Efficacy of transcranial alternating current stimulation over bilateral mastoids (tACS_bm) on enhancing recovery of subacute post-stroke patients

Abstract

Background and aims: Transcranial alternating current stimulation (tACS) offers another method of non-invasive brain stimulation in post-stroke rehabilitation. Because it is not known if tACS over bilateral mastoids (tACS_bm) can promote the functional recovery in subacute post-stroke patients, we wish to learn the effect of tACS_bm on improving neurological function and intracranial hemodynamics of subacute post-stroke patients.

Methods: Sixty subacute post-stroke patients (mean age: 65.4 ± 9.8 years), 15 to 60 days after the onset, were randomly assigned to receiving 15 sessions of usual rehabilitation program without (n = 30) or with tACS_bm (20 Hz and < 400 μA for 30-min; n = 30). The outcome measures included the NIH Stroke Scale (NIHSS) and measures of intracranial hemodynamics before and after treatment.

Results: At the fifteenth session, when compared with the baseline, the mean NIHSS scores of the patients in the tACS_bm group had significantly a larger decrease [18.3 ± 2.6 vs. 10.8 ± 2.7; p < 0.001] than that of the control group [19.1 ± 2.7 vs. 13.0 ± 2.4] [F(1,54) = 4.29, p = 0.043]. After both the first and fifteenth sessions, compared with the control group, the mean blood flow velocity (MFVs) of the tACS_bm group had significantly larger increase in the MCA, ACA, and PCA (p < 0.001), the Gosling pulsatility index (PI) of the tACS_bm group had also significantly larger decline in the MCA, ACA, and PCA than that of the control group (p < 0.001). The best predictor of the changes in the NIHSS scores was the decline in the pulsatility index in the vascular territory of both lesional and non-lesional MCA measured by the end of the last treatment session.

Conclusions: tACS_bm appeared to be effective for enhancing patients’ functional recovery and cerebral hemodynamics in the subacute phase. The extent of recovery seems to be associated with the decline of the resistance in vascular bed of the main cerebral arteries. The mechanisms behind this effect should be explored further through research.

Keywords:

• Transcranial alternating current stimulation
• Electrical stimulation
• Post-stroke rehabilitation
• NIHSS
• Hemodynamic
• Rehabilitation

Acknowledgments

We would like to thank colleagues of the rehabilitation medicine and rehabilitation teams of Huashan Hospital, Fudan University in Shanghai, China for assisting in data collection. Our gratitude also goes to members of the Applied Cognitive Neuroscience Laboratory and Dr Raymond Chung of the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, for their input in data analysis and presentation of the results. This study is supported by the Chinese Development Program of China (863 Program) (2007AA02Z482), the research grant awarded by Huashan Hospital of Fudan University, Shanghai, China, held by Y-S Hu, and the General Research Fund of the Research Grant Council, Hong Kong, held by CCH Chan.

Funding

This work was supported by the Chinese Development Program of China (863 Program) [grant number 2007AA02Z482]; Huashan Hospital of Fudan University, Shanghai, China.