[ARTICLE] Transcranial direct current stimulation and stroke recovery: opportunities and challenges – Full Text PDF


Objectives: Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. However, there is a serious question among developing countries with limited financial and human resources, about the potential returns of an investment in this field and regarding the best time to transfer this technology from controlled experimental settings to health systems in the public and private sectors. This article reviews the tDCS as tools of neuromodulation for stroke and discusses the opportunities and challenges available for clinicians and researchers interested in advancing neuromodulation therapy. The aim of this review is to highlight the usefulness of tDCS and to generate an interest that will lead to appropriate studies that assess the true clinical value of tDCS for brain diseases in developing countries.

Methods: Literature review was done on PubMed from 2016 on neuromodulation in under-developed countries (UDCs) by non-invasive brain stimulation methods, using the key words “stroke”, “rehabilitation”, and “tDCS”.

Results: We first identified articles and websites, of which were further selected for extensive analysis mainly based on clinical relevance, study quality and reliability, and date of publication.

Conclusion: Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity to use in mostly UDCs.

During stroke, an interruption to all or part of the brain’s
blood supply, with the subsequent deprivation of oxygen
and glucose to the affected area, causes the rapid loss
of brain function through the destruction of neuronal
function and the initiation of an ischemic cascade that
seriously damages or kills neurons1. Strokes are
classified as an ischemic (caused by embolism,
thrombosis or systemic hypoperfusion) approximately
80% and hemorrhagic (intracerebral, subarachnoid,
subdural or epidural in type) strokes(1, 2). The main
symptoms associated with stroke are weakness in
facial, speech and a loss in visual field and paralysis in
the arm or leg. These symptoms may last only a few
hours and disappear completely within 24 hours, as
with TIAs, but even under these circumstances,
immediate medical assistance should be sought, as
this will help minimise damage to the brain and help
prevent progression to larger, more serious episodes of
stroke(2). Stroke can result in lasting neurological
damage or may even cause death unless it is
diagnosed and treated promptly. When the stroke is
severe, the patient often faces a prolonged stay in
hospital and, following their discharge and depending
on the severity of the consequences, constant care.
This care is either provided by a family member or, in
the most severe cases, by a nursing home. Stroke
disease not only affects health-related quality of life
(HRQOL) of patients but it can also increase their
hospital length of stay (HLoS)(3, 4). HLoS will even be
more increased if patients are suffering with stroke
combined with diabetes mellitus and hypertension(5). […]

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