Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial

Bibliographic Details
Main Author: da Silva, Taís Regina [UNESP]
Publication Date: 2022
Other Authors: de Carvalho Nunes, Hélio Rubens [UNESP], Martins, Laís Geronutti [UNESP], da Costa, Rafael Dalle Molle [UNESP], de Souza, Juli Thomaz [UNESP], Winckler, Fernanda Cristina [UNESP], Sartor, Lorena Cristina Alvarez [UNESP], Modolo, Gabriel Pinheiro [UNESP], Ferreira, Natalia Cristina [UNESP], da Silva Rodrigues, Josiela Cristina [UNESP], Kanda, Rafael [UNESP], Fogarolli, Marcelo Ortolani [UNESP], Borges, Guilherme Ferreira [UNESP], Rizzatti, Gabriela Rizzo Soares [UNESP], Ribeiro, Priscila Watson [UNESP], Favoretto, Diandra B., dos Santos, Luan R. Aguiar, Bazan, Silméia Garcia Zanati [UNESP], Betting, Luiz Eduardo [UNESP], de Oliveira Antunes, Leticia Cláudia [UNESP], Pereira, Vitor Mendes, Edwards, Taiza G. S., Pontes-Neto, Octávio Marques, Conforto, Adriana Bastos, Bazan, Rodrigo [UNESP], Luvizutto, Gustavo José
Format: Article
Language: eng
Source: Repositório Institucional da UNESP
Download full: http://dx.doi.org/10.1002/ana.26430
http://hdl.handle.net/11449/241234
Summary: Objective: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. Methods: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test–Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. Results: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9–32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = −0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = −9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. Interpretation: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400–410.
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spelling Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON TrialObjective: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. Methods: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test–Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. Results: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9–32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = −0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = −9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. Interpretation: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400–410.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Department of Internal Medicine Botucatu Medical School São Paulo State University (UNESP)Department of Public Health Botucatu Medical School São Paulo State University (UNESP)Department of Rehabilitation Botucatu Medical School São Paulo State University (UNESP)Department of Neurology Department of Psychology and Psychiatry Botucatu Medical School São Paulo State University (UNESP)Department of Neurosciences and Behavioral Sciences Ribeirão Preto Medical School University of São Paulo (USP)Division of Neurosurgery Department of Surgery St Michael's Hospital University of TorontoClinical Hospital São Paulo University (USP) and Hospital Israelita Albert EinsteinDepartment of Applied Physical Therapy Federal University of Triângulo Mineiro (UFTM)Department of Internal Medicine Botucatu Medical School São Paulo State University (UNESP)Department of Public Health Botucatu Medical School São Paulo State University (UNESP)Department of Rehabilitation Botucatu Medical School São Paulo State University (UNESP)Department of Neurology Department of Psychology and Psychiatry Botucatu Medical School São Paulo State University (UNESP)FAPESP: 2015/14231-0CNPq: 423924/2016-8Universidade Estadual Paulista (UNESP)Universidade de São Paulo (USP)University of TorontoFederal University of Triângulo Mineiro (UFTM)da Silva, Taís Regina [UNESP]de Carvalho Nunes, Hélio Rubens [UNESP]Martins, Laís Geronutti [UNESP]da Costa, Rafael Dalle Molle [UNESP]de Souza, Juli Thomaz [UNESP]Winckler, Fernanda Cristina [UNESP]Sartor, Lorena Cristina Alvarez [UNESP]Modolo, Gabriel Pinheiro [UNESP]Ferreira, Natalia Cristina [UNESP]da Silva Rodrigues, Josiela Cristina [UNESP]Kanda, Rafael [UNESP]Fogarolli, Marcelo Ortolani [UNESP]Borges, Guilherme Ferreira [UNESP]Rizzatti, Gabriela Rizzo Soares [UNESP]Ribeiro, Priscila Watson [UNESP]Favoretto, Diandra B.dos Santos, Luan R. AguiarBazan, Silméia Garcia Zanati [UNESP]Betting, Luiz Eduardo [UNESP]de Oliveira Antunes, Leticia Cláudia [UNESP]Pereira, Vitor MendesEdwards, Taiza G. S.Pontes-Neto, Octávio MarquesConforto, Adriana BastosBazan, Rodrigo [UNESP]Luvizutto, Gustavo José2023-03-01T20:52:56Z2023-03-01T20:52:56Z2022-09-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article400-410http://dx.doi.org/10.1002/ana.26430Annals of Neurology, v. 92, n. 3, p. 400-410, 2022.1531-82490364-5134http://hdl.handle.net/11449/24123410.1002/ana.264302-s2.0-85132866848Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengAnnals of Neurologyinfo:eu-repo/semantics/openAccess2024-09-03T14:12:16Zoai:repositorio.unesp.br:11449/241234Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestrepositoriounesp@unesp.bropendoar:29462024-09-03T14:12:16Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
title Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
spellingShingle Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
da Silva, Taís Regina [UNESP]
title_short Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
title_full Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
title_fullStr Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
title_full_unstemmed Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
title_sort Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
author da Silva, Taís Regina [UNESP]
author_facet da Silva, Taís Regina [UNESP]
de Carvalho Nunes, Hélio Rubens [UNESP]
Martins, Laís Geronutti [UNESP]
da Costa, Rafael Dalle Molle [UNESP]
de Souza, Juli Thomaz [UNESP]
Winckler, Fernanda Cristina [UNESP]
Sartor, Lorena Cristina Alvarez [UNESP]
Modolo, Gabriel Pinheiro [UNESP]
Ferreira, Natalia Cristina [UNESP]
da Silva Rodrigues, Josiela Cristina [UNESP]
Kanda, Rafael [UNESP]
Fogarolli, Marcelo Ortolani [UNESP]
Borges, Guilherme Ferreira [UNESP]
Rizzatti, Gabriela Rizzo Soares [UNESP]
Ribeiro, Priscila Watson [UNESP]
Favoretto, Diandra B.
dos Santos, Luan R. Aguiar
Bazan, Silméia Garcia Zanati [UNESP]
Betting, Luiz Eduardo [UNESP]
de Oliveira Antunes, Leticia Cláudia [UNESP]
Pereira, Vitor Mendes
Edwards, Taiza G. S.
Pontes-Neto, Octávio Marques
Conforto, Adriana Bastos
Bazan, Rodrigo [UNESP]
Luvizutto, Gustavo José
author_role author
author2 de Carvalho Nunes, Hélio Rubens [UNESP]
Martins, Laís Geronutti [UNESP]
da Costa, Rafael Dalle Molle [UNESP]
de Souza, Juli Thomaz [UNESP]
Winckler, Fernanda Cristina [UNESP]
Sartor, Lorena Cristina Alvarez [UNESP]
Modolo, Gabriel Pinheiro [UNESP]
Ferreira, Natalia Cristina [UNESP]
da Silva Rodrigues, Josiela Cristina [UNESP]
Kanda, Rafael [UNESP]
Fogarolli, Marcelo Ortolani [UNESP]
Borges, Guilherme Ferreira [UNESP]
Rizzatti, Gabriela Rizzo Soares [UNESP]
Ribeiro, Priscila Watson [UNESP]
Favoretto, Diandra B.
dos Santos, Luan R. Aguiar
Bazan, Silméia Garcia Zanati [UNESP]
Betting, Luiz Eduardo [UNESP]
de Oliveira Antunes, Leticia Cláudia [UNESP]
Pereira, Vitor Mendes
Edwards, Taiza G. S.
Pontes-Neto, Octávio Marques
Conforto, Adriana Bastos
Bazan, Rodrigo [UNESP]
Luvizutto, Gustavo José
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Estadual Paulista (UNESP)
Universidade de São Paulo (USP)
University of Toronto
Federal University of Triângulo Mineiro (UFTM)
dc.contributor.author.fl_str_mv da Silva, Taís Regina [UNESP]
de Carvalho Nunes, Hélio Rubens [UNESP]
Martins, Laís Geronutti [UNESP]
da Costa, Rafael Dalle Molle [UNESP]
de Souza, Juli Thomaz [UNESP]
Winckler, Fernanda Cristina [UNESP]
Sartor, Lorena Cristina Alvarez [UNESP]
Modolo, Gabriel Pinheiro [UNESP]
Ferreira, Natalia Cristina [UNESP]
da Silva Rodrigues, Josiela Cristina [UNESP]
Kanda, Rafael [UNESP]
Fogarolli, Marcelo Ortolani [UNESP]
Borges, Guilherme Ferreira [UNESP]
Rizzatti, Gabriela Rizzo Soares [UNESP]
Ribeiro, Priscila Watson [UNESP]
Favoretto, Diandra B.
dos Santos, Luan R. Aguiar
Bazan, Silméia Garcia Zanati [UNESP]
Betting, Luiz Eduardo [UNESP]
de Oliveira Antunes, Leticia Cláudia [UNESP]
Pereira, Vitor Mendes
Edwards, Taiza G. S.
Pontes-Neto, Octávio Marques
Conforto, Adriana Bastos
Bazan, Rodrigo [UNESP]
Luvizutto, Gustavo José
description Objective: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. Methods: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test–Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. Results: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9–32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = −0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = −9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. Interpretation: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400–410.
publishDate 2022
dc.date.none.fl_str_mv 2022-09-01
2023-03-01T20:52:56Z
2023-03-01T20:52:56Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1002/ana.26430
Annals of Neurology, v. 92, n. 3, p. 400-410, 2022.
1531-8249
0364-5134
http://hdl.handle.net/11449/241234
10.1002/ana.26430
2-s2.0-85132866848
url http://dx.doi.org/10.1002/ana.26430
http://hdl.handle.net/11449/241234
identifier_str_mv Annals of Neurology, v. 92, n. 3, p. 400-410, 2022.
1531-8249
0364-5134
10.1002/ana.26430
2-s2.0-85132866848
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Annals of Neurology
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 400-410
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
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institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv repositoriounesp@unesp.br
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