Chen Joyce L, Schipani Ashley, Schuch Clarissa Pedrini, Lam Henry, Swardfager Walter, Thiel Alexander, Edwards Jodi D
Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada.
Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
Front Neurol. 2021 Apr 15;12:626021. doi: 10.3389/fneur.2021.626021. eCollection 2021.
During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery. The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS. We searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for participants with stroke (>1 week post-onset) with motor impairment and who received cathodal or sham tDCS to contralesional M1 for one or more sessions. The outcomes included a change in any clinically validated assessment of physical function, activity, or participation, or a change in a movement performance variable (., time, accuracy). A meta-analysis was performed by pooling five randomized controlled trials (RCTs) and comparing the change in Fugl-Meyer upper extremity scores between cathodal and sham tDCS groups. Eleven studies met the inclusion criteria. Qualitatively, four out of five cross-over design studies and three out of six RCTs reported a significant effect of cathodal vs. sham tDCS. In the quantitative synthesis, cathodal tDCS ( = 65) did not significantly reduce motor impairment compared to sham tDCS ( = 67; standardized mean difference = 0.33, = 1.79, = 0.07) with a little observed heterogeneity ( = 5%). The effects of cathodal tDCS to contralesional M1 on motor recovery are small and consistent. There may be sub-populations that may respond to this approach; however, further research with larger cohorts is required.
在中风恢复过程中，对侧运动皮层（M1）可能会发生适应不良的变化，这会导致半球间抑制（IHI）受损。将阴极置于对侧M1上的经颅直流电刺激（tDCS）可能会抑制这种适应不良的可塑性，使IHI正常化，并促进运动恢复。本系统评价和荟萃分析的目的是评估现有证据，以确定对侧M1上的阴极tDCS是否比假tDCS更能增强中风后的运动再学习或恢复。我们在OVID Medline、Embase和Cochrane对照试验中央注册库中搜索了患有运动障碍且在中风发作后超过1周接受对侧M1阴极或假tDCS治疗一个或多个疗程的参与者。结局包括任何经临床验证的身体功能、活动或参与评估的变化，或运动表现变量（如时间、准确性）的变化。通过汇总五项随机对照试验（RCT）并比较阴极和假tDCS组之间Fugl-Meyer上肢评分的变化进行荟萃分析。11项研究符合纳入标准。定性分析方面，五项交叉设计研究中的四项以及六项RCT中的三项报告了阴极与假tDCS相比有显著效果。在定量综合分析中，与假tDCS（n = 67）相比，阴极tDCS（n = 65）并没有显著降低运动障碍（标准化均数差 = 0.33，I² = 1.79，P = 0.07），观察到的异质性较小（I² = 5%）。对侧M1阴极tDCS对运动恢复的影响较小且一致。可能存在对此方法有反应的亚组人群；然而，需要对更大队列进行进一步研究。
