tDCS currents >2 mA have not been investigated in stroke patients.
This phase I dose escalation study establishes safety of up to 4 mA in stroke patients.
No predefined major response was noted at any current level.
Skin temperature did not rise, and skin barrier function remained intact.
Transient skin redness without injury was a common finding irrespective of dose level.
Background and Objective
A prior meta-analysis revealed that higher doses of transcranial direct current stimulation (tDCS) have a better post-stroke upper-extremity motor recovery. While this finding suggests that currents greater than the typically used 2 mA may be more efficacious, the safety and tolerability of higher currents have not been assessed in stroke patients. We aim to assess the safety and tolerability of single session of up to 4 mA in stroke patients.
We adapted a traditional 3+3 study design with a current escalation schedule of 1>>2>>2.5>>3>>3.5>>4 mA for this tDCS safety study. We administered one 30-minute session of bihemispheric montage tDCS and simultaneous customary occupational therapy to patients with first-ever ischemic stroke. We assessed safety with pre-defined stopping rules and investigated tolerability through a questionnaire. Additionally, we monitored body resistance and skin temperature in real-time at the electrode contact site.
Eighteen patients completed the study. The current was escalated to 4 mA without meeting the pre-defined stopping rules or causing any major safety concern. 50% of patients experienced transient skin redness without injury. No rise in temperature (range 26°C-35°C) was noted and skin barrier function remained intact (i.e. body resistance >1 kΩ).
Our phase I safety study supports that single session of tDCS with current up to 4 mA is safe and tolerable in stroke patients. A phase II study to further test the safety and preliminary efficacy with multi-session tDCS at 4 mA (as compared with lower current and sham stimulation) is a logical next step.