Effects of anodal transcranial direct current stimulation over motor cortex on resting-state brain activity in the early subacute stroke phase: A power spectral density analysis

Introduction: Despite promising results, the effects of transcranial direct current stimulation (tDCS) in the early stages of stroke and its impact on brain activity have been poorly studied. Therefore, this study aimed to investigate the effect of tDCS applied over the ipsilesional motor cortex on resting-state brain activity in the early subacute phase of stroke. Methods: This is a pilot, randomized, double-blind, proof-of-concept study. The patients with stroke were randomly assigned into two groups: anodal tDCS (A-tDCS) or sham tDCS (S-tDCS). For A-tDCS, the anode was placed over the ipsilesional motor cortex, while the cathode was placed over the left or right supraorbital area (Fp2 for left stroke or Fp1 for right stroke). For the real stimulation, a constant current of 1.0 mA was delivered for 20 min and then ramped down linearly for 30 s, maintaining a resistance below 10 k Omega. For the sham stimulation, the stimulator was turned on, and the current intensity was gradually increased for 30 s, tapered off over 30 s, and maintained for 30 min without stimulation. Each stimulation was performed for three consecutive sessions with an interval of 1 h between them. The primary outcome was spectral electroencephalography (EEG) analysis based on the Power Spectral Density (PSD) determined by EEG records of areas F3, F4, C3, C4, P3, and P4. Brain Vision Analyzer software processed the signals, EEG power spectral density (PSD) was calculated before and after stimulation, and alpha, beta, delta, and theta power were analyzed. The secondary outcomes included hemodynamic variables based on the difference between baseline (D0) and post-intervention session (D1) values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SPO2). Mann-Whitney test was used to compare position measurements of two independent samples; Fisher's exact test was used to compare two proportions; paired Wilcoxon signed-rank test was used to compare the median differences in the within-group comparison, and Spearman correlations matrix among spectral power analysis between EEG bands was performed to verify consistency of occurrence of oscillations. Statistical significance was set at P < 0.05. Results: An increase in PSD in the alpha frequency in the P4 region was observed after the intervention in the AtDCS group, as compared to the placebo group (before = 6.13; after =10.45; p < 0.05). In the beta frequency, an increase in PSD was observed in P4 (before = 4.40; after = 6.79; p < 0.05) and C4 (before = 4.43; after = 6.94; p < 0.05) after intervention in the A-tDCS group. There was a reduction in PSD at delta frequency in C3 (before = 293.8; after = 58.6; p < 0.05) after intervention in the A-tDCS group. In addition, it was observed a strong relationship between alpha and theta power in the A-tDCS group before and after intervention. However, the sham group showed correlations between more power bands (alpha and theta, alpha and delta, and delta and theta) after intervention. There was no difference in hemodynamic variables between the intra- (before and after stimulation) and inter-groups (mean difference). Conclusion: Anodal tDCS over the ipsilesional motor cortex had significant effects on the brain electrical activity in the early subacute stroke phase, increasing alpha and beta wave activities in sensorimotor regions while reducing slow delta wave activity in motor regions. These findings highlight the potential of anodal tDCS as a therapeutic intervention in the early stroke phase.