Repetitive transcranial magnetic stimulation for improving function after stroke

ZiLong, Hao; Wang, Deren; Zeng, Yan; Liu, Ming

doi:10.1590/1516-3180.20131316t2

Cited by 62 publications

(94 citation statements)

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“…These individual studies show the promise of cortical stimulation in stroke recovery. Overall, Cochrane Reviews have shown that there are no consistent effects of rTMS (for measurements of daily living, motor function, cognitive function, depression) or tDCS (for aphasia and naming) in comparison with sham-treated patients but suggest that more randomized control trials are required to determine fully the viability of using cortical stimulation in stroke rehabilitation (Hao et al, 2013;Pollock et al, 2014;Elsner et al, 2015). A major issue with cortical stimulation and reproducible outcomes is that many variables must be controlled to include stimulation strength, pattern of stimulation, location of electrodes, and individual variation in recovery (Gomez Palacio Schjetnan et al, 2013).…”

Section: Cortical Stimulationmentioning

confidence: 99%

Sex differences in stroke therapies

Sohrabji

Park

Mahnke

2016

J of Neuroscience Research

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Stroke is the 5th leading cause of death and acquired disability in aged populations. Women are disproportionally affected by stroke, having a higher incidence and worse outcomes than men. Numerous preclinical studies have discovered novel therapies for the treatment of stroke, but almost all of these were found to be unsuccessful in clinical trials. Despite known sex differences in occurrence and severity of stroke, few therapeutics, both preclinically and clinically, take into account possible sex differences in treatment. Reanalysis of data from the only currently FDA-approved stroke therapy, tPA, has shown to not only improve stroke outcomes for both sexes, but to also show sexual dimorphism by more robust improvement in stroke outcome in females. Experimental evidence supports the inclusion of sex as a variable in the study of a number of novel stroke drugs and therapies, including preclinical studies of anti-inflammatory drugs (minocycline), stimulators of cell survival (IGF-1), and inhibitors of cell death pathways (pharmacological inhibition of PARP-1, NO production, and caspase activation), as well as in current clinical trials of stem cell therapy and cortical stimulation. Overall, study design and analyses in clinical trials, as well as in preclinical studies, must include both sexes equally, consider possible sex differences in the analyses, and report the differences/similarities in more systemized/structured way to translate promising therapies to both sexes and increase stroke recovery.

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Section: Cortical Stimulationmentioning

confidence: 99%

Sex differences in stroke therapies

Sohrabji

Park

Mahnke

2016

J of Neuroscience Research

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“…However, approximately 20–30% of all stroke survivors do not qualify for CIMT or other rehabilitation strategies. For those patients, mirror therapy,6 motor imagery,7, 8 action observation therapy,9 electrical stimulation (e.g., noninvasive brain stimulation,10, 11, 12 or vagus nerve stimulation13) and robot‐aided sensorimotor stimulation14 have been investigated as possible alternatives over the last several years. Driven by advances in other technological areas such as virtual and augmented reality (VR/AR), robotics, invasive and noninvasive brain‐computer interfaces (BCIs),15 as well as pharmacology,16, 17 post‐stroke motor rehabilitation is now a fast growing, emerging field.…”

Section: Introductionmentioning

confidence: 99%

Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

Cervera

Soekadar

Ushiba

et al. 2018

Ann Clin Transl Neurol

345

267

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Brain‐computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations, enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here, we provide a first meta‐analysis evaluating the clinical effectiveness of BCI‐based post‐stroke motor rehabilitation. Trials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post‐stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random‐effects inverse variance method was used to calculate the summary effect size. We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post‐stroke survivors that fulfilled the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta‐analysis. Motor improvements, mostly quantified by the upper limb Fugl‐Meyer Assessment (FMA‐UE), exceeded the minimal clinically important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was associated with a standardized mean difference of 0.79 (95% CI: 0.37 to 1.20) in FMA‐UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI‐induced functional and structural neuroplasticity at a subclinical level. This suggests that BCI technology could be an effective intervention for post‐stroke upper limb rehabilitation. However, more studies with larger sample size are required to increase the reliability of these results.

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“…Several recent studies with healthy participants have highlighted responses following NIBS are variable (Hamada, Murase, Hasan, Balaratnam, & Rothwell, 2013;Hordacre et al, 2017a; L� opez-Alonso, Cheeran, Río-Rodríguez, & Fern� andez-del-Olmo, 2014;M€ uller-Dahlhaus, Orekhov, Liu, & Ziemann, 2008). Furthermore, Cochrane reviews have been unable to support use of NIBS as an intervention for stroke survivors as a result of highly variable responses (Elsner, Kugler, Pohl, & Mehrholz, 2016;Hao, Wang, Zeng, & Liu, 2013). Although producing the desired functional benefit in some stroke survivors, NIBS may not be a one-size-fits-all intervention and it may be that some patients experience no functional benefit from cortical stimulation (Hesse et al, 2011;Rossi, Sallustio, Di Legge, Stanzione, & Koch, 2013).…”

Section: Introductionmentioning

confidence: 99%

Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study

Hordacre

Moezzi

Ridding

2018

Human Brain Mapping

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Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has potential for clinical utility in neurorehabilitation. However, recent evidence indicates that the responses to tDCS are highly variable. This study investigated whether electroencephalographic (EEG) measures of functional connectivity of the target network were associated with the response to ipsilesional anodal tDCS in stroke survivors. Ten chronic stroke patients attended two experimental sessions in a randomized cross-over trial and received anodal or sham tDCS. Single-pulse transcranial magnetic stimulation was used to quantify change in corticospinal excitability following tDCS. At the beginning of each session, functional connectivity was estimated using the debiased-weighted phase lag index from EEG recordings at rest. Magnetic resonance imaging identified lesion location and lesion volume. Partial least squares regression identified models of connectivity which maximally accounted for variance in anodal tDCS responses. Stronger connectivity of a network with a seed approximating the stimulated ipsilesional motor cortex, and clusters of electrodes approximating the ipsilesional parietal cortex and contralesional frontotemporal cortex in the alpha band (8-13 Hz) was strongly associated with a greater increase of corticospinal excitability following anodal tDCS. This association was not observed following sham stimulation. Addition of a structural measure(s) of injury (lesion volume) provided an improved model fit for connectivity between the seed electrode and ipsilesional parietal cortex, but not the contralesional frontotemporal cortex. TDCS has potential to greatly assist stroke rehabilitation and functional connectivity appears a robust and specific biomarker of response which may assist clinical translation of this therapy.

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Repetitive transcranial magnetic stimulation for improving function after stroke

Cited by 62 publications

References 0 publications

Sex differences in stroke therapies

Sex differences in stroke therapies

Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study

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