Evaluation of fMRI activation in post-stroke patients with movement disorders after repetitive transcranial magnetic stimulation: a scoping review

Abstract

BackgroundMovement disorders are one of the most common stroke residual effects, which cause a major stress on their families and society. Repetitive transcranial magnetic stimulation (rTMS) could change neuroplasticity, which has been suggested as an alternative rehabilitative treatment for enhancing stroke recovery. Functional magnetic resonance imaging (fMRI) is a promising tool to explore neural mechanisms underlying rTMS intervention.ObjectOur primary goal is to better understand the neuroplastic mechanisms of rTMS in stroke rehabilitation, this paper provides a scoping review of recent studies, which investigate the alteration of brain activity using fMRI after the application of rTMS over the primary motor area (M1) in movement disorders patients after stroke.MethodThe database PubMed, Embase, Web of Science, WanFang Chinese database, ZhiWang Chinese database from establishment of each database until December 2022 were included. Two researchers reviewed the study, collected the information and the relevant characteristic extracted to a summary table. Two researchers also assessed the quality of literature with the Downs and Black criteria. When the two researchers unable to reach an agreement, a third researcher would have been consulted.ResultsSeven hundred and eleven studies in all were discovered in the databases, and nine were finally enrolled. They were of good quality or fair quality. The literature mainly involved the therapeutic effect and imaging mechanisms of rTMS on improving movement disorders after stroke. In all of them, there was improvement of the motor function post-rTMS treatment. Both high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS) can induce increased functional connectivity, which may not directly correspond to the impact of rTMS on the activation of the stimulated brain areas. Comparing real rTMS with sham group, the neuroplastic effect of real rTMS can lead to better functional connectivity in the brain network in assisting stroke recovery.ConclusionrTMS allows the excitation and synchronization of neural activity, promotes the reorganization of brain function, and achieves the motor function recovery. fMRI can observe the influence of rTMS on brain networks and reveal the neuroplasticity mechanism of post-stroke rehabilitation. The scoping review helps us to put forward a series of recommendations that might guide future researchers exploring the effect of motor stroke treatments on brain connectivity.

Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients with Neurological Disorders: A Narrative Review

“…Through mechanisms, such as synaptic plasticity, neuroprotection, and decreased inflammation, pharmacological therapies show promise in enhancing neuroplasticity and fostering recovery. These methods could be combined with interdisciplinary rehabilitation programs to improve TBI rehabilitation outcomes and the quality of life for those who suffer from this severe neurological illness [ 24 ].…”

“…Researchers and clinicians are investigating the possible synergistic effects of combining several interventions and modalities to maximize neuroplasticity outcomes [ 23 , 24 ]. To simultaneously target several components of neuroplasticity, this strategy entails merging numerous treatments, such as physical therapy, cognitive training, neurostimulation, and pharmaceutical interventions.…”

“…Although neuroplasticity presents intriguing opportunities for enhancing recovery and rehabilitation in people with neurological diseases, several issues must be resolved to realize its potential fully. Key topics that demand ongoing research, collaboration, and innovation include individualized treatments, long-term sustainability, modality combinations, translation into clinical practice, and ethical considerations [22][23][24][25].…”