Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China.
Department of Radiology, The Fifth People's Hospital of Nanchong, Nanchong, China.
Neural Plast. 2019 Nov 16;2019:1372138. doi: 10.1155/2019/1372138. eCollection 2019.
To explore the effects of transcranial direct current stimulation (tDCS) on the motor recovery of stroke patients and the effect differences between the upper limb and lower limb.
Randomized control trials published until January 2019 were searched from PubMed, Embase, ScienceDirect, and Cochrane Library databases. The standardized mean difference (SMD) with 95% confidence interval (CI) was estimated separately for upper and lower limb motor outcomes to understand the mean effect size.
Twenty-nine studies with 664 subjects were included in this meta-analysis. The overall analyses of tDCS demonstrated significant effect size both for the upper limb (SMD = 0.26, = 0.002) and the lower limb (SMD = 0.47, = 0.002). Compared with acute and subacute stroke patients, chronic stroke patients obtained significant effects after tDCS (SMD = 0.25, = 0.03) in upper limb function. Furthermore, both anode and cathode stimulations produced significant effect size for stroke patients after ≤10 sessions of tDCS (anode: SMD = 0.40, = 0.001; cathode: SMD = 0.79, < 0.0001) with >0.029 mA/cm of density (anode: SMD = 0.46, = 0.002; cathode: SMD = 0.79, < 0.0001). But for lower limb function, more prominent effects were found in subacute stroke patients (SMD = 0.56, = 0.001) with bilateral tDCS (SMD = 0.59, = 0.009).
tDCS is effective for the recovery of stroke patients with motor dysfunction. In addition, upper limb and lower limb functions obtain distinct effects from different therapeutic parameters of tDCS at different stages, respectively.
探讨经颅直流电刺激（tDCS）对脑卒中患者运动功能恢复的影响及其在上肢和下肢的疗效差异。
检索 PubMed、Embase、ScienceDirect 和 Cochrane Library 数据库中截至 2019 年 1 月发表的随机对照试验。分别估计上肢和下肢运动结局的标准化均数差（SMD）以了解平均效应量。
本 meta 分析纳入了 29 项研究共 664 例患者。总体分析显示 tDCS 在上肢（SMD = 0.26， = 0.002）和下肢（SMD = 0.47， = 0.002）的疗效均具有显著的效应量。与急性和亚急性期脑卒中患者相比，慢性脑卒中患者在 tDCS 后上肢功能获得了显著的效果（SMD = 0.25， = 0.03）。此外，在 tDCS 治疗≤10 次后，阳极和阴极刺激对脑卒中患者均产生了显著的效应量（阳极：SMD = 0.40， = 0.001；阴极：SMD = 0.79， < 0.0001），且电流密度＞0.029 mA/cm 时（阳极：SMD = 0.46， = 0.002；阴极：SMD = 0.79， < 0.0001）。但对于下肢功能，亚急性期脑卒中患者双侧 tDCS（SMD = 0.56， = 0.001）中效果更显著。
tDCS 对脑卒中运动功能障碍患者的康复有效。此外，在不同阶段，tDCS 的不同治疗参数对上肢和下肢功能有不同的影响。
