Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
Department of Medicine, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
Clin Neurol Neurosurg. 2024 Dec;247:108597. doi: 10.1016/j.clineuro.2024.108597. Epub 2024 Oct 23.
Transcranial direct current stimulation (tDCS) increases cerebral blood flow. This study evaluated the effects of anodal tDCS (A-tDCS) on intracranial compliance (ICC) in patients with subacute stroke using a non-invasive method.
This was a randomized, proof-of-concept, double-blind, pilot study. Patients with ischemic stroke of the middle cerebral artery (MCA) were divided into the following two groups: 1) A-tDCS in the motor cortex on the affected side for 30 min at 2 mA, and 2) sham tDCS in the motor cortex on the affected side. The primary outcomes were intracranial compliance (P2/P1 ratio and time-to-peak [TTP]) and ICC normalization after the intervention (P2/P1 ratio <1). Secondary outcomes were systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation.
No significant differences were observed in the P2/P1 ratio (P = 0.509) and TTP (P = 0.480) between the groups. However, the A-tDCS group was significantly associated with a normal P2/P1 ratio after intervention (B = 2.583; standard error [SE]: 1.277; P = 0.043; corrected for age and stroke severity). No significant associations were observed between the groups and systolic blood pressure (F = 0.16; P = 0.902), diastolic blood pressure (F = 0.18; P = 0.892), heart rate (F = 0.11; P = 0.950), or peripheral oxygen saturation (F = 0.21; P = 0.750).
ICC morphology normalization was observed in the A-tDCS group. However, no differences were observed in the P2/P1 ratio, TTP, or hemodynamic variables between the groups. A sample size of 66 patients with ischemic stroke of the MCA can be estimated using the observed effect size and standard α = 5 % and β = 20 % for future trials. Furthermore, this will aid in conducting the necessary randomized trials targeting these populations.
经颅直流电刺激（tDCS）可增加脑血流。本研究采用一种非侵入性方法，评估了对侧大脑运动皮质阳极 tDCS（A-tDCS）对急性脑卒中患者颅内顺应性（ICC）的影响。
这是一项随机、概念验证、双盲、初步研究。将大脑中动脉（MCA）缺血性脑卒中患者分为以下两组：1）患侧大脑运动皮质 A-tDCS 治疗，30 分钟，2 mA；2）患侧大脑运动皮质假 tDCS。主要结局指标为颅内顺应性（P2/P1 比值和达峰时间[TTP]）和干预后 ICC 正常化（P2/P1 比值＜1）。次要结局指标为收缩压、舒张压、心率和外周血氧饱和度。
两组间 P2/P1 比值（P = 0.509）和 TTP（P = 0.480）无显著差异。然而，A-tDCS 组在干预后 P2/P1 比值正常化（B = 2.583；标准误差 [SE]：1.277；P = 0.043；校正年龄和脑卒中严重程度）方面明显相关。两组间收缩压（F = 0.16；P = 0.902）、舒张压（F = 0.18；P = 0.892）、心率（F = 0.11；P = 0.950）或外周血氧饱和度（F = 0.21；P = 0.750）无显著相关性。
在 A-tDCS 组观察到 ICC 形态学正常化。然而，两组间 P2/P1 比值、TTP 或血流动力学变量无差异。根据观察到的效应量和标准α=5%和β=20%，估计未来试验需要 66 例大脑中动脉 MCA 缺血性脑卒中患者的样本量。此外，这将有助于针对这些人群开展必要的随机试验。
