Repetitive Bihemispheric Transcranial Direct Current Stimulation After Stroke

Bihemispheric Modulation of the Motor Cortex by Repetitive Transcranial Direct Current Stimulation After Stroke

Non-invasive repetitive bi-hemispheric transcranial direct current stimulation (tDCS) may restore post-stroke bi-hemispheric balance by increase peri-lesional cortex activity and suppress abnormal inhibition from non-lesional hemisphere, and therefore enhance after-effects of rehabilitation. In this double-blind, randomized controlled trial, investigators aim to investigate whether multi-session, bihemispheric tDCS to the primary motor cortex (M1) in combination with upper extremity rehabilitation therapy affected motor functional outcome, ipsilesional motor circuit excitability using transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) measures.

Investigators will consecutively enroll subacute (2-6 weeks after stroke onset) patients with first-time, unilateral, ischemic subcortical stroke in the middle cerebral artery territory with mild to moderate hand weakness. All subjects will be randomly allocated to receive daily bihemispheric tDCS (anodal tDCS to ipsilesional M1 and cathodal tDCS to contralesional M1 with 2 mA stimulation for 20 min) or daily sham tDCS (same but stimulation for only 30 seconds) with simultaneous physical/occupational therapy, for total 10 sessions. Changes in upper extremity motor function score (Fugl-Meyer test and Action Research Arm test), corticospinal excitability from the transcranial magnetic stimulation(TMS), and sensorimotor oscillations from the magnetoencephalography (MEG) will be assessed before and after intervention, as well as 3 months after stroke. All stroke patients will receive tDCS and standard medical, rehabilitation treatments in rehabilitation ward.

True repetitive bihemispheric transcranial direct current stimulation, anodal at ipsilesional M1 while cathodal at contralesional M1, daily 20 minutes for 20 sessions

Repetitive bihemispheric transcranial direct current stimulation, as the experimental stimulation condition but only for 120 seconds

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

baseline, change from baseline after 2 weeks' intervention, change from baseline at 3 months after stroke

Inclusion Criteria: Age 20-80 years old Patients with first-time, unilateral, ischemic stroke with contralateral mild to moderate hand weakness Brain MRI confirmed subcortical stroke in the middle cerebral artery territory Post-stroke 2-6 weeks with stable clinical condition Exclusion Criteria: Stroke with cortical lesions Containing metal implants (such as implanted electrodes, pacemakers) Sensitive or fear of electromagnetic waves Pregnant women History of alcohol or drug abuse History of seizures or epilepsy Claustrophobia Other significant disease or neuropsychiatric disorders