{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T01:46:38Z","timestamp":1772070398943,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Uni-hemispheric concurrent dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) may enhance the efficacy of a-tDCS after stroke. However, the cellular and molecular mechanisms underlying its beneficial effects have not been defined. We aimed to investigate the effect of a-tDCSM1-DLPFC on brain metabolite concentrations (N-acetyl aspartate (NAA), choline (Cho)) in stroke patients using magnetic resonance spectroscopy (MRS). In this double-blind, sham-controlled, randomized clinical trial (RCT), 18 patients with a first chronic stroke in the territory of the middle cerebral artery trunk were recruited. Patients were allocated to one of the following two groups: (1) Experimental 1, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (active). (2) Experimental 2, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (sham). MRS assessments were performed before and 24 h after the last intervention. Results showed that after five sessions of a-tDCSM1-DLPFC, there were no significant changes in NAA and Cho levels between groups (Cohen\u2019s d = 1.4, Cohen\u2019s d = 0.93). Thus, dual site a-tDCSM1-DLPFC did not affect brain metabolites compared to single site a-tDCS M1.<\/jats:p>","DOI":"10.3390\/brainsci13071100","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T01:52:35Z","timestamp":1689904355000},"page":"1100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Effect of Uni-Hemispheric Dual-Site Anodal tDCS on Brain Metabolic Changes in Stroke Patients: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-0500","authenticated-orcid":false,"given":"Somaye","family":"Azarnia","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran 19857-13834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamran","family":"Ezzati","sequence":"additional","affiliation":[{"name":"Neuroscience Research Centre, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht 41937-13111, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alia","family":"Saberi","sequence":"additional","affiliation":[{"name":"Neuroscience Research Centre, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht 41937-13111, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soofia","family":"Naghdi","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran 65111-11489, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iraj","family":"Abdollahi","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran 19857-13834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2957-4510","authenticated-orcid":false,"given":"Shapour","family":"Jaberzadeh","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S1474-4422(09)70025-0","article-title":"Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review","volume":"8","author":"Feigin","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_2","first-page":"3238165","article-title":"Stroke in the century: A snapshot of the burden, epidemiology, and quality of life","volume":"2018","author":"Donkor","year":"2018","journal-title":"Stroke Res. 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