Objective

Transcortical direct current stimulation (tDCS) is an emerging technique in the rehabilitation of hemiplegic patients after stroke, and has been mainly evaluated for the upper limb. The feasibility and tolerance of the use of repeated stimulations on the lower limb motor cortex require a clinical evaluation.

Observations

A 72-year-old patient, who suffered from a first ischemic stroke in the left middle cerebral artery area, on July 2015, was admitted, 6 months post-stroke, to the PRM outpatient clinic of the university hospital of Saint-Étienne, for a motor training program combined with iterative tDCS stimulations. She suffered from an initially complete sensor-motor right hemiplegia with facial paralysis, without aphasia and apraxia. Six months post-stroke, she still presented a right hemiparesis, grade 4 on the MRC scale, a short walking distance and a debilitating fatigue.

The motor training program is close to an aerobic training program, with 18 sessions 3 times a week over 6 weeks. Each session is composed of 20 min of cycloergometer interval-training followed by 20 min walking on a treadmill with a body-weight support system. During the initial 20 min of each session, the patient received a 2 mA anodal tDCS over the lower limb ipsilesional motor area. The anodal electrode was positioned on the hotspot previously identified with TMS. The cathode was placed above the contralesional orbit. Exercise capacity evaluation and checking for exercise contraindications were performed during a maximal exercise test.

The walking performance was evaluated with the 6-minute-walking-test (6MWT) before, during and after the rehabilitation program.

Discussion – Conclusion

The patient went through the entire rehabilitation program with no significant side-effects. The 6MWT showed a clear improvement 23% (+79 m). This example illustrates the feasibility and the good tolerance of the motor training program combined with iterative tDCS. The feasibility and tolerance will be confirmed with a series of case prior to a clinical controlled study.