Article ID: 10471
Apathy can be seen in patients with stroke, resulting in adversely affecting the feasibility of rehabilitation. Here, we report a case of post-stroke apathy in which transcranial direct current stimulation improved their spontaneity. A 50-year-old male suffered from multiple cerebral infarction following acute aortic dissection (Stanford type A). He showed severe aspontaneity, leading to inability to intentionally speak and move by themselves, even though intensive rehabilitation and amantadine were given. After obtaining the written informed consent from his family, the transcranial direct current stimulation (tDCS) treatment was started at 100 days post-ictus. Anodal tDCS was applied to the right prefrontal area with an intensity of 2 mA lasting for 20 minutes once a day, during which intensive physical therapy was given concomitantly. Before and after the intervention, neuropsychological testing and resting state fMRI were conducted. Prefrontal tDCS of 11 sessions recovered his spontaneity, resulting in the improvement of the Apathy scale (from impossible to examine to 23), clinical assessment for spontaneity (from 59 to 40) and Hamilton Rating Scale for depression (from 16 to 10). In addition, the resting state fMRI demonstrated the normalization of functional connectivity in the default mode network after tDCS therapy on the right hemisphere. tDCS of the prefrontal area could be one of the treatment options in patients with post-stroke apathy.
