Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation; techniques; transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.
References
[1]
Benjamin, E.J., Blaha, M.J., Chiuve, S.E., Cushman, M., Das, S.R., Deo, R., de Ferranti, S.D., Floyd, J., Fornage, M., Gillespie, C. and Isasi, C.R. (2017) Heart Disease and Stroke Statistics—2017 Update: A Report from the American Heart Association. Circulation, 135, e146-e603. https://doi.org/10.1161/CIR.0000000000000485
[2]
Hadidi, N., Treat-Jacobson, D.J. and Lindquist, R. (2009) Poststroke Depression and Functional Outcome: A Critical Review of Literature. Heart Lung, 38, 151-162.
https://doi.org/10.1016/j.hrtlng.2008.05.002
[3]
Mohammed, G.F., Azab, H.M., Sayed, M.A., Elnady, H.M., Youssif, H. and Mahmoud, O.A. (2019) Risk Factors for Post-Stroke Depression in Sohag University Hospital. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 55, 11.
https://doi.org/10.1186/s41983-019-0057-z
[4]
Jorge, R.E., Robinson, R.G., Tateno, A., et al. (2004) Repetitive Transcranial Magnetic Stimulation as Treatment of Post Stroke Depression: A Preliminary Study. Biological Psychiatry, 55, 398-405. https://doi.org/10.1016/j.biopsych.2003.08.017
[5]
Van Asseldonk, E.H. and Boonstra, T.A. (2016) Transcranial Direct Current Stimulation of the Leg Motor Cortex Enhances Coordinated Motor Output during Walking with a Large Inter-Individual Variability. Brain Stimulation, 9, 182-190.
https://doi.org/10.1016/j.brs.2015.10.001
[6]
Miniussi, C. (2016) A Foreword on the Use of Noninvasive Brain Stimulation in Psychology. European Psychologist, 21, 1-3.
https://doi.org/10.1027/1016-9040/a000253
[7]
Nitsche, M.A., Cohen, L.G., Wassermann, E.M., Priori, A., Lang, N., Antal, A. and Pascual-Leone, A. (2008) Transcranial Direct Current Stimulation: State of the Art. Brain Stimulation, 1, 206-223. https://doi.org/10.1016/j.brs.2008.06.004
[8]
Stagg, C.J. and Nitsche, M.A. (2011) Physiological Basis of Transcranial Direct Current Stimulation. The Neuroscientist, 17, 37-53.
https://doi.org/10.1177/1073858410386614
[9]
Martin, D.M., Moffa, A., Nikolin, S., Bennabi, D., Brunoni, A.R., Flannery, W., et al. (2018) Cognitive Effects of Transcranial Direct Current Stimulation Treatment in Patients with Major Depressive Disorder: An Individual Patient Data Meta-Analysis of Randomized, Sham-Controlled Trials. Neuroscience and Biobehavioral Reviews, 90, 137-145. https://doi.org/10.1016/j.neubiorev.2018.04.008
[10]
Moffa, A.H., Brunoni, A.R., Fregni, F., Palm, U., Padberg, F., Blumberger, D.M., et al. (2017) Safety and Acceptability of Transcranial Direct Current Stimulation for the Acute Treatment of Major Depressive Episodes: Analysis of Individual Patient Data. Journal of Affective Disorders, 221, 1-5.
https://doi.org/10.1016/j.jad.2017.06.021
[11]
Grajny, K., Pyata, H., Spiegel, K., Lacey, E.H., Xing, S., Brophy, C. and Turkeltaub, P.E. (2016) Depression Symptoms in Chronic Left Hemisphere Stroke Are Related to Dorsolateral Prefrontal Cortex Damage. The Journal of Neuropsychiatry and Clinical Neurosciences, 28, 292-298.
https://doi.org/10.1176/appi.neuropsych.16010004
[12]
Hosseinzadeh, S.A., Mazhari, S., Najafi, K., Ahmadi, M., Aghaei, I. and Khaksarian, M. (2018) Anodal Transcranial Direct Current Stimulation Enhances Positive Changes in Movement Functions, Visual Attention and Depression of Patients with Chronic Ischemic Stroke: A Clinical Trail. Biomedical Research and Therapy, 5, 2841-2849. https://doi.org/10.15419/bmrat.v5i11.503
[13]
Fregni, F., Boggio, P.S., Nitsche, M.A., Marcolin, M.A., Rigonatti, S.P. and Pascual-Leone, A. (2006) Treatment of Major Depression with Transcranial Direct Current Stimulation. Bipolar Disorder, 8, 203-204.
https://doi.org/10.1111/j.1399-5618.2006.00291.x
[14]
Rigonatti, S.P., Boggio, P.S., Myczkowski, M.L., Otta, E., Fiquer, J.T., Ribeiro, R.B., Nitsche, M.A., Pascual-Leone, A. and Fregni, F. (2008) Transcranial Direct Stimulation and Fluoxetine for the Treatment of Depression. European Psychiatry, 23, 74-76. https://doi.org/10.1016/j.eurpsy.2007.09.006
[15]
Valiengo, L.C.L., Goulart, A.C., de Oliveira, J.F., Benseñor, I.M., Lotufo, P.A. and Brunoni, A.R. (2017) Transcranial Direct Current Stimulation for the Treatment of Post-Stroke Depression: Results from a Randomised, Sham-Controlled, Double-Blinded Trial. Journal of Neurology, Neurosurgery, and Psychiatry, 88, 170-175.
https://doi.org/10.1136/jnnp-2016-314075
[16]
Brunoni, A.R., Nitsche, M.A., Bolognini, N., Bikson, M., Wagner, T., Merabet, L. and Ferrucci, R. (2012) Clinical Research with Transcranial Direct Current Stimulation (tDCS): Challenges and Future Directions. Brain Stimulation, 5, 175-195.
https://doi.org/10.1016/j.brs.2011.03.002
[17]
Hatano, S. (1976) Experience from a Multicentre Stroke Register: A Preliminary Report. Bulletin of the World Health Organization, 54, 541-553.
[18]
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Press, Inc., Washington DC.
https://doi.org/10.1176/appi.books.9780890425596
[19]
Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
[20]
Rossi, S., Hallett, M., Rossini, P.M. and Pascual-Leone, A. (2009) Safety, Ethical Considerations, and Application Guidelines for the Use of Transcranial Magnetic Stimulation in Clinical Practice and Research. Clinical Neurophysiology, 120, 2008-2039. https://doi.org/10.1016/j.clinph.2009.08.016
[21]
Bueno, V.F., Brunoni, A.R., Boggio, P.S., et al. (2011) Mood and Cognitive Effects of Transcranial Direct Current Stimulation in Post-Stroke Depression. Neurocase, 17, 318-322. https://doi.org/10.1080/13554794.2010.509319
[22]
Hamilton, M. (1960) A Rating Scale for Depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56-62. https://doi.org/10.1136/jnnp.23.1.56
[23]
Williams, L.S., Weinberger, M., Harris, L.E., Clark, D.O. and Biller, J. (1999) Development of a Stroke-Specific Quality of Life Scale. Stroke, 30, 1362-1369.
https://doi.org/10.1161/01.STR.30.7.1362
[24]
Duan, X., Yao, G., Liu, Z., Cui, R. and Yang, W. (2018) Mechanisms of Transcranial Magnetic Stimulation Treating on Post-Stroke Depression. Frontiers in Human Neuroscience, 12, 215. https://doi.org/10.3389/fnhum.2018.00215
[25]
Herrera-Melendez, A., Bajbouj, M. and Aust, S. (2019) Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology, 1-12.
https://doi.org/10.1159/000501227
[26]
Valiengo, L., Casati, R., Bolognini, N., Lotufo, P.A., Benseñor, I.M., Goulart, A.C. and Brunoni, A.R. (2016) Transcranial Direct Current Stimulation for the Treatment of Post-Stroke Depression in Aphasic Patients: A Case Series. Neurocase, 22, 225-228. https://doi.org/10.1080/13554794.2015.1130231
[27]
Grimm, S., Beck, J., Schuepbach, D., Hell, D., Boesiger, P., Bermpohl, F., et al. (2008) Imbalance between Left and Right Dorsolateral Prefrontal Cortex in Major Depression Is Linked to Negative Emotional Judgment: An fMRI Study in Severe Major Depressive Disorder. Biological Psychiatry, 63, 369-376.
https://doi.org/10.1016/j.biopsych.2007.05.033
[28]
Moliadze, V., Antal, A. and Paulus, W. (2010) Electrode-Distance Dependent After-Effects of Transcranial Direct and Random Noise Stimulation with Extracephalic Reference Electrodes. Clinical Neurophysiology, 121, 2165-2171.
https://doi.org/10.1016/j.clinph.2010.04.033
[29]
Viana, R.T., Laurentino, G.E., Souza, R.J., et al. (2014) Effects of the Addition of Transcranial Direct Current Stimulation to Virtual Reality Therapy after Stroke: A Pilot Randomized Controlled Trial. NeuroRehabilitation, 34, 437-446.
https://doi.org/10.3233/NRE-141065
[30]
Elsner, B., Kwakkel, G., Kugler, J. and Mehrholz, J. (2017) Transcranial Direct Current Stimulation (tDCS) for Improving Capacity in Activities and Arm Function after Stroke: A Network Meta-Analysis of Randomized Controlled Trials. Journal of NeuroEngineering and Rehabilitation, 14, 95.
https://doi.org/10.1186/s12984-017-0301-7
[31]
Elsner, B., Kugler, J. and Mehrholz, J. (2018) Transcranial Direct Current Stimulation (tDCS) for Upper Limb Rehabilitation after Stroke: Future Directions. Journal of NeuroEngineering and Rehabilitation, 15, 106.
https://doi.org/10.1186/s12984-018-0459-7
[32]
Schjetnan, A.G., Faraji, J., Metz, G.A., Tatsuno, M. and Luczak, A. (2013) Transcranial Direct Current Stimulation in Stroke Rehabilitation: A Review of Recent Advancements. Stroke Research and Treatment, 2013, Article ID: 170256.
https://doi.org/10.1155/2013/170256
[33]
Fregni, F., Boggio, P., Nitsche, M. and Rigonatti, S. (2006) Cognitive Effects of Repeated Sessions of Transcranial Direct Current Stimulation in Patients with Depression. Depression and Anxiety, 23, 482-484. https://doi.org/10.1002/da.20201
[34]
Pisoni, A., Mattavelli, G., Papagno, C., Rosanova, M., Cacali, A. and Lauro, L. (2018) Cognitive Enhancement Induced by Anodal tDCS Drives Circuit-Specific Cortical Plasticity. Cerebral Cortex, 28, 1132-1140.
https://doi.org/10.1093/cercor/bhx021
