Valiengo Leandro, Casati Roberta, Bolognini Nadia, Lotufo Paulo A, Benseñor Isabela M, Goulart Alessandra C, Brunoni André R
a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.
b Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry , Faculty of Medicine of University of São Paulo , São Paulo , Brazil.
Neurocase. 2016;22(2):225-8. doi: 10.1080/13554794.2015.1130231. Epub 2016 Jan 8.
Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.
失语症是中风的常见后果；据估计，约三分之二的失语症患者在中风后的第一年将患上抑郁症。由于药物治疗的副作用以及评估包括失语症在内的临床结果存在困难，中风后抑郁症（PSD）的治疗具有挑战性。经颅直流电刺激（tDCS）是一种新型治疗方法，可能会改善传统药物治疗难治性PSD的临床结果。我们的目的是评估tDCS对患有PSD和失语症患者的安全性和有效性。使用中风失语症抑郁问卷（SADQ）和失语症抑郁评定量表（ADRS）来评估PSD的严重程度。PSD和失语症的诊断分别由精神科医生和言语语言病理学家确认。在这个开放性病例系列中，患者（n = 4）接受了10次（每天一次）双侧tDCS刺激背外侧前额叶皮层（DLPFC），并在两周和四周后额外接受两次刺激，总共12次。所有患者在tDCS治疗后抑郁症状均有所改善，SADQ评分降低了47.5%，ADRS评分降低了65.7%。这种改善在治疗后四周得以维持。在这项对4名患有失语症的PSD患者进行的初步开放性标签研究中，DLPFC上的双侧tDCS被证明能显著改善情绪；tDCS安全且每位患者耐受性良好。患有失语症的中风患者可以安全地接受tDCS治疗PSD。需要进行假对照研究以进一步评估该技术。
