Department of Medical Rehabilitation (Physiotherapy), College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria.
Department of Physiotherapy, Federal Medical Centre, Nguru, Nigeria.
Physiother Theory Pract. 2022 Nov;38(11):1799-1806. doi: 10.1080/09593985.2021.1891591. Epub 2021 Mar 2.
Transcranial direct current stimulation (tDCS) is effective in the management of patients with central post-stroke pain (CPSP) and post-stroke depression (PSD) individually. However, it is not known if tDCS delivered via dorsolateral prefrontal cortex (DLPFC) can be used to ameliorate both symptoms.
The purpose of this case report was to share the effectiveness of using tDCS of the DLPFC with short inter-session intervals to reduce central pain and depression in a stroke survivor.
A 45-year-old patient presented with CPSP and depression following a stroke. The CPSP and depression were diagnosed using the Douleur Neuropathique 4 Questionnaire (DN4Q) and the Beck Depression Index (BDI) respectively. The pain score was 10 on a visual analogue scale (VAS) and it was a hemi-body burning sensation, with a score of 7 on DN4Q, and the depression score was 25 on the BDI. The patient received anodal tDCS to the left DLPFC using two different application protocols. Initially, a stimulation session of 2 milliamperes (mA) intensity for 20 minutes was given every working day for 2 weeks. After 3 weeks, she then received 7 daily sessions of periodic stimulations of 2 mA intensity for 13 minutes each with 20 minutes inter-session intervals for 1 week. The patient was followed up for 6 months post-intervention.
Immediately following the last session of the initial protocol of stimulation, the BDI score reduced from 25 to 7 and the pain became abolished. However, the symptoms relapsed at 3 weeks post-intervention to the initial BDI score of 25, VAS score of 10 and DN4Q score of 7. Following the application of the second protocol of stimulation, the BDI score improved to 18 at three weeks and later to 7 at six months post-intervention while the pain (both VAS and DN4Q) became completely abolished.
Further research is needed to determine if a series of periodic tDCS with short-intersession intervals applied to the DLPFC may be more effective than a single tDCS with long inter-session intervals, in decreasing pain and inducing long-term improvement in mood in people with stroke.
经颅直流电刺激（tDCS）在治疗中风后中枢性疼痛（CPSP）和中风后抑郁（PSD）方面均有疗效。然而，目前尚不清楚刺激背外侧前额叶皮质（DLPFC）是否可以同时改善这两种症状。
本病例报告旨在分享使用短间隔间 tDCS 治疗中风幸存者的中枢性疼痛和抑郁的效果。
一名 45 岁的患者在中风后出现 CPSP 和抑郁。CPSP 和抑郁分别通过疼痛神经病理性问卷 4 项（DN4Q）和贝克抑郁指数（BDI）进行诊断。疼痛评分采用视觉模拟量表（VAS）为 10，表现为半身烧灼感，DN4Q 评分为 7，抑郁评分为 BDI 25。患者接受左 DLPFC 双相阳极 tDCS，采用两种不同的应用方案。最初，2 毫安（mA）强度刺激 20 分钟，每周 5 天，持续 2 周。3 周后，改为每周 7 次，每次 2 mA 强度刺激 13 分钟，间隔 20 分钟，持续 1 周。患者在干预后 6 个月进行随访。
初始刺激方案的最后一次治疗后，BDI 评分从 25 分降至 7 分，疼痛消失。然而，3 周后，BDI 评分回升至初始的 25 分，VAS 评分 10 分，DN4Q 评分 7 分，症状再次出现。在应用第二种刺激方案后，BDI 评分在 3 周时改善至 18 分，6 个月时改善至 7 分，而疼痛（VAS 和 DN4Q）完全消失。
需要进一步研究确定，与长间隔间单次 tDCS 相比，应用 DLPFC 的短间隔间周期性 tDCS 系列是否更能有效降低疼痛，并在中风患者中诱导情绪的长期改善。
