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Annals of Physical and Rehabilitation Medicine
Volume 55, n° S1
pages e5-e6 (octobre 2012)
Doi : 10.1016/j.rehab.2012.07.015
Accident vasculaire cérébral (I) / Post-stroke rehabilitation (I)

Effect of repeated sessions of combined anodal tDCS and peripheral nerve stimulation on motor performance in acute stroke: A behavioural and electrophysiological study
 

V. Sattler a, , B. Acket b, A. Gerdelat-Mas a, N. Raposo b, J.-F. Albucher b, C. Thalamas c, I. Loubinoux d, F. Chollet b, M. Simonetta-Moreau a
a Pôle neurosciences, neurologie, CHU Purpan, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France 
b Pôle neurosciences, unité neurovasculaire, CHU Purpan, Toulouse cedex 9, France 
c Centre d’investigation clinique, CHU Purpan, Toulouse cedex 9, France 
d Inserm U825, pavillon Baudot, CHU Purpan, Toulouse cedex 9, France 

Corresponding author.

Keywords : tDCS, Stroke, Acute phase, Peripheral nerve stimulation, Rehabilitation, Cortical plasticity


Background and purpose .– Non-invasive neuromodulation such as repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) applied over the contralesional or ipsilesional motor cortices (M1), in association with neurorehabilitation, can improve motor recovery in patients after stroke [1, 2, 3]. Most studies have been performed in the chronic phase and very few in the acute one. The purpose of this study was to assess in the acute phase of post-stroke recovery the effect of anodal direct current stimulation (tDCS) applied over the ipsilesional primary motor cortex (M1) combined with repetitive peripheral nerve stimulation (rEPNS) on the motor performance of the paretic hand.

Methods .– In this double-blind, sham-controlled study, 20 patients are enrolled within the first month after a cortical or subcortical stroke and are randomized in two parallel groups. The first group receives five consecutive daily sessions of anodal tDCS over the ipsilesional M1 in association with rEPNS of the radial nerve applied on the paretic side. The second group receives the same rEPNS combined with sham tDCS. Motor performance and cortical excitability are tested at baseline and after the intervention at day 5, 15 and 30. The primary endpoint is the full time to complete the Jebsen and Taylor Hand Function Test (JTHFT).

Results .– So far, 17 patients have been included within the 5 days (±3) after stroke. No side effects have been reported during the treatment. Preliminary results show significant differences between the two groups at day 5 (P =0.006) and day 15 P =0.04) for the 14 patients who have ended the study (three are still on course).

Conclusion .– These promising results could suggest, as far as they will be further confirmed, that an early cortical neuromodulation with anodal tDCS in association with rEPNS, could act in the early post-stroke phase as an efficient adjuvant to promote the natural cortical plasticity involved in the recovery processes.

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References

Celnik et al. Stroke 2009.
Khedr et al. Neurology 2005.
Boggio et al. Restor Neurol Neurosc 2007.


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© 2012  Published by Elsevier Masson SAS.
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