Non-invasive electrical brain stimulation for vision restoration after stroke: An exploratory randomized trial (REVIS)

Silja Räty, Carolin Borrmann, Giuseppe Granata, Lizbeth Cárdenas-Morales, Ariel Schoenfeld, Michael Sailer, Katri Silvennoinen, Juha Holopainen, Francesca De Rossi, Andrea Antal, Paolo M. Rossini, Turgut Tatlisumak, Bernhard A. Sabel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke. Methods: In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n = 8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n = 8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm. Results: Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well. Conclusions: This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials.

Original languageEnglish
Pages (from-to)221-235
Number of pages15
JournalRestorative Neurology and Neuroscience
Volume39
Issue number3
DOIs
Publication statusPublished - 2021

Keywords

  • Electrical stimulation
  • homonymous hemianopia
  • occipital stroke
  • randomized controlled trial
  • rehabilitation
  • vision restoration

ASJC Scopus subject areas

  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

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