Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series

Author(s)

Valiengo, Leandro ^{[1, 2, 3, 4, 5, 6]} ; Casati, Roberta ^{[2, 3, 4, 7, 5]} ; Bolognini, Nadia ^{[7, 8]} ; Lotufo, Paulo A. ^{[3, 4]} ; Bensenor, Isabela M. ^{[3, 4]} ; Goulart, Alessandra C. ^{[3, 4]} ; Brunoni, Andre R. ^{[1, 2, 3, 4, 5, 6]}

Affiliation

^[1] Univ Sao Paulo, Inst Psychiat, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Inst Psychiat, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Univ Hosp, Ctr Clin & Epidemiol Res, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Univ Hosp, Interdisciplinary Ctr Appl Neuromodulat CINA, Sao Paulo - Brazil

^[5] Univ Sao Paulo, Fac Med, Dept Psychiat, Serv Interdisciplinary Neuromodulat, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Dept Psychiat, Lab Neurosci LIM27, Sao Paulo - Brazil

^[7] Univ Milano Bicocca, Dept Psychol, Milan - Italy

^[8] IRCCS Ist Auxol Italiano, Neuropsychol Lab, Milan - Italy

• Document type: Journal article
• Source: NEUROCASE; v. 22, n. 2, p. 225-228, MAR 3 2016.
• Web of Science Citations: 6

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. (AU)

• FAPESP's process: 12/20911-5 - Escitalopram and transcranial direct current stimulation in major depressive disorder: a double blind, placebo-controlled, randomized, non-inferiority trial
• Grantee: Andre Russowsky Brunoni
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 11/22872-4 - Treatment of major depressive disorder post stroke with transcranial direct corrent stimulation (TDCS): randomized, double-blind, clinical trial
• Grantee: Alessandra Carvalho Goulart
• Support Opportunities: Regular Research Grants