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Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials.
J Neuroeng Rehabil. 2020 07 08; 17(1):88.JN

Abstract

BACKGROUND

Transcranial Direct Current Stimulation (tDCS) is an emerging approach for improving aphasia after stroke. However, it remains unclear what type of tDCS stimulation is most effective. Our aim was to give an overview of the evidence network regarding the efficacy and safety of tDCS and to estimate the effectiveness of the different stimulation types.

METHODS

This is a systematic review of randomized controlled trials with network meta-analysis (NMA). We searched the following databases until 4 February 2020: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and four other databases. We included studies with adult people with stroke. We compared any kind of active tDCS (anodal, cathodal, or dual, that is applying anodal and cathodal tDCS concurrently) regarding improvement of our primary outcome of functional communication, versus control, after stroke.

PROSPERO ID

CRD42019135696.

RESULTS

We included 25 studies with 471 participants. Our NMA showed that tDCS did not improve our primary outcome, that of functional communication. There was evidence of an effect of anodal tDCS, particularly over the left inferior frontal gyrus, in improving our secondary outcome, that of performance in naming nouns (SMD = 0.51; 95% CI 0.11 to 0.90). There was no difference in safety between tDCS and its control interventions, measured by the number of dropouts and adverse events.

CONCLUSION

Comparing different application/protocols of tDCS shows that the anodal application, particularly over the left inferior frontal gyrus, seems to be the most promising tDCS treatment option to improve performance in naming in people with stroke.

Authors+Show Affiliations

Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany. bernhard.elsner@tu-dresden.de. Physiotherapy and Neurorehabilitation, SRH University of Applied Health Sciences Gera, Gera, Germany. bernhard.elsner@tu-dresden.de.Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany.Department of Public Health, Dresden Medical School, Technical University Dresden, Fetscherstr. 74, 01307, Dresden, Germany. Physiotherapy and Neurorehabilitation, SRH University of Applied Health Sciences Gera, Gera, Germany. Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32641152

Citation

Elsner, Bernhard, et al. "Transcranial Direct Current Stimulation (tDCS) for Improving Aphasia After Stroke: a Systematic Review With Network Meta-analysis of Randomized Controlled Trials." Journal of Neuroengineering and Rehabilitation, vol. 17, no. 1, 2020, p. 88.
Elsner B, Kugler J, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials. J Neuroeng Rehabil. 2020;17(1):88.
Elsner, B., Kugler, J., & Mehrholz, J. (2020). Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials. Journal of Neuroengineering and Rehabilitation, 17(1), 88. https://doi.org/10.1186/s12984-020-00708-z
Elsner B, Kugler J, Mehrholz J. Transcranial Direct Current Stimulation (tDCS) for Improving Aphasia After Stroke: a Systematic Review With Network Meta-analysis of Randomized Controlled Trials. J Neuroeng Rehabil. 2020 07 8;17(1):88. PubMed PMID: 32641152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials. AU - Elsner,Bernhard, AU - Kugler,Joachim, AU - Mehrholz,Jan, Y1 - 2020/07/08/ PY - 2020/03/09/received PY - 2020/06/11/accepted PY - 2020/7/10/entrez PY - 2020/7/10/pubmed PY - 2020/7/10/medline KW - Aphasia KW - Meta-analysis KW - Review KW - Stroke KW - Transcranial direct current stimulation SP - 88 EP - 88 JF - Journal of neuroengineering and rehabilitation JO - J Neuroeng Rehabil VL - 17 IS - 1 N2 - BACKGROUND: Transcranial Direct Current Stimulation (tDCS) is an emerging approach for improving aphasia after stroke. However, it remains unclear what type of tDCS stimulation is most effective. Our aim was to give an overview of the evidence network regarding the efficacy and safety of tDCS and to estimate the effectiveness of the different stimulation types. METHODS: This is a systematic review of randomized controlled trials with network meta-analysis (NMA). We searched the following databases until 4 February 2020: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and four other databases. We included studies with adult people with stroke. We compared any kind of active tDCS (anodal, cathodal, or dual, that is applying anodal and cathodal tDCS concurrently) regarding improvement of our primary outcome of functional communication, versus control, after stroke. PROSPERO ID: CRD42019135696. RESULTS: We included 25 studies with 471 participants. Our NMA showed that tDCS did not improve our primary outcome, that of functional communication. There was evidence of an effect of anodal tDCS, particularly over the left inferior frontal gyrus, in improving our secondary outcome, that of performance in naming nouns (SMD = 0.51; 95% CI 0.11 to 0.90). There was no difference in safety between tDCS and its control interventions, measured by the number of dropouts and adverse events. CONCLUSION: Comparing different application/protocols of tDCS shows that the anodal application, particularly over the left inferior frontal gyrus, seems to be the most promising tDCS treatment option to improve performance in naming in people with stroke. SN - 1743-0003 UR - https://www.unboundmedicine.com/medline/citation/32641152/Transcranial_direct_current_stimulation__tDCS__for_improving_aphasia_after_stroke:_a_systematic_review_with_network_meta_analysis_of_randomized_controlled_trials_ L2 - https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-020-00708-z DB - PRIME DP - Unbound Medicine ER -