Transcranial Magnetic Stimulation as an Intervention Tool to Recover from Language, Swallowing and Attentional Deficits after Stroke: A Systematic Review

Abstract

Background: Following a stroke event, patients often are severely affected by disabilities that hinder their quality-of-life. There are currently several rehabilitative options and strategies, and it is crucial to find the most effective interventions. The applicability of transcranial magnetic stimulation (TMS) to the recovery of nonmotor functions such as communication skills, swallowing ability and spatial attention after stroke remains important clinical questions. Summary: We searched PubMed and ISI Web of Science for articles that used repetitive TMS protocols to rehabilitate post-stroke deficits. We analysed qualitatively 38 articles that met the eligibility criteria; of these, 21 dealt with aphasia, 8 with dysphagia, 8 with neglect and 1 with visual extinction. The efficacy of TMS as an intervention for post-stroke rehabilitation of these nonmotor deficits was studied as well as the current limitations were assessed. Key Messages: Most part of the included studies reported statistically significant functional improvements, supporting the use of TMS for the rehabilitation of aphasia, dysphagia and neglect. Future research, with larger sample sizes, is mandatory to confirm its efficacy, determine the optimal stimulation parameters and investigate inter-subject variability.

Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial

“…The interventions of PSCI included controlling vascular risk factors, pharmacological treatments such as cholinesterase inhibitors (galantamine, donepezil, rivastigmine), the N -methyl D -aspartate antagonist memantine, and various Chinese medicines, cognitive training, and non-invasive stimulation ( Beristain and Golombievski, 2015 ; Iadecola et al, 2019 ). Recently, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively safe electrophysiological technique, based on the principle of electromagnetic induction of an electric field in the brain, that has been widely used in the field of rehabilitation of post-stroke dysfunctions such as motor disorder, neglect, and swallowing impairment ( Winstein et al, 2016 ; Dionisio et al, 2018 ; Lefaucheur et al, 2020 ). Nevertheless, there are few studies about the treatment of PSCI by rTMS, and its therapeutic effects remain unclear.…”

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls

“…10 In a recent systematic review, most of the included studies supported the use of TMS for the rehabilitation of aphasia, dysphagia, and neglect, although the heterogeneity of stimulation protocols did not allow definitive conclusions to be drawn. 37…”

“…10 In a recent systematic review, most of the included studies supported the use of TMS for the rehabilitation of aphasia, dysphagia, and neglect, although the heterogeneity of stimulation protocols did not allow definitive conclusions to be drawn. 37 Post-stroke depression is a relevant complication of cerebrovascular diseases. 38 The role of rTMS in the management of major depressive disorders is well documented, 39,40 and currently, rTMS is internationally approved and indicated for the treatment of major depression in adults with antidepressant medication resistance, and in those with a recurrent course of illness, or in cases of moderate-to-severe disease severity.…”

Identifiable Patterns of Trait, State, and Experience in Chronic Stroke Recovery

“…Future studies in brain connectivity will further elucidate the complex nature of the changes that occur in response to treatment of stroke and its behavioral sequelae such as aphasia, and which support functional recovery. Such studies will include those involving external manipulation of the brain through noninvasive stimulation, of growing interest in treatment of chronic stroke, [33][34][35][36][37][38][39][40] which may affect the stability of an individual's whole brain functional connectivity.…”