High Definition Cathodal transcranial direct current stimulation successful for Acute Ischemic Stroke

New research revealed that High-definition cathodal direct current stimulation (HD C-tDCS) is a feasible and tolerable treatment for acute ischemic stroke (AIS) patients ineligible for reperfusion treatment. There were beneficial effects on penumbral salvage, hypoperfusion region, and quantified relative cerebral blood volume (qrCBV). The trial results were published in JAMA Network Open.

Acute ischemic stroke (AIS) is the leading cause of death and disability globally. Present treatment options are restricted to reperfusion therapies: intravenous thrombolysis and endovascular thrombectomy. Due to a relatively low outcome rate, additional therapies have been developed. Past literature showed the preclinical models of cathodal transcranial direct current stimulation (C-tDCS) providing neuroprotection for acute ischemic stroke (AIS) by inhibiting peri-infarct excitotoxic effects and enhancing collateral perfusion due to its vasodilatory properties. Hence researchers conducted a randomized clinical trial to report the first-in-human pilot study using individualized high-definition (HD) C-tDCS as a treatment of AIS.

The trial was sham-controlled with a 3 + 3 dose escalation design, was conducted at a single center from October 2018 to July 2021, and participants were followed for 90 days. The inclusion criteria were those treated for AIS within 24 hours from the onset, had imaging evidence of cortical ischemia with salvageable penumbra, and were ineligible for reperfusion therapies. HD C-tDCS electrode montage was selected for each patient to deliver the electric current to the ischemic region only. There were 3 Primary outcomes: