Effect of Transcranial direct current stimulation (tDCS) on altered conscious patients after traumatic brain injury & cerebrovascular accident: A randomized clinical control trial

Abstract

Background & Objective: Traumatic brain injury and cerebrovascular accidents can result in altered levels of consciousness. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on the level of consciousness in these patients. Methods: A total of 100 patients admitted to the neurological ICU of the hospital were screened and 40 subjects after satisfying inclusion criteria were recruited within the first one to two weeks of injury. They were randomly divided into two groups after written consent from a caretaker, Group A (experimental) (n=20) and Group B (control) (n=20) by computerized randomization. Group A received Anodal tDCS to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional) and left dorsolateral prefrontal cortex (F3) according to the 10/20 EEG montage for two sessions of 20min/day for 7 consecutive days and routine physiotherapy. Group B only received routine physiotherapy similar to Group A. Glasgow coma scale (GCS) and Rancho Los Amigos scale (RLAS) was taken pre and post-intervention to assess the level of consciousness. Results: The pretest and post-test GCS and RLAS scores in groups A and B showed statistical significance at p<0.01. The differences of mean GCS and RLAS between pretest and posttest in group A showed better improvement than that of group B. The results were statistically significant at p<0.01. The effect size was large, calculated by Cohen’s d. Conclusion: The tDCS can be effective in improving GCS and RLAS in altered consciousness patients in the acute period after injury. It is non-invasive, cost-effective with minimal contraindications, and doesnot interfere with other modalities in the intensive care unit.