Trans-Spinal Direct Current Stimulation in Neurological Disorders: A systematic review

Abstract

Background and Purpose: Trans-spinal direct current stimulation (tsDCS) is a noninvasive stimulation technique that applies direct current stimulation over spinal levels. However, the effectiveness and feasibility of this stimulation are still unclear. This systematic review summarizes the effectiveness of tsDCS in clinical and neurophysiological outcomes in neurological patients, as well as its feasibility and safety. Methods: The search was conducted using the following databases: PEDro, Scopus, Web of Science, CINAHL, SPORTDiscus, and PubMed. The inclusion criteria were: Participants: people with central nervous system diseases; Interventions: tsDCS alone or in combination with locomotion training; Comparators: sham tsDCS, transcranial direct current stimulation, or locomotion training; Outcomes: clinical and neurophysiological measures; and Studies: randomized clinical trials. Results: Eight studies with a total of 143 subjects were included. Anodal tsDCS led to a reduction in hypertonia, neuropathic pain intensity, and balance deficits in people with hereditary spastic paraplegia, multiple sclerosis, and primary orthostatic tremor, respectively. In contrast, cathodal tsDCS only had positive effects on balance and tremor in people with primary orthostatic tremor. No severe adverse effects were reported during and after anodal or cathodal tsDCS. Discussion and Conclusions: Although certain studies have found an effect of anodal tsDCS on specific clinical outcomes in people with central nervous system diseases, its effectiveness cannot be established since these findings have not been replicated and the results were heterogeneous. This stimulation was feasible and safe to apply. Further studies are needed to replicate the obtained results of tsDCS when applied in populations with neurological diseases. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at http://links.lww.com/JNPT/A456).