Gong Qiuwen, Yan Rubing, Chen Han, Duan Xia, Wu Xiaoyu, Zhang Xin, Zhou Yi, Feng Zhou, Chen Ya, Liu Jianbo, Xu Peng, Qiu Jing, Liu Hongliang, Hou Jingming
Department of Rehabilitation, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China.
Front Neurol. 2023 Mar 16;14:1044333. doi: 10.3389/fneur.2023.1044333. eCollection 2023.
The cerebellum is involved in the control and coordination of movements but it remains unclear whether stimulation of the cerebellum could improve the recovery of upper limb motor function. Therefore, this study aimed to explore whether cerebellar transcranial direct current stimulation (tDCS) therapy could promote the recovery of upper limb motor function in patients who suffered a stroke.
In this randomized, double-blind, and sham-controlled prospective study, 77 stroke patients were recruited and randomly assigned to the tDCS group ( = 39) or the control group ( = 38). The patients received anodal (2 mA, 20 min) or sham tDCS therapy for 4 weeks. The primary outcome was the change in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score from baseline to the first day after 4 weeks of treatment (T1) and 60 days after 4 weeks of treatment (T2). The secondary outcomes were the FMA-UE response rates assessed at T1 and T2. Adverse events (AEs) related to the tDCS treatment were also recorded.
At T1, the mean FMA-UE score increased by 10.7 points [standard error of the mean (SEM) = 1.4] in the tDCS group and by 5.8 points (SEM = 1.3) in the control group (difference between the two groups was 4.9 points, = 0.013). At T2, the mean FMA-UE score increased by 18.9 points (SEM = 2.1) in the tDCS group and by 12.7 points (SEM = 2.1) in the control group (the difference between the two groups was 6.2 points, = 0.043). At T1, 26 (70.3%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared to 12 (34.3%) patients in the control group (the difference between the two groups was 36.0%, =0.002). At T2, 33 (89.2%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared with 19 (54.3%) patients in the control group (the difference between the two groups was 34.9%, = 0.001). There was no statistically significant difference in the incidence of adverse events between the two groups. In the subgroup analysis of different hemiplegic sides, the rehabilitation effect of patients with right hemiplegia was better than that of patients with left hemiplegia ( < 0.05); in the age subgroup analysis, different age groups of patients did not show a significant difference in the rehabilitation effect ( > 0.05).
Cerebellar tDCS can be used as an effective and safe treatment to promote recovery of upper limb motor function in stroke patients.
ChiCTR.org.cn, identifier: ChiCTR2200061838.
小脑参与运动的控制与协调，但小脑刺激是否能改善上肢运动功能的恢复尚不清楚。因此，本研究旨在探讨小脑经颅直流电刺激（tDCS）疗法能否促进中风患者上肢运动功能的恢复。
在这项随机、双盲、假刺激对照的前瞻性研究中，招募了77例中风患者，并将其随机分为tDCS组（n = 39）或对照组（n = 38）。患者接受阳极（2 mA，20分钟）或假tDCS治疗，为期4周。主要结局是从基线到治疗4周后第1天（T1）和治疗4周后60天（T2）的Fugl-Meyer上肢评估（FMA-UE）评分的变化。次要结局是在T1和T2评估的FMA-UE反应率。还记录了与tDCS治疗相关的不良事件（AE）。
在T1时，tDCS组的FMA-UE平均评分增加了10.7分[平均标准误差（SEM）= 1.4]，对照组增加了5.8分（SEM = 1.3）（两组间差异为4.9分，P = 0.013）。在T2时，tDCS组的FMA-UE平均评分增加了18.9分（SEM = 2.1），对照组增加了12.7分（SEM = 2.1）（两组间差异为6.2分，P = 0.043）。在T1时，tDCS组26例（70.3%）患者的FMA-UE评分有临床意义的改善，而对照组为12例（34.3%）（两组间差异为36.0%，P = 0.002）。在T2时，tDCS组33例（89.2%）患者的FMA-UE评分有临床意义的改善，而对照组为19例（54.3%）（两组间差异为34.9%，P = 0.001）。两组不良事件发生率无统计学显著差异。在不同偏瘫侧的亚组分析中，右侧偏瘫患者的康复效果优于左侧偏瘫患者（P < 0.05）；在年龄亚组分析中，不同年龄组患者的康复效果无显著差异（P > 0.05）。
小脑tDCS可作为一种有效且安全的治疗方法，促进中风患者上肢运动功能的恢复。
中国临床试验注册中心（ChiCTR.org.cn），标识符：ChiCTR2200061838。
