title: Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series.
abstract: Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.|b Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry , Faculty of Medicine of University of São Paulo , São Paulo , Brazil.|c Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry , University of São Paulo , São Paulo , Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Valiengo
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.|b Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry , Faculty of Medicine of University of São Paulo , São Paulo , Brazil.|d Department of Psychology , University of Milano-Bicocca , Milan , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Casati
authors.affiliation: d Department of Psychology , University of Milano-Bicocca , Milan , Italy.|e Laboratory of Neuropsychology , IRCCS Istituto Auxologico Italiano , Milan , Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bolognini
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: a Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA) , University Hospital, University of São Paulo , São Paulo , Brazil.|b Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry , Faculty of Medicine of University of São Paulo , São Paulo , Brazil.|c Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry , University of São Paulo , São Paulo , Brazil.
authors.forename: André R
authors.initials: AR
authors.lastname: Brunoni
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001037:Aphasia / Q000209:etiology*; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D020521:Stroke / Q000150:complications*; D011795:Surveys and Questionnaires; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Post-stroke depression; aphasia; noninvasive brain stimulation; stroke; tDCS