Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial

Robson Luis Oliveira de Amorim, André Russowsky Brunoni, Mirian Akiko Furutani de Oliveira, Ana Luiza Costa Zaninotto, Marcia Mitie Nagumo, Vinícius Monteiro de Paula Guirado, Iuri Santana Neville, Gláucia Rosana Guerra Benute, Mara Cristina Souza de Lucia, Wellingson Silva Paiva, Almir Ferreira de Andrade, Manoel Jacobsen Teixeira, Robson Luis Oliveira de Amorim, André Russowsky Brunoni, Mirian Akiko Furutani de Oliveira, Ana Luiza Costa Zaninotto, Marcia Mitie Nagumo, Vinícius Monteiro de Paula Guirado, Iuri Santana Neville, Gláucia Rosana Guerra Benute, Mara Cristina Souza de Lucia, Wellingson Silva Paiva, Almir Ferreira de Andrade, Manoel Jacobsen Teixeira

Abstract

Background: Mild traumatic brain injury (MTBI) represents 70-80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI.

Methods/design: This is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement.

Discussion: There is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction.

Clinical trial registration: www.ClinicalTrials.gov, identifier NCT02292589 (https://register.clinicaltrials.gov).

Keywords: brain injuries; crossover studies; non-invasive brain stimulation; post-concussion syndrome; transcranial direct current stimulation.

Figures

Figure 1
Figure 1
Fluxogram of the study.

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