Kliniken Beelitz GmbH, Neurologische Rehabilitationsklinik, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany.
Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
BMC Res Notes. 2021 Jan 25;14(1):35. doi: 10.1186/s13104-020-05421-7.
Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors, higher current densities are probably needed for effective treatment in aged stroke patients. Validation of treatment efficacy requires sham-controlled experiments, but increased current densities might comprise blinding. Therefore, a pilot study was conducted to test sham adequacy when using current density of 0.8 A/m. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a randomized cross-over design (active/sham stimulation) in 12 early subacute patients with left-sided hemineglect. Stimulation (0.8 A/m) was performed simultaneous to standard care neglect therapy.
Odds ratio of correct guessing an atDCS condition compared to wrongly judge an atDCS condition as sham was 10.00 (95%CI 0.65-154.40, p = 0.099). However, given the small sample size and high OR, although likely somewhat overestimated, results require careful interpretation and blinding success in neglect studies with current densities of 0.8 A/m should be further confirmed.
脑卒中后忽视是一种致残性疾病，其康复是一项重大挑战。经颅直流电刺激（tDCS）似乎是一种有前途的辅助技术，可以改善标准的忽视治疗。由于电场受到与年龄相关的因素的影响，对于老年脑卒中患者，可能需要更高的电流密度才能进行有效的治疗。为了验证治疗效果，需要进行假刺激对照实验，但增加电流密度可能会影响到盲法。因此，进行了一项试点研究，以测试在使用 0.8 A/m 电流密度时的假刺激的充分性。在一项随机交叉设计（真刺激/假刺激）中，12 名左侧偏侧忽略的早期亚急性患者接受了标准的忽视治疗，同时进行了真刺激/假刺激。结果：与错误判断真刺激为假刺激相比，正确猜测真刺激的优势比为 10.00（95%CI 0.65-154.40，p=0.099）。然而，由于样本量小且优势比高，尽管可能有些高估，结果需要仔细解释，并且需要进一步确认在电流密度为 0.8 A/m 的忽视研究中假刺激的成功。
