Do Higher Transcranial Direct Current Stimulation Doses Lead to Greater Gains in Upper Limb Motor Function in Post-Stroke Patients?

Abstract

Objective: To investigate whether a higher number of transcranial direct current stimulation (tDCS) sessions results in a greater improvement in upper limb function in chronic post-stroke patients. Materials and methods: A randomized, sham-controlled, double-blind clinical trial was conducted in 57 chronic post-stroke patients (≥ 3 months after their injuries). The patients were allocated to receive sessions of tDCS combined with physiotherapy and divided into three groups (anodal, cathodal, and sham). The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) was used to assess the sensorimotor impairment of the patients’ upper limbs before (baseline) and after five and ten sessions. The percentage of patients who achieved a clinically significant improvement (> five points on the FMA-UE) was also analyzed. Results: The FMA-UE score increased after five and ten sessions in both the anodal and cathodal tDCS groups, respectively, compared to the baseline. However, in the sham group, the FMA-UE score increased only after ten sessions. When compared to the sham group, the mean difference from the baseline after five sessions was higher in the anodal tDCS group. The percentage of individuals who achieved greater clinical improvement was higher in the stimulation groups than in the sham group and after ten sessions when compared to five sessions. Conclusions: Our results suggest that five tDCS sessions are sufficient to augment the effect of standard physiotherapy on upper limb function recovery in chronic post-stroke patients, and ten sessions resulted in greater gains.