Transcranial direct current stimulation linked to improved object naming post-stroke

1. In this randomized trial of patients with aphasia, use of anodal transcranial direct current stimulation (A-tDCS) demonstrated improved object naming compared to sham procedure.

2. Further study in the use of A-tDCS for aphasia recovery post-stroke may be warranted.

Evidence Rating Level: 2 (Good)          

Study Rundown: Aphasia remains a significant source of morbidity following stroke. Behavioral aphasia treatment has proven benefit in improving speech but major deficits still remain. The use of anodal transcranial direct current stimulation (A-tDCS) has been suggested to increase cortical activity. The current study is a double-blinded, sham controlled randomized trial that evaluated the use of A-tDCS with a futility design. The use of A-tDCS in patient undergoing speech therapy for stroke-related aphasia demonstrated increased performance in assessment of object naming.

The main take-away from the results of this study is that further investigation into use of A-tDCS for aphasia is not futile. The main strength of the study is its rigorous, blinded, and shame-controlled design. The main limitations include the small sample size that could not confirm superiority of A-tDCS, and the end point reflecting performance on testing scores but not data on quality of life or real-world functional status.

Click to read the study in JAMA Neurology

Relevant Reading: Bilateral Transcranial Direct Current Stimulation Language Treatment Enhances Functional Connectivity in the Left Hemisphere: Preliminary Data from Aphasia

In-Depth [randomized controlled trial]: This study is a sham-controlled, randomized trial powered as a futility trial. Participants were those with single-event ischemia stroke in the left hemisphere, more than 6 months post-stroke, between the ages of 25 and 80, right-handed, no contra-indications to MRI, have a diagnosis of aphasia (by Western Aphasia Battery- Revised criteria), and achieved 65% accuracy on screening aphasia treatment testing. A-tDCS and sham procedure were combined with standard outpatient speech therapy. Primary outcome was change in object naming accuracy.

For the 74 patients included in the trial the increase from baseline naming was greater for the A-tDCS (13.9 (2.4) words, 95%CI, 9.0-18.7), than the sham procedure (8.2 (2.2) words (95%CI, 3.8-12.6). This increase represented a 70% relative increase for the A-tDCS group compared to the sham group.

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