Combined taVNS and tDCS in Subacute Stroke Patients
Combining Closed-loop Transcutaneous Auricular Vagus Nerve Stimulation and Focal Transcranial Direct Current Stimulation as an Adjuvant Treatment for Acute and Subacute Strokes
National Cheng-Kung University Hospital
80 participants
Feb 15, 2024
INTERVENTIONAL
Conditions
Summary
Ischemic stroke, the most prevalent neurological disorder, is treated with medication and thrombectomy but with limited success, especially in chronic stages where traditional rehabilitation is the primary option. Stroke often leads to post-stroke autonomic imbalance, deteriorating functional outcomes and increasing recurrence risk. Emerging non-pharmacological treatments like Transcutaneous Auricular Vagus Nerve Stimulation (VNS) and Focused Transcranial Direct Current Stimulation (tDCS) offer new possibilities. VNS targets post-stroke tissue injury and promotes healing and neurogenesis, while tDCS aims to enhance motor learning by rebalancing brain activity. Both therapies seek to improve outcomes in both acute and chronic stroke stages.
Eligibility
Inclusion Criteria7
- Age ≥ 18 years old
- Subacute ischemic stroke patients within 7-30 days after stroke symptoms is stabilized
- Stroke will be documented by DWI-MRI
- Lesion locations at least involve supratentorial area
- Patients have unilateral weakness documented with manual muscle testing scales less than 4
- Stable vital signs and stable neurological signs
- Able to receive regular rehabilitation programs, and 8) modified Rankin Scales (mRS) less than 5.
Exclusion Criteria18
- A National Institute of Health Stroke Scale (NIHSS) score > 25 at study entry
- The presence of hemineglect
- Moderate-to-severe pain in any limb
- Unstable clinical condition
- Recurrent strokes or brainstem strokes
- Marked arrhythmia or cardiovascular complications
- Bradycardia (HR≤50 bpm) or low blood pressure (SBP≤100 mmHg or DBP≤60mmHg) at admission
- Patients with radiographic evidence or suspicion of chronic conditions that may predispose them to intracranial hemorrhage including brain arteriovenous malformations, cerebral cavernous malformations, cerebral telangiectasia, multiple previous intracerebral hemorrhages (amyloid angiopathy)
- Pre-existing coagulopathy, consist of platelet count of ≤100, INR≥ 3, PTT≥ 90
- Patients suspected of having infective endocarditis and ischemic stroke related to septic emboli
- Signs or symptoms of acute myocardial infarction, including EKG findings
- Concomitant experimental therapy
- Suspected cerebral vasculitis based on medical history and CTA/Magnetic Resonance Angiogram (MRA)
- Suspected cranial dural arteriovenous fistula, and evidence of dissection in the intracranial cerebral arteries
- Cerebral venous thrombosis and significant mass effect with midline shift
- History of left atrial myxoma
- Presence of contraindication for VNS (TENS) and tDCS: (A) Intracranial space occupied lesion, (B) Presence of a pacemaker, (C) History of brain neurosurgery, (D) Active CNS or systemic infection, (E) Presence of a metallic foreign body implant, (F) Skin abnormalities, (G) History of alcohol/drug abuse, (H) Epilepsy/History of epilepsy at family (I) Hyperacusis, (J) Cognitive/Consciousness disturbance, (K) Pregnancy or nursing females, (L) Use of neuropsycoactive drugs, (M) Psychiatric/ Neurologic disease
- Not suitable for equipping ECG recorders: (A) Chronic disease, and allergic to polyester, (B) Acute and severe patients
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Interventions
tDCS 1mA will be applied for 20min. tDCS will be applied around the infract area. taVNS or sham taVNS wil be applied before tDCS. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.
taVNS will be applied for 30 min. The electrode will be placed on the left ear of the patient. The amplitude of taVNS will be adjusted under the patient's pain threshold. After taVNS, tDCS will be applied for 20 min. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.
sham tDCS 1mA will be applied for 20min. sham tDCS will be applied around the infract area. The stimulation will be applied for only 10 seconds and no stimulation afterward. taVNS or sham taVNS wil be applied before sham tDCS.The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.
sham taVNS will be applied for 30 min. The electrode will be placed on the left ear of the patient. The amplitude of sham taVNS will be adjusted under the patient's pain threshold. The stimulation was only applied for 5 seconds and no stimulation afterward. After sham taVNS, tDCS or sham tDCS will be applied for 20 min. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT06244914