Transcranial Direct Current Stimulation (tDCS) Enhanced Stroke Recovery and Cortical Reorganization
Timea Hodics1, Alexander Dromerick2, John Pezzullo3, Karen Kowalske4, Leonardo Cohen5
1Houston Methodist Hospital, 2National Rehabilitation Hospital, 3Georgetown University, 4University of Texas Southwestern, 5National Institute of Neurological Disorders and Stroke, Human Cortical Physiology and Neurorehabilitation Section
To determine whether tDCS application is feasible and safe early after stroke, and if it improves motor recovery of the upper extremity after stroke beyond what is achievable with standard rehabilitative treatment (SRT) alone. 
Stroke is the most common cause of adult long-term disability. A noninvasive intervention, tDCS, may facilitate cortical plasticity and motor behavior in chronic stroke patients. It is desirable to develop noninvasive strategies to increase the effectiveness of rehabilitative therapy on motor recovery in the early phase after stroke when the speed of recovery is fastest.

This is a randomized, controlled triple masked clinical trial. We enrolled patients who had a single ischemic stroke that resulted in moderate to severe hand weakness but were able to activate their hand or forearm muscles and could be safely included within 15 days of stroke onset. 

Patients were randomized in one of the two study arms: standard rehabilitation therapy (SRT) + tDCS or in SRT + sham. Patients received 20 minutes of 1mA anodal tDCS or sham of the affected motor cortex simultaneously with SRT Monday-Friday for a total of ten sessions. Outcome measures were collected at discharge, 3 months and at 12 months.

We enrolled 36 (19 female) stroke patients. No severe treatment related adverse events occurred. Baseline upper extremity Fugl-Meyer (UFM) score was 22.6 ± 15.8 in the tDCS group and 21.2 ± 17.1 in the sham group. Immediate post-treatment UFM score was 30.2 ± 21.2 in the real stimulation group and 36.8 ± 22.4 in the sham group. (p=0.428). At 3 months follow-up UFM 32.4 ± 24.5 in the tDCS and 47.7 ± 18.7 in the sham group. (p=0.121)
Study procedures were well tolerated, were feasible and safe. There was no significant difference in primary outcome measures between the tDCS and sham treatment groups.