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

Publication ,  Journal Article
Chhatbar, PY; Ramakrishnan, V; Kautz, S; George, MS; Adams, RJ; Feng, W
Published in: Brain stimulation
January 2016

Transcranial direct current stimulation (tDCS) has shown mixed results in post-stroke 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.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. Inverse-variance-weighted linear meta-regression across individual studies was performed between various tDCS parameters and Hedge's g to test for dose-response relationships.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).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.

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Published In

Brain stimulation

DOI

EISSN

1876-4754

ISSN

1935-861X

Publication Date

January 2016

Volume

9

Issue

1

Start / End Page

16 / 26

Related Subject Headings

  • Upper Extremity
  • Transcranial Direct Current Stimulation
  • Stroke Rehabilitation
  • Stroke
  • Recovery of Function
  • Neurology & Neurosurgery
  • Humans
  • Aged
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

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Chhatbar, P. Y., Ramakrishnan, V., Kautz, S., George, M. S., Adams, R. J., & Feng, W. (2016). Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship. Brain Stimulation, 9(1), 16–26. https://doi.org/10.1016/j.brs.2015.09.002
Chhatbar, Pratik Y., Viswanathan Ramakrishnan, Steven Kautz, Mark S. George, Robert J. Adams, and Wuwei Feng. “Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship.Brain Stimulation 9, no. 1 (January 2016): 16–26. https://doi.org/10.1016/j.brs.2015.09.002.
Chhatbar PY, Ramakrishnan V, Kautz S, George MS, Adams RJ, Feng W. Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship. Brain stimulation. 2016 Jan;9(1):16–26.
Chhatbar, Pratik Y., et al. “Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship.Brain Stimulation, vol. 9, no. 1, Jan. 2016, pp. 16–26. Epmc, doi:10.1016/j.brs.2015.09.002.
Chhatbar PY, Ramakrishnan V, Kautz S, George MS, Adams RJ, Feng W. Transcranial Direct Current Stimulation Post-Stroke Upper Extremity Motor Recovery Studies Exhibit a Dose-Response Relationship. Brain stimulation. 2016 Jan;9(1):16–26.
Journal cover image

Published In

Brain stimulation

DOI

EISSN

1876-4754

ISSN

1935-861X

Publication Date

January 2016

Volume

9

Issue

1

Start / End Page

16 / 26

Related Subject Headings

  • Upper Extremity
  • Transcranial Direct Current Stimulation
  • Stroke Rehabilitation
  • Stroke
  • Recovery of Function
  • Neurology & Neurosurgery
  • Humans
  • Aged
  • 42 Health sciences
  • 32 Biomedical and clinical sciences