Transcranial magnetic stimulation combined with upper-limb training for improving function after stroke: A systematic review and meta-analysis

Graef, Patrícia; Dadalt4, Maria Luísa Rocha; Rodrigués, Daiana Amaral Medeiros da Silva; Stein, Cinara; Pagnussat, Aline de Souza

doi:10.1016/j.jns.2016.08.016

Cited by 57 publications

(47 citation statements)

References 52 publications

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“…(3) The study by Murase and colleagues had a small sample of patients at only one time point in the chronic stage, which makes inference about changes over time, or recovery, impossible. The overinterpretation of the Murase and colleagues results led, in turn, to a large number of studies that attempted, or claimed, to rebalance IHI using noninvasive brain stimulation (NIBS) in the acute and chronic stages after stroke . What should have been established first, in our view, is the time course of the development of premovement IHI abnormality from the acute/subacute period to the chronic stage.…”

Section: Discussionmentioning

confidence: 99%

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation

Branscheidt

Schambra

et al. 2019

Annals of Neurology

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Objective: Patients with chronic stroke have been shown to have failure to release interhemispheric inhibition (IHI) from the intact to the damaged hemisphere before movement execution (premovement IHI). This inhibitory imbalance was found to correlate with poor motor performance in the chronic stage after stroke and has since become a target for therapeutic interventions. The logic of this approach, however, implies that abnormal premovement IHI is causal to poor behavioral outcome and should therefore be present early after stroke when motor impairment is at its worst. To test this idea, in a longitudinal study, we investigated interhemispheric interactions by tracking patients' premovement IHI for one year following stroke. Methods: We assessed premovement IHI and motor behavior five times over a 1-year period after ischemic stroke in 22 patients and 11 healthy participants. Results: We found that premovement IHI was normal during the acute/subacute period and only became abnormal at the chronic stage; specifically, release of IHI in movement preparation worsened as motor behavior improved. In addition, premovement IHI did not correlate with behavioral measures cross-sectionally, whereas the longitudinal emergence of abnormal premovement IHI from the acute to the chronic stage was inversely correlated with recovery of finger individuation. Interpretation: These results suggest that interhemispheric imbalance is not a cause of poor motor recovery, but instead might be the consequence of underlying recovery processes. These findings call into question the rehabilitation strategy of attempting to rebalance interhemispheric interactions in order to improve motor recovery after stroke. ANN NEUROL 2019;85:502-513 I t has been proposed that one contributor to chronic hemiparesis is an imbalanced inhibitory interaction between the lesioned and intact hemispheres via transcallosal connections. This interhemispheric-competition model proposes that the two hemispheres, which normally exert mutual inhibition in healthy individuals, become imbalanced after stroke, and that unopposed inhibition from the healthy to the damaged side impedes recovery. 1 This framework is largely based on a seminal study that showed persistent premovement interhemispheric inhibition (IHI) from the contra-to ipsilesional motor cortex before movement execution in patients with chronic stroke. 2 This failure to release IHI before movement onset (abnormal premovement IHI) correlated with weakness and impaired finger tapping performance. 2 Influenced by this stroke-recovery View this article online at wileyonlinelibrary.com.

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Section: Discussionmentioning

confidence: 99%

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation

Branscheidt

Schambra

et al. 2019

Annals of Neurology

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“…Therapies targeting restorative processes encompass brain stimulation techniques. Advancement to clinical practice has so far been unsuccessful, which is partly attributable to poorly understood links between stimulation mechanism and individual pathophysiology . An emerging new avenue of brain stimulation strongly relies on a close link between the stimulation effects and pathophysiology and follows the rationale of replacing pathophysiologically missing signals via on‐demand electric stimulation, thereby normalizing neural coding in downstream brain regions .…”

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confidence: 99%

Low‐Frequency Brain Oscillations Track Motor Recovery in Human Stroke

Bönstrup

Krawinkel

Schulz

et al. 2019

Annals of Neurology

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Objective The majority of patients with stroke survive the acute episode and live with enduring disability. Effective therapies to support recovery of motor function after stroke are yet to be developed. Key to this development is the identification of neurophysiologic signals that mark recovery and are suitable and susceptible to interventional therapies. Movement preparatory low‐frequency oscillations (LFOs) play a key role in cortical control of movement. Recent animal data point to a mechanistic role of motor cortical LFOs in stroke motor deficits and demonstrate neuromodulation intervention with therapeutic benefit. Their relevance in human stroke pathophysiology is unknown. Methods We studied the relationship between movement‐preparatory LFOs during the performance of a visuomotor grip task and motor function in a longitudinal (<5 days, 1 and 3 months) cohort study of 33 patients with motor stroke and in 19 healthy volunteers. Results Acute stroke–lesioned brains fail to generate the LFO signal. Whereas in healthy humans, a transient occurrence of LFOs preceded movement onset at predominantly contralateral frontoparietal motor regions, recordings in patients revealed that movement‐preparatory LFOs were substantially diminished to a level of 38% after acute stroke. LFOs progressively increased at 1 and 3 months. This re‐emergence closely tracked the recovery of motor function across several movement qualities including grip strength, fine motor skills, and synergies and was frequency band specific. Interpretation Our results provide the first human evidence for a link between movement‐preparatory LFOs and functional recovery after stroke, promoting their relevance for movement control. These results suggest that it may be interesting to explore targeted, LFOs‐restorative brain stimulation therapy in human stroke patients. ANN NEUROL 2019;86:853–865

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“…After examination of the full text of the remaining 123 articles, 109 additional references were discarded. 14 meta-analyses (8 for neurological disorders [18][19][20][21][22][23][24][25] and 6 for psychiatric disorders [12,26-30]) were included in the analysis. A flowchart, detailing the study selection process and reasons for exclusion, is provided in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

Excess significance bias in repetitive transcranial magnetic stimulation literature for neuropsychiatric disorders

Amad

Jardri²,

Rousseau

et al. 2019

Preprint

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IntroductionRepetitive transcranial magnetic stimulation (rTMS) has been widely tested and promoted for use in multiple neuropsychiatric conditions, but as for many other medical devices, some gaps may exist in the literature and the evidence base for rTMS clinical efficacy remains under debate. We aimed to empirically test for an excess number of statistically significant results in the literature on rTMS therapeutic efficacy across a wide range of meta-analyses and to characterize the power of studies included in these meta-analyses. MethodsBased on power calculations, we computed the expected number of "positive" datasets for a medium effect-size (standardized mean difference, SMD=0.30) and compared it with the number of observed "positive" datasets. Sensitivity analyses considered small (SMD=0.20), modest (SMD=0.50), and large (SMD=0.80) effect sizes. Results14 meta-analyses with 228 datasets (110 for neurological disorders and 118 for psychiatric disorders) were assessed. For SMD=0.3, the number of observed "positive" studies (n=94) was larger than expected (n=35). We found evidence for an excess of significant findings overall (p<0.0001) and in 8/14 meta-analyses. Evidence for an excess of significant findings was also observed for SMD=0.5 for neurological disorders. 0 (0 %), 0 (0 %), 3 (1 %), and 53 (23 %) of the 228 datasets had power >0.80, respectively for SMDs of 0.30, 0.20, 0.50, and 0.80. ConclusionMost studies in the rTMS literature are underpowered. This results in fragmentation and waste of research efforts. The somewhat high frequency of "positive" results seems spurious and may reflect bias.

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Transcranial magnetic stimulation combined with upper-limb training for improving function after stroke: A systematic review and meta-analysis

Cited by 57 publications

References 52 publications

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation

Rethinking interhemispheric imbalance as a target for stroke neurorehabilitation

Low‐Frequency Brain Oscillations Track Motor Recovery in Human Stroke

Excess significance bias in repetitive transcranial magnetic stimulation literature for neuropsychiatric disorders

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