HD-tDCS as a neurorehabilitation technique for a case of post-anoxic leukoencephalopathy

ABSTRACT

Post-anoxic leukoencephalopathy is a rare event that causes global demyelination secondary to anoxic injury. Given the nature and extent of the damage, cognitive and functional deficits are typically chronic even after standard therapies. Here, we describe a novel treatment approach that used high definition transcranial direct-current stimulation (HD-tDCS) with a 62-year-old male who was 5 years post-anoxic leukoencephalopathy secondary to an accidental drug overdose. HD-tDCS was administered over the left lateral prefrontal cortex across 29 daily sessions at 2 mA (20 min/session) in order to address dysexecutive behaviors. Results demonstrated improved delayed memory and trends for improved visuospatial and semantic fluency performance as well as improved insight and daily functioning, all of which returned to baseline by the end of a 10 week no-contact follow up period. Resting state fMRI connectivity results mirrored these changes by showing increased dorsal attention and cingulo-opercular but reduced ventral attention network connectivity after session 29, all of which returned to baseline at follow-up. These findings suggest HD-tDCS may benefit functioning even following serious and pervasive anoxic injury. Findings also suggest the need for continued HD-tDCS for maintenance purposes, though future work is needed to identify optimal dose-response information.

KEYWORDS:

• Leukoencephalopathy
• HD-tDCS
• Neurostimulation
• fMRI
• Prefrontal cortex

Acknowledgements

This work was supported by the NIH/NIA via R01AG058724 (to BMH), the Michigan Alzheimer’s Disease Research Center (MADRC) (P30AG053760), and an MADRC pilot grant (to BMH). The authors would like to thank Sean Ma, Ph.D., Oliver Calhoun, B.A., and Alina Lesnovskaya, B.A., for their assistance with this case.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the NIH/NIA via R01 AG058724 (to BMH), the Michigan Alzheimer’s Disease Research Center (MADRC) (P30 AG053760), and an MADRC pilot grant (to BMH). The authors would like to thank Sean Ma, Ph.D., Oliver Calhoun, B.A., and Alina Lesnovskaya, B.A., for their assistance with this case; National Institute on Aging.