Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review

Ana Luiza Zaninotto, Mirret M El-Hagrassy, Jordan R Green, Maíra Babo, Vanessa Maria Paglioni, Glaucia Guerra Benute, Wellingson Silva Paiva, Ana Luiza Zaninotto, Mirret M El-Hagrassy, Jordan R Green, Maíra Babo, Vanessa Maria Paglioni, Glaucia Guerra Benute, Wellingson Silva Paiva

Abstract

Traumatic brain injury (TBI) is a major cause of chronic disability. Less than a quarter of moderate and severe TBI patients improved in their cognition within 5 years. Non-invasive brain stimulation, including transcranial direct current stimulation (tDCS), may help neurorehabilitation by boosting adaptive neuroplasticity and reducing pathological sequelae following TBI.

Methods: we searched MEDLINE/PubMed and Web of Science databases. We used Jadad scale to assess methodological assumptions.

Results: the 14 papers included reported different study designs; 2 studies were open-label, 9 were crossover randomized clinical trials (RCTs), and 3 were parallel group RCTs. Most studies used anodal tDCS of the left dorsolateral prefrontal cortex, but montages and stimulation parameters varied. Multiple studies showed improved coma recovery scales in disorders of consciousness, and improved cognition on neuropsychological assessments. Some studies showed changes in neurophysiologic measures (electroencephalography (EEG) and transcranial magnetic stimulation (TMS), correlating with clinical findings. The main methodological biases were lack of blinding and randomization reports.

Conclusion: tDCS is a safe, non-invasive neuromodulatory technique that can be given as monotherapy but may be best combined with other therapeutic strategies (such as cognitive rehabilitation and physical therapy) to further improve clinical cognitive and motor outcomes. EEG and TMS may help guide research due to their roles as biomarkers for neuroplasticity.

Keywords: neuronal plasticity; non-invasive brain stimulation; rehabilitation; transcranial direct current stimulation; traumatic brain injury.

Conflict of interest statement

Disclosure: The authors report no conflicts of interest.

Figures

Figure 1. Flow diagram following Prisma Statement.
Figure 1. Flow diagram following Prisma Statement.

References

    1. Bruns J, Jr, Hauser WA. The epidemiology of traumatic brain injury: a review. Epilepsia. 2003;44(s10):2–10.
    1. de Almeida CER, de Sousa JL, Dourado JC, Gontijo PAM, Dellaretti MA, Costa BS. Traumatic Brain Injury Epidemiology in Brazil. World Neurosurgery. 2016;87:540–547.
    1. Bramley H, Hong J, Zacko C, Royer C, Silvis M. Mild Traumatic Brain Injury and Post-concussion Syndrome: Treatment and Related Sequela for Persistent Symptomatic Disease. Sports Med Arthrosc Rev. 2016;24(3):123–129.
    1. Lima DPD, Simao C, Abib SDV, de Figueiredo LFP. Quality of life and neuropsychological changes in mild head trauma - Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission. Injury. 2008;39(5):604–611.
    1. Feltrin FS, Zaninotto AL, Guirado VMP, Macruz F, Sakuno D, Dalaqua M. Longitudinal changes in brain volumetry and cognitive functions after moderate and severe diffuse axonal injury. Brain Inj. 2018;32(10):1208–1217.
    1. Sozda CN, Muir JJ, Springer US, Partovi D, Cole MA. Differential Learning and Memory Performance in OEF/OIF Veterans for Verbal and Visual Material. Neuropsychology. 2014;28(3):347–352.
    1. Levin HS. Memory deficit after closed-head injury. J Clin Exp Neuropsychol. 1990;12(1):129–153.
    1. Tam SF, Man WK. Evaluating computer-assisted memory retraining programmes for people with post-head injury amnesia. Brain Inj. 2004;18(5):461–470.
    1. Kim HJ, Burke DT, Dowds MM, George J. Utility of a microcomputer as an external memory aid for a memory-impaired head injury patient during in-patient rehabilitation. Brain Inj. 1999;13(2):147–150.
    1. Kelly JP. Traumatic brain injury and concussion in sports. JAMA. 1999;282(10):989–991.
    1. Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Society. 2010;16(3):401–411.
    1. Godefroy O. Frontal syndrome and disorders of executive functions. J Neurol. 2003;250(1):1–6.
    1. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. 5 ed. New York, NY: Oxford University Press; 2012.
    1. Costa TL, Zaninotto ALC, Benute GG, De Lucia MCS, Paiva WS, Wagemans J. Perceptual organization deficits in traumatic brain injury patients. Neuropsychologia. 2015;78:142–152.
    1. Zaninotto AL, de Paula Guirado VM, Baldivia B, Nunes MD, Oliveira Amorim RL, Teixeira MJ, et al. Improvement of verbal fluency in patients with diffuse brain injury over time. Neuropsychiatr Dis Treat. 2014;10:1155–1160.
    1. Zaninotto AL, Vicentini JE, Solla DJ, Silva TT, Guirado VM, Feltrin F. Visuospatial memory improvement in patients with diffuse axonal injury (DAI): a 1-year follow-up study. Acta Neuropsychiatr. 2017;29(1):35–42.
    1. Schacter LD, Glisky EL, McGlynn SM. The Neuropsychology of Everyday Life: Assessment and Basic Competencies. Boston: Martinus Nijhoff; 1990. pp. 231–257.
    1. Hoofien D, Gilboa A, Vakil E, Donovick PJ. Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Inj. 2001;15(3):189–209.
    1. Whiteneck GG, Eagye C, Cuthbert JP, Corrigan JD, Bell JM, et al. One and Five Year Outcomes After Moderate-to-Severe Traumatic Brain Injury Requiring Inpatient Rehabilitation: U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Injury Prevention and Control Administration for Community Living (ACL) National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) 2018. [Available from: .
    1. Cognitive Rehabilitation Therapy for Traumatic Brain Injury: Evaluating the Evidence.
    1. Villamar MF, Portilla AS, Fregni F, Zafonte R. Noninvasive Brain Stimulation to Modulate Neuroplasticity in Traumatic Brain Injury. Neuromodulation. 2012;15(4):326–338.
    1. Li SS, Zaninotto AL, Neville IS, Paiva WS, Nunn D, Fregni F. Clinical utility of brain stimulation modalities following traumatic brain injury current evidence. Neuropsychiatr Dis Treat. 2015;11:1573–1586.
    1. Pascual-Leone A, Amedi A, Fregni F, Merabet LB. The plastic human brain cortex. Ann Rev Neurosci. 2005;28:377–401.
    1. Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A. Transcranial direct current stimulation: State of the art 2008. Brain Stimul. 2008;1(3):206–223.
    1. Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS) Clin Neurophysiol. 2017;128(1):56–92.
    1. Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol. 2003;114(11):2220–2222.
    1. Miniussi C, Ruzzoli M. Transcranial stimulation and cognition. Hand Clin Neurol. 2013;116:739–750.
    1. Miniussi C, Harris JA, Ruzzoli M. Modelling non-invasive brain stimulation in cognitive neuroscience. Neurosci Biobehav Rev. 2013;37(8):1702–1712.
    1. Antal A, Nitsche MA, Kruse W, Kincses TZ, Hoffmann KP, Paulus W. Direct current stimulation over V5 enhances visuomotor coordination by improving motion perception in humans. J Cogn Neurosci. 2004;16(4):521–527.
    1. Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016;9(5):641–661.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.
    1. O'Neil-Pirozzi TM, Doruk D, Thomson JM, Fregni F. Immediate memory and electrophysiologic effects of prefrontal cortex transcranial direct current stimulation on neurotypical individuals and individuals with chronic traumatic brain injury: a pilot study. Int J Neurosci. 2017;127(7):592–600.
    1. Angelakis E, Liouta E, Andreadis N, Korfias S, Ktonas P, Stranjalis G. Transcranial Direct Current Stimulation Effects in Disorders of Consciousness. Arch Phys Med Rehabil. 2014;95(2):283–289.
    1. Middleton A, Fritz SL, Liuzzo DM, Newman-Norlund R, Herter TM. Using clinical and robotic assessment tools to examine the feasibility of pairing tDCS with upper extremity physical therapy in patients with stroke and TBI A consideration-of-concept pilot study. Neurorehabilitation. 2014;35(4):741–754.
    1. Martens G, Lejeune N, O'Brien AT, Fregni F, Martial C, Wannez S, et al. Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state. Brain Stimul. 2018;11(5):982–990.
    1. Estraneo A, Pascarella A, Moretta P, Masotta O, Fiorenza S, Chirico G. Repeated transcranial direct current stimulation in prolonged disorders of consciousness: A double-blind cross-over study. J Neurol Sci. 2017;375:464–470.
    1. Thibaut A, Bruno M-A, Ledoux D, Demertzi A, Laureys S. tDCS in patients with disorders of consciousness. Neurology. 2014;82(13):1112–1118.
    1. Thibaut A, Wannez S, Donneau AF, Chatelle C, Gosseries O, Bruno MA. Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state. Brain Inj. 2017;31(4):466–474.
    1. Bai Y, Xia XY, Kang JN, Yang Y, He JH, Li XL. TDCS modulates cortical excitability in patients with disorders of consciousness. Neuroimage Clin. 2017;15:702–709.
    1. Kang EK, Kim DY, Paik NJ. Transcranial direct current stimulation of the left prefrontal cortex improves attention in patients with traumatic brain injury: a pilot study. J Rehabil Med. 2012;44(4):346–350.
    1. Wilke S, List J, Mekle R, Lindenberg R, Bukowski M, Ott S. No Effect of Anodal Transcranial Direct Current Stimulation on Gamma-Aminobutyric Acid Levels in Patients with Recurrent Mild Traumatic Brain Injury. J Neurotrauma. 2017;34(2):281–290.
    1. Naro A, Calabro RS, Russo M, Leo A, Pollicino P, Quartarone A. Can transcranial direct current stimulation be useful in differentiating unresponsive wakefulness syndrome from minimally conscious state patients? Restor Neurol Neurosci. 2015;33(2):159–176.
    1. Ulam F, Shelton C, Richards L, Davis L, Hunter B, Fregni F. Cumulative effects of transcranial direct current stimulation on EEG oscillations and attention/working memory during subacute neurorehabilitation of traumatic brain injury. Clin Neurophysiol. 2015;126(3):486–496.
    1. Sacco K, Galetto V, Dimitri D, Geda E, Perotti F, Zettin M, et al. Concomitant Use of Transcranial Direct Current Stimulation and Computer-Assisted Training for the Rehabilitation of Attention in Traumatic Brain Injured Patients: Behavioral and Neuroimaging Results. Front Behav Neurosci. 2016;10:57–57.
    1. Lesniak M, Polanowska K, Seniow J, Czlonkowska A. Effects of Repeated Anodal tDCS Coupled With Cognitive Training for Patients With Severe Traumatic Brain Injury: A Pilot Randomized Controlled Trial. J Head Trauma Rehabil. 2014;29(3):E20–EE9.
    1. Pagulayan KF, Temkin NR, Machamer J, Dikmen SS. A longitudinal study of health-related quality of life after traumatic brain injury. Arch Phys Med Rehabil. 2006;87(5):611–618.
    1. Rogers L. Transcranial Direct Current Stimulation (tDCS): Emerging Uses, Safety and Neurobiological Effects. Neuroscience research progression series: Nova Science Publishers, Incorporated. 2016:104–104.
    1. Menon P, Geevasinga N, Yiannikas C, Howells J, Kiernan MC, Vucic S. Sensitivity and specificity of threshold tracking transcranial magnetic stimulation for diagnosis of amyotrophic lateral sclerosis: a prospective study. Lancet Neurol. 2015;14(5):478–484.
    1. Schmitt S, Dichter MA. Electrophysiologic recordings in traumatic brain injury. Hand Clin Neurol. 2015;127:319–339.
    1. Tolonen A, Sarkela MOK, Takala RSK, Katila A, Frantzen J, Posti JP. Quantitative EEG Parameters for Prediction of Outcome in Severe Traumatic Brain Injury: Development Study. Clin EEG Neurosci. 2018;49(4):248–257.
    1. Benbadis S. Focal disturbances of brain function. In: Levin KH, Luders HO, editors. Comprehensive Clinical Neurophysiology. Philadelphia, PA: Saunders; 2000. pp. 457–467.

Source: PubMed

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