Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
Main Author: | |
---|---|
Publication Date: | 2022 |
Other Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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. |
id |
UNSP_09c73982937a583ad6e9692ff4c1a6bb |
---|---|
oai_identifier_str |
oai:repositorio.unesp.br:11449/241234 |
network_acronym_str |
UNSP |
network_name_str |
Repositório Institucional da UNESP |
repository_id_str |
2946 |
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) |
instacron_str |
UNESP |
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 |
_version_ |
1810021411648962560 |