Different Therapeutic Effects of Transcranial Direct Current Stimulation on Upper and Lower Limb Recovery of Stroke Patients with Motor Dysfunction: A Meta-Analysis

Objective. To explore the effects of transcranial direct current stimulation (tDCS) on the motor recovery of stroke patients and the effect differences between the upper limb and lower limb. Methods. Randomized control trials published until January 2019 were searched from PubMed, Embase, ScienceDirect, and Cochrane Library databases. The standardized mean difference (SMD) with 95% confidence interval (CI) was estimated separately for upper and lower limb motor outcomes to understand the mean effect size. Results. Twenty-nine studies with 664 subjects were included in this meta-analysis. The overall analyses of tDCS demonstrated significant effect size both for the upper limb (SMD=0.26, P=0.002) and the lower limb (SMD=0.47, P=0.002). Compared with acute and subacute stroke patients, chronic stroke patients obtained significant effects after tDCS (SMD=0.25, P=0.03) in upper limb function. Furthermore, both anode and cathode stimulations produced significant effect size for stroke patients after <= 10 sessions of tDCS (anode: SMD=0.40, P=0.001; cathode: SMD=0.79, P<0.0001) with >0.029 mA/cm(2) of density (anode: SMD=0.46, P=0.002; cathode: SMD=0.79, P<0.0001). But for lower limb function, more prominent effects were found in subacute stroke patients (SMD=0.56, P=0.001) with bilateral tDCS (SMD=0.59, p=0.009). Conclusion. tDCS is effective for the recovery of stroke patients with motor dysfunction. In addition, upper limb and lower limb functions obtain distinct effects from different therapeutic parameters of tDCS at different stages, respectively.