Transcranial Direct Current Stimulation in Poststroke Hemianopia


Introduction. Development of the new approaches to the rehabilitation of patients with poststroke hemianopia is of great importance, given the high prevalence of that disorder and its negative impact on patients’ quality of life.

This study aimed to investigate the effect of transcranial direct current stimulation (tDCS) on the quality of life and the quality of visual perception in patients with poststroke hemianopia, as well as to study the safety and tolerability of this technique.

Materials and methods. The study included ten patients with poststroke hemianopia. Patients underwent ten tDCS sessions (2 mA, 20 min with anode placed over Oz, cathode — over Cz for a unilateral lesion, and anode — over O1 and O2, cathode — over Fp1 and Fp2 for bilateral lesions). The tolerability of tDCS was evaluated after each session using a standardized questionnaire. Clinical assessment before and after tDCS was performed using the Visual Function Questionnaire (VFQ-25) and the 36-item Short Form Survey (SF-36). Functional MRI using a visual paradigm was performed in 5 patients before and after the course of tDCS.

Results. Adverse effects were recorded during 9.9% of the sessions and had low severity in most cases. There was one withdrawal from the study because of increased pain in the hand and leg, in a patient with central post-stroke pain syndrome, which was likely unrelated to the biological effects of stimulation. Data of 9 patients were included in the analysis. There was a statistically significant increase in the overall score on the VFQ-25 (p = 0.02) after tDCS with improvements in the social activity (p = 0.02), mental health (p = 0.02), dependence on others (p = 0.04), and peripheral vision (p = 0.04) sections. A statistically significant improvement was also found in the psychological component of quality of life (p = 0.04), vitality (p = 0.03), social functioning (p = 0.02), role functioning due to physical health (p = 0.04), and general health (p = 0.008). In 3 cases, increased activation of the occipital cortex after tDCS was identified using functional MRI with a visual paradigm.

Conclusion. tDCS is a safe, well-tolerated, and potentially effective method in patients with poststroke hemianopia. Larger, controlled, and randomized studies are needed to clarify the efficacy of this method in hemianopia.

About the authors

Ilya S. Bakulin

Research Center of Neurology, Moscow

Author for correspondence.
Russian Federation

Dmitry Yu. Lagoda

Research Center of Neurology, Moscow

Russian Federation

Alexandra G. Poydasheva

Research Center of Neurology, Moscow

Russian Federation

Elena I. Kremneva

Research Center of Neurology, Moscow

Russian Federation

Natalia A. Suponeva

Research Center of Neurology, Moscow

Russian Federation

Mikhail A. Piradov

Research Center of Neurology, Moscow

Russian Federation


  1. Список литературы
  2. Rowe F., Brand D., Jackson C.A. et al. Visual impairment following stroke: do stroke patients require vision assessment? Ageing 2009; 38: 188–193. doi: 10.1093/ageing/afn230. PMID: 19029069.
  3. Rowe F.J.; VIS writing Group. Vision In Stroke cohort: Profile overview of visual impairment. Brain Behav 2017; 7: e00771. doi: 10.1002/brb3.771. PMID: 29201538.
  4. Pula J.H., Yuen C.A. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2: 210–220. doi: 10.1136/svn-2017-000079. PMID: 29507782.
  5. Zhang X., Kedar S., Lynn M.J. et al. Homonymous hemianopia in stroke. J Neuroophthalmol 2006; 26: 180–183. doi: 10.1097/01.wno.0000235587.41040.39. PMID: 16966935.
  6. Gilhotra J.S., Mitchell P., Healey P.R. et al. Homonymous visual field defects and stroke in an older population. Stroke 2002; 33: 2417–2420. doi: 10.1161/01.str.0000037647.10414.d2. PMID: 12364731.
  7. Zhang X., Kedar S., Lynn M.J. et al. Homonymous hemianopias: clinical-anatomic correlations in 904 cases. Neurology 2006; 66: 906–910. doi: 10.1212/01.wnl.0000203913.12088.93. PMID: 16567710.
  8. Rowe F.J., Wright D., Brand D. et al. A prospective profile of visual field loss following stroke: prevalence, type, rehabilitation and outcome. Biomed Res Int 2013; 2013: 719096. doi: 10.1155/2013/719096. PMID: 24089687.
  9. Urbanski M., Coubard O.A., Bourlon C. Visualizing the blind brain: brain imaging of visual field defects from early recovery to rehabilitation techniques. Front Integr Neurosci 2014; 8: 74. doi: 10.3389/fnint.2014.00074. PMID: 25324739.
  10. Gall C., Franke G.H., Sabel B.A. Vision-related quality of life in first stroke patients with homonymous visual field defects. Health Qual Life Outcomes 2010; 8: 33. doi: 10.1186/1477-7525-8-33. PMID: 20346125.
  11. Sand K.M., Wilhelmsen G., Naess H. et al. Vision problems in ischaemic stroke patients: effects on life quality and disability. Eur J Neurol 2016; 23 Suppl 1: 1–7. doi: 10.1111/ene.12848. PMID: 26563092.
  12. Bowers A.R. Driving with homonymous visual field loss: a review of the literature. ClinExpOptom 2016; 99: 402–418. doi: 10.1111/cxo.12425. PMID: 27535208.
  13. Gall C., Sabel B.A. Reading performance after vision rehabilitation of subjects with homonymous visual field defects. PM R 2012; 4: 928–935. doi: 10.1016/j.pmrj.2012.08.020. PMID: 23122896.
  14. Ramrattan R.S., Wolfs R.C., Panda-Jonas S. et al. Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study. Arch Ophthalmol 2001; 119: 1788–1794. doi: 10.1001/archopht.119.12.1788. PMID: 11735788.
  15. Wolter M., Preda S. Visual deficits following stroke: maximizing participation in rehabilitation. Top Stroke Rehabil 2006; 13: 12–21. doi: 10.1310/3JRY-B168-5N49-XQWA. PMID: 16987788.
  16. Sand K.M., Naess H., Thomassen L., Hoff J.M. Visual field defect after ischemic stroke-impact on mortality. Acta Neurol Scand 2018; 137: 293–298. doi: 10.1111/ane.12870. PMID: 29148038.
  17. Grunda T., Marsalek P., Sykorova P. Homonymous hemianopia and related visual defects: Restoration of vision after a stroke. Acta Neurobiol Exp (Wars) 2013; 73: 237–49. PMID: 23823985.
  18. Goodwin D. Homonymous hemianopia: challenges and solutions. Clin Ophthalmol 2014; 8: 1919–1927. doi: 10.2147/OPTH.S59452. PMID: 25284978.
  19. Frolov A., Feuerstein J., Subramanian P.S. Homonymous hemianopia and vision restoration therapy. Neurol Clin 2017; 35: 29–43. doi: 10.1016/j.ncl.2016.08.010. PMID: 27886894.
  20. Sabel B.A., Henrich-Noack P., Fedorov A., Gall C. Vision restoration after brain and retina damage: the "residual vision activation theory". Prog Brain Res 2011; 192: 199–262. doi: 10.1016/B978-0-444-53355-5.00013-0. PMID: 21763527.
  21. Gall C., Silvennoinen K., Granata G. et al. Non-invasive electric current stimulation for restoration of vision after unilateral occipital stroke. Contemp Clin Trials 2015; 43: 231–236. doi: 10.1016/j.cct.2015.06.005. PMID: 26072125.
  22. Priori A., Berardelli A., Rona S. et al. Polarization of the human motor cortex through the scalp. Neuroreport 1998; 9: 2257–2260. doi: 10.1097/00001756-199807130-00020. PMID: 9694210.
  23. Nitsche M.A., Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000; 527(Pt 3): 633–639. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x. PMID: 10990547.
  24. Yavari F., Jamil A., MosayebiSamani M. et al. Basic and functional effects of transcranial electrical stimulation (tES) — an introduction. Neurosci Biobehav Rev 2018; 85: 81–92. doi: 10.1016/j.neubiorev.2017.06.015. PMID: 28688701.
  25. Cirillo G., Di Pino G., Capone F. et al. Neurobiological after-effects of non-invasive brain stimulation. Brain Stimul 2017; 10: 1–18. doi: 10.1016/j.brs.2016.11.009. PMID: 27931886.
  26. Lefaucheur J.P., Antal A., Ayache S.S. et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2017; 128: 56–92. doi: 10.1016/j.clinph.2016.10.087. PMID: 27866120.
  27. Бакулин И.С., Пойдашева А.Г., Павлов Н.А. и др. Транскраниальная электрическая стимуляция в улучшении функции руки при инсульте. Успехи физиологических наук 2019; 50(1): 90–104. doi: 10.1134/S030117981901003X.
  28. Salazar A.P.S., Vaz P.G., Marchese R.R. et al. Noninvasive brain stimulation improves hemispatial neglect after stroke: a systematic review and meta-analysis. Arch Phys Med Rehab 2018; 99: 355–366.e1. doi: 10.1016/j.apmr.2017.07.009. PMID: 28802812.
  29. Sebastian R., Tsapkini K., Tippett D.C. Transcranial direct current stimulation in post stroke aphasia and primary progressive aphasia: Current knowledge and future clinical applications. NeuroRehabilitation 2016; 39: 141–152. doi: 10.3233/NRE-161346. PMID: 27314871.
  30. Plow E.B., Obretenova S.N., Fregni F. et al. Comparison of visual field training for hemianopia with active versus sham transcranial direct cortical stimulation. Neurorehabil Neural Repair 2012; 26: 616–626. doi: 10.1177/1545968311431963. PMID: 22291042.
  31. Plow E.B., Obretenova S.N., Jackson M.L., Merabet L.B. Temporal profile of functional visual rehabilitative outcomes modulated by transcranial direct current stimulation. Neuromodulation 2012; 15: 367–373. doi: 10.1111/j.1525-1403.2012.00440.x. PMID: 22376226.
  32. Alber R., Moser H., Gall C. et al. Combined transcranial direct current stimulation and vision restoration training in subacute stroke rehabilitation: a pilot study. PM R 2017; 9: 787–794. doi: 10.1016/j.pmrj.2016.12.003. PMID: 28082176.
  33. Halko M.A., Datta A., Plow E.B. et al. Neuroplastic changes following rehabilitative training correlate with regional electrical field induced with tDCS. Neuroimage 2011; 57: 885–891. doi: 10.1016/j.neuroimage.2011.05.026. PMID: 21620985.
  34. Plow E.B., Obretenova S.N., Halko M.A. et al. Combining visual rehabilitative training and noninvasive brain stimulation to enhance visual function in patients with hemianopia: a comparative case study. PM R 2011; 3: 825–835. doi: 10.1016/j.pmrj.2011.05.026. PMID: 21944300.
  35. Matteo B.M., Viganò B., Cerri C.G. et al. Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases. J Phys Ther Sci 2017; 29: 1700–1705. doi: 10.1589/jpts.29.1700. PMID: 28932016.
  36. Larcombe S.J., Kulyomina Y., Antonova N. et al. Visual training in hemianopia alters neural activity in the absence of behavioural improvement: a pilot study. Ophthalmic Physiol Opt 2018; 38: 538–549. doi: 10.1111/opo.12584. PMID: 30357899
  37. Mangione C.M., Lee P.P., Gutierrez P.R. et al. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 2001; 119: 1050–1058. doi: 10.1001/archopht.119.7.1050. PMID: 11448327.
  38. Мочалова А.С. Качество жизни пациентов при различных вариантах лечения меланомы хориоидеи: дис. … канд. мед. наук. Челябинск, 2014. 128 с.
  39. Новик А.А., Ионова Т.И. Руководство по исследованию качества жизни в медицине. М.: ОЛМА Медиа Групп, 2007. 313 с.
  40. Antal A., Alekseichuk I., Bikson M. et al. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128: 1774–1809. doi: 10.1016/j.clinph.2017.06.001. PMID: 28709880.
  41. Antal A., Kincses T.Z., Nitsche M.A., Paulus W. Manipulation of phosphene thresholds by transcranial direct current stimulation in man. Exp Brain Res 2003; 150: 375–378. doi: 10.1007/s00221-003-1459-8. PMID: 12698316.
  42. Antal A., Kincses T.Z., Nitsche M.A. et al. Excitability changes induced in the human primary visual cortex by transcranial direct current stimulation: direct electrophysiological evidence. Invest Ophthalmol Vis Sci 2004; 45: 702–707. doi: 10.1167/iovs.03-0688. PMID: 14744917.
  43. Kraft A., Roehmel J., Olma M.C. et al. Transcranial direct current stimulation affects visual perception measured by threshold perimetry. Exp Brain Res 2010; 207: 283–290. doi: 10.1007/s00221-010-2453-6. PMID: 21046369.
  44. Costa T.L., Gualtieri M., Barboni M.T. et al. Contrasting effects of transcranial direct current stimulation on central and peripheral visual fields. Exp Brain Res 2015; 233: 1391–1397. doi: 10.1007/s00221-015-4213-0. PMID: 25650104.
  45. Behrens J.R., Kraft A., Irlbacher K. et al. Long-lasting enhancement of visual perception with repetitive noninvasive transcranial direct current stimulation. Front Cell Neurosci 2017; 11: 238. doi: 10.3389/fncel.2017.00238. PMID: 28860969.
  46. Matteo B.M., Vigano B., Cerri C.G., Perin C. Visual field restorative rehabilitation after brain injury. J Vis 2016; 16: 11. doi: 10.1167/16.9.11. PMID: 27472498.
  47. Morland A.B., Le S., Carroll E. et al. The role of spared calcarine cortex and lateral occipital cortex in the responses of human hemianopes to visual motion. J Cogn Neurosci 2004; 16: 204–218. doi: 10.1162/089892904322984517. PMID: 15068592.
  48. Chokron S., Perez C., Peyrin C. Behavioral consequences and cortical reorganization in homonymous hemianopia. Front Syst Neurosci 2016; 10: 57. doi: 10.3389/fnsys.2016.00057. PMID: 27445717.
  49. Fendrich R., Wessinger C.M., Gazzaniga M.S. Speculations on the neural basis of islands of blindsight. Prog Brain Res 2001; 134: 353–366. doi: 10.1016/s0079-6123(01)34023-2. PMID: 11702554.
  50. Eysel U.T., Schweigart G. Increased receptive field size in the surround of chronic lesions in the adult cat visual cortex. Cereb Cortex 1999; 9: 101–109. doi: 10.1016/s0304-3940(02)01153-9. PMID: 12531465.
  51. Pleger B., Foerster A.F., Widdig W. et al. Functional magnetic resonance imaging mirrors recovery of visual perception after repetitive tachistoscopic stimulation in patients with partial cortical blindness. Neurosci Lett 2003; 335: 192–196.
  52. Nelles G., Widman G., de Greiff A. et al. Brain representation of hemifield stimulation in poststroke visual field defects. Stroke 2002; 33: 1286–1293. PMID: 11988605.
  53. Nelles G., de Greiff A., Pscherer A. et al. Cortical activation in hemianopia after stroke. Neurosci Lett 2007; 426: 34–38. PMID: 17881128.



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Copyright (c) 2020 Bakulin I.S., Lagoda D.Y., Poydasheva A.G., Kremneva E.I., Suponeva N.A., Piradov M.A.

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