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Transcranial direct current stimulation (tDCS) for improving aphasia in patients after stroke.

Abstract

BACKGROUND

Stroke is one of the leading causes of disability worldwide. Aphasia among stroke survivors is common. Current speech and language therapy (SLT) strategies have only limited effectiveness in improving aphasia. A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability and hence to improve aphasia.

OBJECTIVES

To assess the effects of tDCS for improving aphasia in patients after stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, March 2012), MEDLINE (1948 to March 2012), EMBASE (1980 to March 2012), CINAHL (1982 to March 2012), AMED (1985 to April 2012), Science Citation Index (1899 to April 2012) and seven additional databases. We also searched trials registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers.

SELECTION CRITERIA

We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials (from which we only analysed the first period as a parallel group design) comparing tDCS versus control in adults with aphasia due to stroke.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted the data. If necessary, we contacted study authors for additional information. We collected information on dropouts and adverse events from the trials.

MAIN RESULTS

We included five trials involving 54 participants. None of the included studies used any formal outcome measure for measuring functional communication, that is measuring aphasia in a real-life communicative setting. All five trials measured correct picture naming as a surrogate for aphasia. There was no evidence that tDCS enhanced SLT outcomes. No adverse events were reported and the proportion of dropouts was comparable between groups.

AUTHORS' CONCLUSIONS

Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS) versus control (sham tDCS). However, it appears that cathodal tDCS over the non-lesioned hemisphere might be the most promising approach.

Authors+Show Affiliations

Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany. brnhrd.lsnr@googlemail.com.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23799617

Citation

Elsner, Bernhard, et al. "Transcranial Direct Current Stimulation (tDCS) for Improving Aphasia in Patients After Stroke." The Cochrane Database of Systematic Reviews, 2013, p. CD009760.
Elsner B, Kugler J, Pohl M, et al. Transcranial direct current stimulation (tDCS) for improving aphasia in patients after stroke. Cochrane Database Syst Rev. 2013.
Elsner, B., Kugler, J., Pohl, M., & Mehrholz, J. (2013). Transcranial direct current stimulation (tDCS) for improving aphasia in patients after stroke. The Cochrane Database of Systematic Reviews, (6), CD009760. https://doi.org/10.1002/14651858.CD009760.pub2
Elsner B, et al. Transcranial Direct Current Stimulation (tDCS) for Improving Aphasia in Patients After Stroke. Cochrane Database Syst Rev. 2013 Jun 25;(6)CD009760. PubMed PMID: 23799617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcranial direct current stimulation (tDCS) for improving aphasia in patients after stroke. AU - Elsner,Bernhard, AU - Kugler,Joachim, AU - Pohl,Marcus, AU - Mehrholz,Jan, Y1 - 2013/06/25/ PY - 2013/6/27/entrez PY - 2013/6/27/pubmed PY - 2013/11/20/medline SP - CD009760 EP - CD009760 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 6 N2 - BACKGROUND: Stroke is one of the leading causes of disability worldwide. Aphasia among stroke survivors is common. Current speech and language therapy (SLT) strategies have only limited effectiveness in improving aphasia. A possible adjunct to SLT for improving SLT outcomes might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability and hence to improve aphasia. OBJECTIVES: To assess the effects of tDCS for improving aphasia in patients after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, March 2012), MEDLINE (1948 to March 2012), EMBASE (1980 to March 2012), CINAHL (1982 to March 2012), AMED (1985 to April 2012), Science Citation Index (1899 to April 2012) and seven additional databases. We also searched trials registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers. SELECTION CRITERIA: We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials (from which we only analysed the first period as a parallel group design) comparing tDCS versus control in adults with aphasia due to stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. If necessary, we contacted study authors for additional information. We collected information on dropouts and adverse events from the trials. MAIN RESULTS: We included five trials involving 54 participants. None of the included studies used any formal outcome measure for measuring functional communication, that is measuring aphasia in a real-life communicative setting. All five trials measured correct picture naming as a surrogate for aphasia. There was no evidence that tDCS enhanced SLT outcomes. No adverse events were reported and the proportion of dropouts was comparable between groups. AUTHORS' CONCLUSIONS: Currently there is no evidence of the effectiveness of tDCS (anodal tDCS, cathodal tDCS) versus control (sham tDCS). However, it appears that cathodal tDCS over the non-lesioned hemisphere might be the most promising approach. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/23799617/Transcranial_direct_current_stimulation__tDCS__for_improving_aphasia_in_patients_after_stroke_ L2 - https://doi.org/10.1002/14651858.CD009760.pub2 DB - PRIME DP - Unbound Medicine ER -