Charit Universittsmedizin Berlin MSc Medical Neurosciences Richard A.

Dargie Master Thesis 2011 AG Brandt, Klinik fr Neurologie, Charit Campus Mitte, Charit Platz 1, 10117 Berlin, Germany Serial anodal transcranial direct current stimulation in the treatment of chronic post-stroke homonymous visual field defects: a double-blind sham-controlled study. ABSTRACT: Homonymous visual field defects (hVFDs) are a common and highly debilitating consequence of ischaemic stroke, for which there is currently no satisfactory therapy. Recent research has suggested that transcranial direct current stimulation (tDCS) may have therapeutic potential for chronic post-stroke hVFDs. TDCS is a safe, painless, non-invasive brain stimulation technique, which modulates cortical excitability via sub-threshold alteration of the neuronal membrane potential. Anodal tDCS over the occipital cortex has recently been shown to induce significant long-term (28 day) increases in contrast sensitivity when compared to sham tDCS in healthy subjects. This study is the first to apply tDCS to a visual disorder: 12 patients with chronic (>6 months) post-stroke hVFDs (hemianopia or quadrantanopia) participated in a within-subject, sham-controlled, double-blind study. MRI-registered anodal tDCS or sham tDCS was applied on five consecutive days. Automatic threshold perimetry (2-10 SITA in Humphrey Visual Field Analyzer) and campimetric tests of colour, movement and form perception were conducted before and after stimulation each day, and at day 19 and 33. After a one-month interval, this procedure was repeated with the second condition (anodal or sham). We report a statistically significant increase in contrast sensitivity (specifically an enlargement of the functional visual field), in campimetric test performance (specifically in colour and movement perception) and in subjective vision after anodal tDCS compared to sham tDCS. This paper also presents pre-study criteria that significantly predicted outcome success (multifocal VEP characteristics, lesion size and location). These encouraging results prompt larger clinical trials into tDCS for chronic post-stroke hVFDs.

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