Feasibility of Multi-Session tDCS in Rehabilitating Post-Stroke Hemispatial Neglect

Background: Transcranial direct current stimulation (tDCS) has been proposed as a low-cost method of rehabilitating a range of disorders. At present there is little robust evidence with which to assess its effectiveness, mainly due to low patient recruitment rates. Smit et al., (2015) concluded that it is unfeasible to use tDCS to rehabilitate hemispatial neglect after stroke, due to the high incidence of tDCS-related exclusion criteria in this population (e.g. epilepsy). Objective: To assess the feasibility of a multi-session tDCS trial in post-stroke hemispatial neglect, by recruiting prospectively from a large hyper-acute receiving hospital. Method: Stroke patients admitted to the Queen Elizabeth University Hospital, Glasgow were screened between September 2015 and March 2017. They were considered for inclusion if neglect was medically diagnosed or screened for separately. Eligible patients were randomised into 1 of 4 groups, receiving 10 sessions of either 1) tDCS, 2) Behavioural training, 3) Combined tDCS & behavioural training or 4) A control behavioural training protocol. Results: Of 2013 admissions in the study period, 166 patients had hemispatial neglect, and 10.8% (18 patients) were randomised. We excluded 89.2% (148), mainly due to medical/cognitive comorbidities. Few (8.4%) failed tDCS safety criteria. Some patients were lost after randomisation: 1 failed to tolerate tDCS, 2 withdrew pre-intervention, 2 died and 2 did not respond to contact at the 6-month follow-up. Conclusion: This is an interim review of an on-going trial which indicates that ten percent of neglect patients can be successfully recruited for a rehabilitation trial that includes multi-session tDCS