Salazar Claudia A, Feng Wuwei, Bonilha Leonardo, Kautz Steven, Jensen Jens H, George Mark S, Rowland Nathan C
Department of Neurosurgery, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
Center for Biomedical Imaging, University of South Carolina, Columbia, SC 29208, USA.
J Clin Med. 2023 Mar 30;12(7):2601. doi: 10.3390/jcm12072601.
During rehabilitation, a large proportion of stroke patients either plateau or begin to lose motor skills. By priming the motor system, transcranial direct current stimulation (tDCS) is a promising clinical adjunct that could augment the gains acquired during therapy sessions. However, the extent to which patients show improvements following tDCS is highly variable. This variability may be due to heterogeneity in regions of cortical infarct, descending motor tract injury, and/or connectivity changes, all factors that require neuroimaging for precise quantification and that affect the actual amount and location of current delivery. If the relationship between these factors and tDCS efficacy were clarified, recovery from stroke using tDCS might be become more predictable. This review provides a comprehensive summary and timeline of the development of tDCS for stroke from the viewpoint of neuroimaging. Both animal and human studies that have explored detailed aspects of anatomy, connectivity, and brain activation dynamics relevant to tDCS are discussed. Selected computational works are also included to demonstrate how sophisticated strategies for reducing variable effects of tDCS, including electric field modeling, are moving the field ever closer towards the goal of personalizing tDCS for each individual. Finally, larger and more comprehensive randomized controlled trials involving tDCS for chronic stroke recovery are underway that likely will shed light on how specific tDCS parameters, such as dose, affect stroke outcomes. The success of these collective efforts will determine whether tDCS for chronic stroke gains regulatory approval and becomes clinical practice in the future.
在康复过程中，很大一部分中风患者的恢复会进入平台期或开始丧失运动技能。通过激发运动系统，经颅直流电刺激（tDCS）是一种很有前景的临床辅助手段，可增强在治疗过程中获得的恢复效果。然而，患者在接受tDCS治疗后表现出改善的程度差异很大。这种变异性可能是由于皮质梗死区域的异质性、下行运动束损伤和/或连接性变化，所有这些因素都需要神经成像来进行精确量化，并且会影响电流传递的实际量和位置。如果能阐明这些因素与tDCS疗效之间的关系，那么使用tDCS治疗中风的恢复情况可能会变得更可预测。这篇综述从神经成像的角度对tDCS治疗中风的发展进行了全面总结并梳理了时间线。讨论了探索与tDCS相关的解剖学、连接性和脑激活动力学详细方面的动物和人体研究。还纳入了一些精选的计算研究，以展示诸如电场建模等复杂策略如何减少tDCS可变效应，使该领域越来越接近为每个个体定制tDCS的目标。最后，涉及tDCS用于慢性中风恢复的更大规模、更全面的随机对照试验正在进行中，这可能会揭示特定的tDCS参数，如剂量，如何影响中风结局。这些共同努力的成功将决定tDCS用于慢性中风是否能获得监管批准并在未来成为临床实践。
