Can repetitive transcranial magnetic stimulation enhance motor outcomes in cerebral infarct patients?

Kim, Jun Young; Boudier‐Revéret, Mathieu; Lee, Hee Jin

doi:10.31083/j.jin.2020.01.20

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…Half of the included studies (13/26), encompassing a large majority of the patient population, were single-arm, non-randomized retrospective or prospective studies (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)36). Eleven studies included a sham-control condition either in a crossover or parallel-group design (16,20,(33)(34)(35)(37)(38)(39)(40)(41)(42). Of the 11 shamcontrolled trials, only four were randomized, double-blind trials (19,20,35,38).…”

Section: Resultsmentioning

confidence: 99%

“…Stroke can lead to a disruption of neural signal transmission due to changes in axon diameter and changes in the myelination of white matter tracts ( 39 ). It has been hypothesized that this disruption of structural and functional connectivity may hinder the propagation of rTMS-modulated cortical activity from the site of stimulation throughout the motor network ( 39 , 42 , 59 ). A certain degree of preserved descending white matter projections, as well as functional motor network connectivity, may thus be needed for rTMS-induced changes in neural activity to manifest into improved motor behavior ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several of the identified studies in this review showed that patients with purely subcortical stroke were more likely to have a greater response to rTMS intervention than patients with cortical involvement. In cortical stroke, intracortical inhibition is suppressed ( 42 , 68 ). Reduced inhibition in the ipsilesional hemisphere drives a downregulation of inhibitory activity in the contralesional hemisphere through axonal connections ( 69 ).…”

Section: Discussionmentioning

confidence: 99%

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Predicting Individual Treatment Response to rTMS for Motor Recovery After Stroke: A Review and the CanStim Perspective

Hildesheim

Silver

Dominguez-Vargas

et al. 2022

Front. Rehabilit. Sci.

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BackgroundRehabilitation is critical for reducing stroke-related disability and improving quality-of-life post-stroke. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique used as stand-alone or adjunct treatment to physiotherapy, may be of benefit for motor recovery in subgroups of stroke patients. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) seeks to advance the use of these techniques to improve post-stroke recovery through clinical trials and pre-clinical studies using standardized research protocols. Here, we review existing clinical trials for demographic, clinical, and neurobiological factors which may predict treatment response to identify knowledge gaps which need to be addressed before implementing these parameters for patient stratification in clinical trial protocols.ObjectiveTo provide a review of clinical rTMS trials of stroke recovery identifying factors associated with rTMS response in stroke patients with motor deficits and develop research perspectives for pre-clinical and clinical studies.MethodsA literature search was performed in PubMed, using the Boolean search terms stroke AND repetitive transcranial magnetic stimulation OR rTMS AND motor for studies investigating the use of rTMS for motor recovery in stroke patients at any recovery phase. A total of 1,676 articles were screened by two blinded raters, with 26 papers identified for inclusion in this review.ResultsMultiple possible factors associated with rTMS response were identified, including stroke location, cortical thickness, brain-derived neurotrophic factor (BDNF) genotype, initial stroke severity, and several imaging and clinical factors associated with a relatively preserved functional motor network of the ipsilesional hemisphere. Age, sex, and time post-stroke were generally not related to rTMS response. Factors associated with greater response were identified in studies of both excitatory ipsilesional and inhibitory contralesional rTMS. Heterogeneous study designs and contradictory data exemplify the need for greater protocol standardization and high-quality controlled trials.ConclusionClinical, brain structural and neurobiological factors have been identified as potential predictors for rTMS response in stroke patients with motor impairment. These factors can inform the design of future clinical trials, before being considered for optimization of individual rehabilitation therapy for stroke patients. Pre-clinical models for stroke recovery, specifically developed in a clinical context, may accelerate this process.

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