Transcranial direct current stimulation is safe and feasible in hyperacute ischemic stroke (DICAST-SF trial)

Area of Science:

• Neurology
• Neuroscience
• Medical Devices

Background:

• Ischemic stroke requires urgent neuroprotection in the hyperacute phase.
• Cathodal transcranial direct current stimulation (C-tDCS) is a potential neuroprotective intervention.
• Assessing C-tDCS in stroke patients with salvageable penumbra is crucial.

Purpose of the Study:

• To evaluate the safety, tolerability, and feasibility of C-tDCS.
• To explore the potential efficacy of C-tDCS in acute ischemic stroke.
• To determine C-tDCS parameters in a dose-escalation trial.

Main Methods:

• A double-blind, randomized, sham-controlled, dose-escalation trial (DICAST-SF).
• Inclusion of stroke patients with internal carotid/middle cerebral artery occlusion, within 24h, and salvageable penumbra.
• Application of C-tDCS over the affected primary motor cortex at six dose tiers.

Main Results:

• No symptomatic intracranial hemorrhage (SICH) occurred in the active C-tDCS group.
• C-tDCS was well-tolerated and feasible, with a median randomization-to-stimulation start time of 8 minutes.
• Asymptomatic intracranial hemorrhage (AICH) and other adverse events were comparable between active and sham groups.

Conclusions:

• C-tDCS is a safe, well-tolerated, and feasible treatment for hyperacute ischemic stroke.
• The findings support further investigation of C-tDCS in larger clinical trials for stroke efficacy.
• C-tDCS demonstrates promise as a neuroprotective strategy in acute stroke management.