Mechanisms underlying transcranial direct current stimulation in rehabilitation

For a few years, the non-invasive modulation of motor cortex has become the centre of much attention because of its possible clinical impact. Among the different mechanism allowing to modify motor-cortex excitability, transcranial direct current stimulation (tDCS), with its efficacy and ease of use, plays a major role. The aim of this review is to improve the understanding of the underlying mechanisms of the tDCS effect in the field of rehabilitation. The mechanisms underlying tDCS effects when applied over the motor cortex differ depending on the polarity used. Moreover, the mechanisms underlying these effects differ during stimulation (per-stimulation) and after the end of it (after-effects). This review highlights the known mechanisms involved in tDCS effects on brain excitability and illustrates that most remain not well understood and debated. Further studies are necessary to elucidate the mode of action of tDCS and determine the best paradigm of stimulation depending on the goals.