Transcranial Direct Current Stimulation as an Adjunct Intervention to Acute Neurorehabilitation in Locked-in Syndrome: A Case Report
Elizabeth Quilty1, Matthew Brecher1, Leila Simani1, Prin Amorapanth2, Lindsey Gurin3, Benjamin Babaev1, Allan George1, Holly O’Hearn4, Diana Moreno4, Shayna Pehel1, Giuseppina Pilloni1, Leigh Charvet1
1Department of Neurology, 2Department of Physical Medicine and Rehabilitation, 3Departments of Neurology, Physical Medicine and Rehabilitation, NYU Grossman School of Medicine, 4Rusk Rehabilitation, NYU Langone Health
Objective:
To describe the feasibility, safety, and outcomes of intensive, team-based neurorehabilitation incorporating transcranial direct current stimulation (tDCS) in acute locked-in syndrome (LIS).
Background:
LIS following pontine infarct results in near-complete paralysis with preserved consciousness. Recovery is rare and treatment options are limited. While tDCS has shown promise in enhancing motor network plasticity after stroke, its use in LIS remains virtually unreported.
Design/Methods:
A 37-year-old woman with LIS after pontine infarct entered an interdisciplinary neurorehabilitation program. After limited early gains in the first 2 months of her recovery, she began adjunct treatment with tDCS to complement ongoing care. The core protocol targeted the bilateral motor cortex (C3-C4; 2.5 mA, 20 min) administered twice daily for one month, then increased to three times daily, integrated with occupational therapy, physical therapy, and motor imagery exercises. A bifrontal montage (F3-F4; 2.0 mA, 30 min) combined with mindfulness was used intermittently across the treatment period, and anodal stimulation (F7; 2.5 mA, 20 min) was added later to support speech therapy.
Results:
After 100 sessions over two months, the patient showed progressive, sustained neurologic recovery. The tDCS treatment was well tolerated with no adverse effects. Motor gains included midline head control (up to 7 min), reliable call-bell activation by head movement, purposeful blinking/nodding, volitional facial movement, and emerging bilateral limb extension. Functional mobility improved with initiation of gait trials in LiteGait. Communication gains included improved facial muscle control and consistent head-nodding, with emerging vocalization through sighing. The patient reported better mood and motivation.
Conclusions:
Within comprehensive inpatient rehabilitation, adjunctive tDCS was feasible, safe, and associated with meaningful motor and behavioral gains, supporting multimodal, team-based neuromodulation for severe brainstem stroke recovery.
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