From the Guidelines
Transcranial direct current stimulation (tDCS) is currently indicated as an adjunct to upper extremity therapy in stroke rehabilitation, with an evidence level of A, as stated in the Canadian Stroke Best Practice Recommendations 1.
Clinical Indications
While tDCS has shown promising results in research settings for conditions such as depression, chronic pain, and certain cognitive disorders, the evidence is still considered preliminary and insufficient to establish it as a standard treatment option for these conditions. Some key points to consider:
- The mechanism of tDCS involves applying weak electrical currents to specific brain regions to modulate neuronal activity, potentially enhancing neuroplasticity and altering cortical excitability.
- Optimal stimulation parameters, treatment protocols, and patient selection criteria have not been standardized, which limits its clinical implementation.
- Patients interested in tDCS should be aware that commercial devices marketed for home use lack regulatory oversight, and treatment should ideally be pursued under clinical supervision within research protocols or specialized centers familiar with neuromodulation techniques.
Research and Evidence
Recent studies, such as those published in 2019 1, 1, provide insight into the potential applications of tDCS in various fields, including addiction medicine and obsessive-compulsive disorder. However, as noted in a 2021 review 1, the current evidence for the use of tDCS in cognitive deficits is conflicting and limited by small sample sizes, highlighting the need for further research to establish its clinical efficacy.
Clinical Practice
In clinical practice, tDCS may be considered as an adjunctive therapy for certain conditions, but its use should be approached with caution and ideally pursued under clinical supervision. The lack of standardization in treatment protocols and patient selection criteria underscores the importance of careful consideration and monitoring in the use of tDCS. Ultimately, the decision to use tDCS should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Current Indications for tDCS
- tDCS is currently being investigated for the treatment of various clinical conditions, including depression, with some studies suggesting its efficacy in reducing depressive symptoms 2, 3, 4.
- The evidence-based guidelines on the therapeutic use of tDCS propose a Level B recommendation (probable efficacy) for the use of anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) in major depressive episode without drug resistance 5.
- However, the guidelines also propose a Level B recommendation (probable inefficacy) for the use of anodal tDCS of the left DLPFC in drug-resistant major depressive episode 5.
Conditions with Possible Efficacy
- Fibromyalgia: anodal tDCS of the left primary motor cortex (M1) may be effective in reducing pain symptoms 5.
- Addiction/craving: anodal tDCS of the right DLPFC may be effective in reducing craving symptoms 5.
- Chronic lower limb neuropathic pain secondary to spinal cord lesion: anodal tDCS of the left M1 may be effective in reducing pain symptoms 5.