, studies that used bihemispheric tDCS montage (Hedge's g = 1.30, p = 0.08) or that recruited chronic stroke patients (Hedge's g = 1.23, p = 0.02) showed large improvements in the active group. A positive dose-response relationship was found with current density (p = 0.017) and charge density (p = 0.004), but not with current amplitude. Moreover, a negative dose-response relationship was found with electrode size (p < 0.001, smaller electrodes were more effective). Conclusions: Our meta-analysis and meta-regression results suggest superior motor recovery in the active group when compared to the sham group and dose-response relationships relating to electrode size, charge density and current density. These results need to be confirmed in future dedicated studies. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码:16 / 26
页数:11
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