Justyna Brożonowicz, Natalia Wołoszyn, Justyna Leszczak, Krzysztof Bylicki, Gabriela Ciąpała, Agnieszka Wiśniowska-Szurlej
Randomized evidence shows no analgesic benefit of low-pressure pneumoperitoneum in RARP at any assessed time point, and the associated increases in blood loss and operative time are too small to matter clinically. Current evidence supports neither routine adoption nor avoidance; pressure should be individualized to surgical exposure, bleeding risk, and cardiopulmonary tolerance.
INTRODUCTION: Spasticity is a common motor disorder that develops after stroke, negatively impacting motor control and functional capacity. Non-pharmacological methods, including transcranial direct current stimulation (tDCS), are increasingly used in its treatment; however, the optimal stimulation protocol remains unclear. Therefore, the aim of this study was to conduct a systematic review of the literature regarding the efficacy of tDCS in treating upper limb spasticity in post-stroke patients.
METHODS: A systematic review of randomized controlled trials was conducted in accordance with the PRISMA guidelines. PubMed, Scopus, PEDro, Cochrane CENTRAL, ScienceDirect, Web of Science, and Google Scholar were searched using the following keywords and their combinations: transcranial direct current stimulation, stroke, muscle spasticity and upper limb. The eligibility criteria were defined according to the PICOTS framework. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias 2 tool. The review was registered in PROSPERO (CRD420261363944).
RESULTS: Of the 2,797 records identified, nine publications met the eligibility criteria and were included in the analysis. These studies differed in terms of participant characteristics. In most cases, the intervention involved anodal stimulation of the primary motor cortex; however, the treatment parameters, including stimulation duration, current intensity, and number of sessions, were heterogeneous. A clear beneficial effect of tDCS on upper limb spasticity in patients after stroke was observed in three articles.
DISCUSSION: The available evidence regarding the effectiveness of tDCS in reducing upper limb spasticity after stroke remains inconclusive. Further high-quality studies using standardized research protocols are required.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261363944, PROSPERO; registration number CRD420261363944.