Efficacy of Transcranial Direct Current Stimulation in Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Stimulation Montages and Timing.
OBJECTIVE To evaluate the efficacy and safety of transcranial direct current stimulation (tDCS) initiated strictly within the acute ischemic stroke. DESIGN A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted via PubMed, Embase, and Cochrane Library. Outcomes included neurological deficit, upper limb and lower limb motor function, and functional independence. Data were synthesized using random-effects models to calculate weighted mean differences (WMD) and standardized mean differences (SMD). RESULTS Ten RCTs involving 419 participants were included. Active tDCS significantly reduced neurological deficits compared to sham stimulation (WMD=-0.86, 95% CI: -1.38 to -0.34, P=0.001). While tDCS did not significantly improve short-term or long-term upper limb function, it demonstrated a significant improvement on lower limb motor recovery (SMD=3.50, 95% CI: 2.56 to 4.44, P<0.001), which was sustained at follow-up. No significant difference was found in functional independence or safety outcomes between groups. CONCLUSIONS tDCS initiated in the acute phase is safe and effective for reducing neurological deficits and enhancing lower limb motor recovery. The discrepancy between lower and upper limb outcomes suggests distinct neuroplastic mechanisms, highlighting the potential of tDCS, particularly bilateral montages, as a targeted intervention for early gait rehabilitation.