Application of Transcranial Direct Current Stimulation in Neurocritical Care
Abstract
Background: Transcranial direct current stimulation (tDCS) is an emerging, non-invasive neuromodulation technique with massive potential in neurocritical care settings. This review covers the applications, mechanisms, and outcomes of tDCS in patients with severe neurological disorders.
Methods: tDCS uses low-intensity direct current to modulate cortical excitability and induce neuroplasticity, which aids in recovering motor, cognitive, and sensory functions. Its simplicity and noninvasive nature enable bedside use, making it a good alternative to invasive interventions.
Results: The evidence suggests that tDCS improves recovery in stroke, TBI, and DOC by affecting synaptic plasticity, releasing neurotrophic factors, and improving cerebral perfusion. However, due to the variability in the methodology and stimulation parameters of the studies, further research is required to determine standardized protocols. Safety appears minimal, with most side effects including mild discomfort.
Conclusion: This review underlines the promise of tDCS as an adjunctive therapy in neurocritical care and recommends its integration into traditional rehabilitative strategies to enhance patient outcomes. Future studies should investigate optimizing stimulation parameters, long-term efficacy, and condition-specific applications to exploit tDCS's therapeutic benefits.
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[5] Tao M, Zhang S, Han Y, Li C, Wei Q, Chen D, et al. Efficacy of transcranial direct current stimulation on postoperative delirium in elderly patients undergoing lower limb major arthroplasty: A randomized controlled trial. Brain Stimul. 2023; 16(1):88-96.
[6] Siegert A, Diedrich L, Antal A. New Methods, Old Brains-A Systematic Review on the Effects of tDCS on the Cognition of Elderly People. Front Hum Neurosci. 2021; 15:730134.
[7] Majdi A, van Boekholdt L, Sadigh-Eteghad S, Mc Laughlin M. A systematic review and meta-analysis of transcranial direct-current stimulation effects on cognitive function in patients with Alzheimer's disease. Mol Psychiatry. 2022; 27(4):2000-2009.
[8] Suchting R, Teixeira AL, Ahn B, Colpo GD, Park J, Ahn H. Changes in Brain-derived Neurotrophic Factor From Active and Sham Transcranial Direct Current Stimulation in Older Adults With Knee Osteoarthritis. Clin J Pain. 2021; 37(12):898-903.
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[11] Woods AJ, Antal A, Bikson M, Boggio PS, Brunoni AR, Celnik P, et al. A technical guide to tDCS, and related non-invasive brain stimulation tools. Clin Neurophysiol. 2016; 127(2):1031-1048.
[12] Tanaka T, Isomura Y, Kobayashi K, Hanakawa T, Tanaka S, Honda M. Electrophysiological Effects of Transcranial Direct Current Stimulation on Neural Activity in the Rat Motor Cortex. Front Neurosci. 2020; 14:495.
[13] Thibaut A, Bruno MA, Ledoux D, Demertzi A, Laureys S. tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology. 2014; 82(13):1112-8.
[14] Schlaug G, Renga V, Nair D. Transcranial direct current stimulation in stroke recovery. Arch Neurol. 2008; 65(12):1571-6.
[15] Nitsche MA, Paulus W. Transcranial direct current stimulation--update 2011. Restor Neurol Neurosci. 2011; 29(6):463-92.
[16] Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017; 128(1):56-92.
[17] Huang J, Zhao K, Zhao Z, Qu Y. Neuroprotection by Transcranial Direct Current Stimulation in Rodent Models of Focal Ischemic Stroke: A Meta-Analysis. Front Neurosci. 2021; 15:761971.
[18] Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007; 33(11):1876-91.
[19] Hiser SL, Fatima A, Ali M, et al. Post-intensive care syndrome (PICS): recent updates. J Intensive Care. 2023; 11:23.
[20] Frisvold S, Coppola S, Ehrmann S, Chiumello D, Guérin C. Respiratory challenges and ventilatory management in different types of acute brain-injured patients. Crit Care. 2023; 27(1):247.
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[23] Faria P, Hallett M, Miranda PC. A finite element analysis of the effect of electrode area and inter-electrode distance on the spatial distribution of the current density in tDCS. J Neural Eng. 2011; 8(6):066017.
[24] Minhas P, Bikson M, Woods AJ, Rosen AR, Kessler SK. Transcranial direct current stimulation in pediatric brain: a computational modeling study. Annu Int Conf IEEE Eng Med Biol Soc. 2012; 2012:859-62.
[25] Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000; 527(Pt 3):633-9.
[26] Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, et al. Transcranial direct current stimulation: State of the art 2008. Brain Stimul. 2008; 1(3):206-23.
[27] Costa TL, Lapenta OM, Boggio PS, Ventura DF. Transcranial direct current stimulation as a tool in the study of sensory-perceptual processing. Atten Percept Psychophys. 2015; 77(6):1813-40.
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How to Cite
1.
Hajiesmaeili M, Goharani R, Zangi M, Amirdosara M, Mokhtari M. Application of Transcranial Direct Current Stimulation in Neurocritical Care. Arch Anesth & Crit Care. 2026;.
