Gunduz Muhammed Enes, Kocahasan Melike, Keser Zafer
Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA.
School of Medicine, Koc University, Istanbul 34450, Turkey.
Medicina (Kaunas). 2024 Dec 14;60(12):2061. doi: 10.3390/medicina60122061.
Stroke remains a leading cause of global disability and mortality despite advancements in acute interventions. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has primarily been studied for its effects on cortical excitability, with limited exploration of its neuroprotective and hemodynamic benefits. This review examines the role of tDCS in stroke, with a focus on neuroprotection in acute settings and cerebral blood flow (CBF) modulation in both acute and chronic phases. tDCS offers rapid, localized delivery to salvageable ischemic tissue, exerting pleiotropic effects that address a broader spectrum of pathological processes compared to pharmacological agents. Cathodal tDCS shows promise in acute ischemic stroke for neuroprotection in small-scale clinical studies, enhancing CBF and promoting vessel recanalization, while anodal tDCS demonstrates stronger effects on CBF, particularly in chronic stroke and hypoperfusion cases. Bihemispheric stimulation may offer additional benefits, with evidence suggesting a dose-dependent relationship between stimulation parameters and therapeutic outcomes. Further research is warranted to optimize stimulation protocols, evaluate safety and feasibility, and explore the potential of tDCS to promote neuroplasticity and functional recovery across different stroke populations and stages. By addressing these gaps, tDCS could emerge as a valuable adjunctive therapy in stroke management, complementing current interventions and expanding therapeutic windows.
尽管急性干预取得了进展，但中风仍然是全球残疾和死亡的主要原因。经颅直流电刺激（tDCS）是一种非侵入性神经调节技术，主要研究了其对皮质兴奋性的影响，而对其神经保护和血流动力学益处的探索有限。本综述探讨了tDCS在中风中的作用，重点关注急性情况下的神经保护以及急性和慢性期的脑血流（CBF）调节。tDCS能够快速、局部地作用于可挽救的缺血组织，与药物相比，它具有多效性，可应对更广泛的病理过程。在小规模临床研究中，阴极tDCS在急性缺血性中风的神经保护方面显示出前景，可增强脑血流并促进血管再通，而阳极tDCS对脑血流的影响更强，尤其是在慢性中风和灌注不足的病例中。双侧刺激可能会带来额外的益处，有证据表明刺激参数与治疗效果之间存在剂量依赖关系。有必要进一步研究以优化刺激方案，评估安全性和可行性，并探索tDCS在不同中风人群和阶段促进神经可塑性和功能恢复的潜力。通过填补这些空白，tDCS可能成为中风管理中有价值的辅助治疗方法，补充当前的干预措施并扩大治疗窗口。
