title: Immediate and late modulation of interhemipheric imbalance with bilateral transcranial direct current stimulation in acute stroke.
abstract: BACKGROUND
  Significant changes in neurophysiological and clinical outcomes in chronic stroke had been reported after tDCS; but there is a paucity of data in acute stroke.
  
  
  OBJECTIVE
  We aimed to evaluate whether a tDCS-induced modulation of primary motor cortex excitability in patients with acute stroke enhances motor recovery associated with rehabilitation and induces differential neuroplasticity.
  
  
  METHODS
  We conducted two experiments in acute stroke patients. In experiment 1 (14 patients), we tested the immediate effects of bilateral tDCS alone as compared to sham tDCS on recovery. Experiment 2 (20 patients) was designed to assess effects of bilateral tDCS delivered together with constraint-induced movement therapy (CIMT). In this experiment, we included a longer follow-up (3 months) and measured, in addition to the same clinical outcomes of experiment 1, changes of motor cortex excitability and the amount of promoted LTP-like activity.
  
  
  RESULTS
  Despite the expected improvement at 1 week, none of the clinical measures showed any different modulation in dependence of CIMT and tDCS. On the neurophysiological assessments, on the other hand, the Real_tDCS group, compared to Sham_tDCS group, showed a reduction of inter-hemispheric imbalance when considering the differences of motor evoked potential between both 3-month and 1 week follow up (P = 0.007) and three month and baseline (P = 0.015).
  
  
  CONCLUSIONS
  Despite the lack of additional clinical changes, real bilateral tDCS, together with CIMT, significantly reduces inter-hemispheric imbalance between affected and unaffected hemispheres. These findings may shed light on plasticity changes in acute stroke and its potential impact in chronic phases.
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy. Electronic address: v.dilazzaro@unicampus.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.affiliation: Neuroscience Department, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Dileone
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Fioravante
authors.initials: F
authors.lastname: Capone
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellegrino
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Ranieri
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Florio
authors.affiliation: Institute of Neurology, Campus Bio-Medico University, Rome, Italy; Fondazione Alberto Sordi - Research Institute for Ageing, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Pino
authors.affiliation: Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D019054:Evoked Potentials, Motor / Q000502:physiology; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation; D050781:Transcranial Magnetic Stimulation
keywords: Acute stroke; Recovery; Transcranial direct current stimulation; Transcranial magnetic stimulation