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Li XY, Hu R, Lou TX, Liu Y, Ding L. Global research trends in transcranial magnetic stimulation for stroke (1994-2023): promising, yet requiring further practice. Front Neurol 2024; 15:1424545. [PMID: 39268062 PMCID: PMC11390666 DOI: 10.3389/fneur.2024.1424545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/09/2024] [Indexed: 09/15/2024] Open
Abstract
Background Scholars have been committed to investigating stroke rehabilitation strategies over many years. Since its invention, transcranial magnetic stimulation (TMS) has been increasingly employed in contemporary stroke rehabilitation research. Evidence has shown the significant potential of TMS in stroke research and treatment. Objective This article reviews the research conducted on the use of TMS in stroke from 1994 to 2023. This study applied bibliometric analysis to delineate the current research landscape and to anticipate future research hotspots. Method The study utilized the Web of Science Core Collection to retrieve and acquire literature data. Various software tools, including VOSviewer (version 1.6.19), CiteSpace (version 6.3.R1), Scimago Graphica (version 1.0.36), and WPS (version 11572), were used for data analysis and visualization. The review included analyses of countries, institutions, authors, journals, articles, and keywords. Results A total of 3,425 articles were collected. The top three countries in terms of publication output were the United States (953 articles), China (546 articles), and Germany (424 articles). The United States also had the highest citation counts (56,764 citations), followed by Germany (35,211 citations) and the United Kingdom (32,383 citations). The top three institutions based on the number of publications were Harvard University with 138 articles, the University of Auckland with 81 articles, and University College London with 80 articles. The most prolific authors were Abo, Masahiro with 54 articles, Fregni, Felipe with 53 articles, and Pascual-Leone, Alvaro with 50 articles. The top three journals in terms of article count were Neurorehabilitation and Neural Repair with 139 articles, Clinical Neurophysiology with 128 articles, and Frontiers in Neurology with 110 articles. The most frequently occurring keywords were stroke (1,275 occurrences), transcranial magnetic stimulation (1,119 occurrences), and rehabilitation (420 occurrences). Conclusion The application of TMS in stroke research is rapidly gaining momentum, with the USA leading in publications. Prominent institutions, such as Harvard University and University College London, show potential for collaborative research. The key areas of focus include post-stroke cognitive impairment, aphasia, and dysphagia, which are expected to remain significant hotspots in future research. Future research should involve large-scale, randomized, and controlled trials in these fields. Additionally, identifying more effective combined therapies with rTMS should be a priority.
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Affiliation(s)
- Xin-Yu Li
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Rong Hu
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Tian-Xiao Lou
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Yang Liu
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Ling Ding
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
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Zhang W, Dai L, Fang L, Zhang H, Li X, Hong Y, Chen S, Zhang Y, Zheng B, Wu J, Cao M, Chen J. Effectiveness of repetitive transcranial magnetic stimulation combined with intelligent Gait-Adaptability Training in improving lower limb function and brain symmetry after subacute stroke: a preliminary study. J Stroke Cerebrovasc Dis 2024:107961. [PMID: 39173684 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES Persistent lower limb dysfunction is a major challenge in post-stroke recovery. Repetitive transcranial magnetic stimulation is recognized for addressing post-stroke motor deficits. Our study explores the efficacy of combining rTMS with gait-adaptive training to enhance lower limb function and regulatory mechanisms in subacute stroke. MATERIALS AND METHODS This randomized controlled trial enrolled 27 patients with subacute hemiparesis, dividing them into experimental and control groups. Both groups underwent gait-adaptability training 5 times/week for 4 weeks, with the experimental group receiving daily low-frequency transcranial magnetic stimulation before training. Primary outcomes included the pairwise derived brain symmetry index, lower-extremity Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale. Assessments occurred before and after the four-week intervention. RESULTS The experimental and control groups showed significant improvements in the Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale after the 4-week intervention compared to baseline (all p<0.05). However, the experimental group demonstrated significantly greater improvements compared to the control group in the Fugl-Meyer Assessment (p=0.024) and the 10-meter walk test (p=0.033). Additionally, the experimental group exhibited a more pronounced decrease in the pairwise derived brain symmetry index (p=0.026) compared to the control group. Within the experimental group, the cortical subgroup's pairwise derived brain symmetry index was significantly lower than that of the control group (p=0.006). CONCLUSIONS Combining low-frequency transcranial magnetic stimulation with Gait-Adaptive Training effectively enhances lower limb function and Regulatory mechanisms of the cerebral hemisphere in subacute stroke recovery, and it can provide rapid and effective rehabilitation effect compared with gait adaptation training alone.
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Affiliation(s)
- Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Lei Dai
- Psychological Hospital of Anhui Medical University; Anhui Mental Health Center; Hefei Fourth People's Hospital
| | - Linjie Fang
- Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China
| | - Huihuang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Xiang Li
- Xiang'an Hospital of Xiamen University, School of Medicine, 361000, Xiamen, China
| | - Yu Hong
- Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China
| | - Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Yujia Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Jianing Wu
- Department of Medical Rehabilitation, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, 310016, Hangzhou, Zhejiang, China
| | - Manting Cao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China.
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Fan S, Yan L, Zhang J, Qian Y, Wang M, Yang L, Yu T. Effects of repetitive transcranial magnetic stimulation on lower extremity motor function and optimal parameters in stroke patients with different stages of stroke: a systematic evaluation and meta-analysis. Front Neurol 2024; 15:1372159. [PMID: 39131051 PMCID: PMC11310066 DOI: 10.3389/fneur.2024.1372159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS), as an emerging non-invasive neuromodulation technique, is now widely employed in rehabilitation therapy. The purpose of this paper is to comprehensively summarize existing evidence regarding rTMS intervention for lower limb motor function in patients at different stages of stroke. Methods A systematic search was conducted to identify randomized controlled trials (RCTs) assessing the efficacy of rTMS for treating lower limb motor dysfunction after stroke. Multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library, were searched. The search period extended from the inception of the libraries to June 2024. Literature information was extracted, and methodological quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook. Meta-analysis was performed using Stata 17.0 software. Results Overall, 49 appropriate studies (including 3,558 stroke subjects) were found. Meta-analysis results demonstrated that rTMS effectively improved lower limb motor function across all stages of stroke. The intervention was particularly more effective in patients in the subacute stage than in the acute or chronic stages. Subgroup analysis revealed that, for acute-stage patients, low-frequency stimulation targeting the M1 or DLPFC brain regions on the unaffected side with 20-40 sessions significantly improved FMA-LE scores. In subacute-phase patients, low-frequency stimulation targeting the M1 brain regions on the unaffected side with 18 sessions significantly improved FMA-LE scores. The results demonstrated that HF-rTMS was more effective than LF-rTMS in improving walking speed, with the greatest efficacy observed at 20 sessions. While for enhancing gait balance in stroke patients, LF-rTMS with the best therapeutic effect was observed at a frequency of 20-40 treatments. Conclusion This study demonstrates the efficacy of rTMS in improving lower limb motor function, balance, and walking speed in stroke patients at various stages. The findings provide a valuable reference for the development of optimized rTMS treatment plans in clinical practice.Systematic review registration: PROSPERO: CRD42023466094.
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Affiliation(s)
- Shiyu Fan
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Long Yan
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junfeng Zhang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yulin Qian
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
| | - Meng Wang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
| | - Lingqing Yang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tao Yu
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
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Fang L, Zhang W, Wu J, Yu H, Zhang H, Chen S, Zheng B, Cao M, Zhang Y, Dai L, Chen J. Effects of combining rTMs and augmented reality gait adaptive training on walking function of patients with stroke based on three-dimensional gait analysis and sEMG: a randomized controlled trial. Physiother Theory Pract 2024:1-11. [PMID: 39007911 DOI: 10.1080/09593985.2024.2378905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke. PURPOSE To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke. METHODS The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS). RESULTS Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093). CONCLUSION The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.
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Affiliation(s)
- Linjie Fang
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wanying Zhang
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianing Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Yu
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- Department of Center for Rehabilitation Assessment and Therapy, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
| | - Huihuang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Manting Cao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujia Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Dai
- Rehabilitation Center, Hefei Fourth People's Hospital, Hefei, Anhui, China
| | - Jianer Chen
- The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University (Zhejiang Rehabilitation Medical Center), Hangzhou, China
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Geriatric Rehabilitation, Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China
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Markowska A, Tarnacka B. Molecular Changes in the Ischemic Brain as Non-Invasive Brain Stimulation Targets-TMS and tDCS Mechanisms, Therapeutic Challenges, and Combination Therapies. Biomedicines 2024; 12:1560. [PMID: 39062133 PMCID: PMC11274560 DOI: 10.3390/biomedicines12071560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic stroke is one of the leading causes of death and disability. As the currently used neurorehabilitation methods present several limitations, the ongoing research focuses on the use of non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). NIBS methods were demonstrated to modulate neural excitability and improve motor and cognitive functioning in neurodegenerative diseases. However, their mechanisms of action are not fully elucidated, and the clinical outcomes are often unpredictable. This review explores the molecular processes underlying the effects of TMS and tDCS in stroke rehabilitation, including oxidative stress reduction, cell death, stimulation of neurogenesis, and neuroprotective phenotypes of glial cells. A highlight is put on the newly emerging therapeutic targets, such as ferroptotic and pyroptotic pathways. In addition, the issue of interindividual variability is discussed, and the role of neuroimaging techniques is investigated to get closer to personalized medicine. Furthermore, translational challenges of NIBS techniques are analyzed, and limitations of current clinical trials are investigated. The paper concludes with suggestions for further neurorehabilitation stroke treatment, putting the focus on combination and personalized therapies, as well as novel protocols of brain stimulation techniques.
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Affiliation(s)
- Aleksandra Markowska
- Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Spartańska 1, 02-637 Warsaw, Poland;
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Chen SY, Tsou MH, Chen KY, Liu YC, Lin MT. Impact of repetitive transcranial magnetic stimulation on cortical activity: a systematic review and meta-analysis utilizing functional near-infrared spectroscopy evaluation. J Neuroeng Rehabil 2024; 21:108. [PMID: 38915003 PMCID: PMC11194950 DOI: 10.1186/s12984-024-01407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Repeated transcranial magnetic stimulation (rTMS) could induce alterations in cortical excitability and promote neuroplasticity. To precisely quantify these effects, functional near-infrared spectroscopy (fNIRS), an optical neuroimaging modality adept at detecting changes in cortical hemodynamic responses, has been employed concurrently alongside rTMS to measure and tailor the impact of diverse rTMS protocols on the brain cortex. OBJECTIVE This systematic review and meta-analysis aimed to elucidate the effects of rTMS on cortical hemodynamic responses over the primary motor cortex (M1) as detected by fNIRS. METHODS Original articles that utilized rTMS to stimulate the M1 cortex in combination with fNIRS for the assessment of cortical activity were systematically searched across the PubMed, Embase, and Scopus databases. The search encompassed records from the inception of these databases up until April, 2024. The assessment for risk of bias was also conducted. A meta-analysis was also conducted in studies with extractable raw data. RESULTS Among 312 studies, 14 articles were eligible for qualitative review. 7 studies were eligible for meta-analysis. A variety of rTMS protocols was employed on M1 cortex. In inhibitory rTMS, multiple studies observed a reduction in the concentration of oxygenated hemoglobin [HbO] at the ipsilateral M1, contrasted by an elevation at the contralateral M1. Meta-analysis also corroborated this consistent trend. Nevertheless, certain investigations unveiled diminished [HbO] in bilateral M1. Several studies also depicted intricate inhibitory or excitatory interplay among distinct cortical regions. CONCLUSION Diverse rTMS protocols led to varied patterns of cortical activity detected by fNIRS. Meta-analysis revealed a trend of increasing [HbO] in the contralateral cortices and decreasing [HbO] in the ipsilateral cortices following low frequency inhibitory rTMS. However, due to the heterogeneity between studies, further research is necessary to comprehensively understand rTMS-induced alterations in brain activity.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Meng-Hsuan Tsou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan
| | - Kuan-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan
| | - Yan-Ci Liu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F., No.17, Xuzhou Rd., Zhongzheng Dist, Taipei City, 10002, Taiwan.
- Physical Therapy Center, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 1, Changde St., Zhongzheng Dist, Taipei City, 10022, Taiwan.
| | - Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei City, 10002, Taiwan.
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7
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Li X, Liu J, Wei S, Yu C, Wang D, Li Y, Li J, Zhuang W, Luo RCX, Li Y, Liu Z, Su Y, Liu J, Xu Y, Fan J, Zhu G, Xu W, Tang Y, Yan H, Cho RY, Kosten TR, Zhou D, Zhang X. Cognitive enhancing effect of rTMS combined with tDCS in patients with major depressive disorder: a double-blind, randomized, sham-controlled study. BMC Med 2024; 22:253. [PMID: 38902735 PMCID: PMC11188255 DOI: 10.1186/s12916-024-03443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/24/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Cognitive dysfunction is one of the common symptoms in patients with major depressive disorder (MDD). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been studied separately in the treatment of cognitive dysfunction in MDD patients. We aimed to investigate the effectiveness and safety of rTMS combined with tDCS as a new therapy to improve neurocognitive impairment in MDD patients. METHODS In this brief 2-week, double-blind, randomized, and sham-controlled trial, a total of 550 patients were screened, and 240 MDD inpatients were randomized into four groups (active rTMS + active tDCS, active rTMS + sham tDCS, sham rTMS + active tDCS, sham rTMS + sham tDCS). Finally, 203 patients completed the study and received 10 treatment sessions over a 2-week period. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess patients' cognitive function at baseline and week 2. Also, we applied the 24-item Hamilton Depression Rating Scale (HDRS-24) to assess patients' depressive symptoms at baseline and week 2. RESULTS After 10 sessions of treatment, the rTMS combined with the tDCS group showed more significant improvements in the RBANS total score, immediate memory, and visuospatial/constructional index score (all p < 0.05). Moreover, post hoc tests revealed a significant increase in the RBANS total score and Visuospatial/Constructional in the combined treatment group compared to the other three groups but in the immediate memory, the combined treatment group only showed a better improvement than the sham group. The results also showed the RBANS total score increased significantly higher in the active rTMS group compared with the sham group. However, rTMS or tDCS alone was not superior to the sham group in terms of other cognitive performance. In addition, the rTMS combined with the tDCS group showed a greater reduction in HDRS-24 total score and a better depression response rate than the other three groups. CONCLUSIONS rTMS combined with tDCS treatment is more effective than any single intervention in treating cognitive dysfunction and depressive symptoms in MDD patients. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100052122).
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Affiliation(s)
- Xingxing Li
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Junyao Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shuochi Wei
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Chang Yu
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuchen Li
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Jiaxin Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wenhao Zhuang
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Rui-Chen-Xi Luo
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Yanli Li
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Zhiwang Liu
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Yuqiu Su
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Jimeng Liu
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Yongming Xu
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China
| | - Jialin Fan
- The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Guidong Zhu
- The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Weiqian Xu
- Taizhou Second People's Hospital, Taizhou, Zhejiang, China
| | - Yiping Tang
- Taizhou Second People's Hospital, Taizhou, Zhejiang, China
| | - Hui Yan
- Taizhou Second People's Hospital, Taizhou, Zhejiang, China
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Thomas R Kosten
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Dongsheng Zhou
- Ningbo Key Laboratory for Physical Diagnosis and Treatment of Mental and Psychological Disorders, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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8
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Wang C, Zhang Q, Zhang L, Zhao D, Xu Y, Liu Z, Wu C, Wu S, Yong M, Wu L. Comparative efficacy of different repetitive transcranial magnetic stimulation protocols for lower extremity motor function in stroke patients: a network meta-analysis. Front Neurosci 2024; 18:1352212. [PMID: 38426021 PMCID: PMC10902063 DOI: 10.3389/fnins.2024.1352212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Lower extremity motor dysfunction is one of the most severe consequences after stroke, restricting functional mobility and impairing daily activities. Growing evidence suggests that repetitive transcranial magnetic stimulation (rTMS) can improve stroke patients' lower extremity motor function. However, there is still controversy about the optimal rTMS protocol. Therefore, we compared and analyzed the effects of different rTMS protocols on lower extremity motor function in stroke patients using network meta-analysis (NMA). Methods We systematically searched CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases (from origin to 31 December 2023). Randomized controlled trials (RCTs) or crossover RCTs on rTMS improving lower extremity motor function in stroke patients were included. Two authors independently completed article screening, data extraction, and quality assessment. RevMan (version 5.4) and Stata (version 17.0) were used to analyze the data. Results A total of 38 studies with 2,022 patients were eligible for the NMA. The interventions included HFrTMS-M1, LFrTMS-M1, iTBS-Cerebellum, iTBS-M1, dTMS-M1, and Placebo. The results of NMA showed that LFrTMS-M1 ranked first in FMA-LE and speed, and HFrTMS-M1 ranked first in BBS, TUGT, and MEP amplitude. The subgroup analysis of FMA-LE showed that HFrTMS-M1 was the best stimulation protocol for post-stroke time > 1 month, and LFrTMS-M1 was the best stimulation protocol for post-stroke time ≤ 1 month. Conclusion Considering the impact of the stroke phase on the lower extremity motor function, the current research evidence shows that HFrTMS-M1 may be the preferred stimulation protocol to improve the lower extremity motor function of patients for post-stroke time > 1 month, and LFrTMS-M1 for post-stroke time ≤ 1 month. However, the above conclusion needs further analysis and validation by more high-quality RCTs.Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier (CRD42023474215).
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Affiliation(s)
- Chengshuo Wang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Qin Zhang
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Linli Zhang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | | | - Yanan Xu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Zejian Liu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Chunli Wu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Shengzhu Wu
- Department of Rehabilitation Medicine, Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan, China
| | - Mingjin Yong
- Department of Rehabilitation, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China
| | - Liang Wu
- Beijing Xiaotangshan Hospital, Beijing, China
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Marín-Medina DS, Arenas-Vargas PA, Arias-Botero JC, Gómez-Vásquez M, Jaramillo-López MF, Gaspar-Toro JM. New approaches to recovery after stroke. Neurol Sci 2024; 45:55-63. [PMID: 37697027 PMCID: PMC10761524 DOI: 10.1007/s10072-023-07012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
After a stroke, several mechanisms of neural plasticity can be activated, which may lead to significant recovery. Rehabilitation therapies aim to restore surviving tissue over time and reorganize neural connections. With more patients surviving stroke with varying degrees of neurological impairment, new technologies have emerged as a promising option for better functional outcomes. This review explores restorative therapies based on brain-computer interfaces, robot-assisted and virtual reality, brain stimulation, and cell therapies. Brain-computer interfaces allow for the translation of brain signals into motor patterns. Robot-assisted and virtual reality therapies provide interactive interfaces that simulate real-life situations and physical support to compensate for lost motor function. Brain stimulation can modify the electrical activity of neurons in the affected cortex. Cell therapy may promote regeneration in damaged brain tissue. Taken together, these new approaches could substantially benefit specific deficits such as arm-motor control and cognitive impairment after stroke, and even the chronic phase of recovery, where traditional rehabilitation methods may be limited, and the window for repair is narrow.
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Affiliation(s)
- Daniel S Marín-Medina
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Paula A Arenas-Vargas
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan C Arias-Botero
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuela Gómez-Vásquez
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuel F Jaramillo-López
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge M Gaspar-Toro
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
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10
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Zhang W, Dai L, Liu W, Li X, Chen J, Zhang H, Chen W, Duan W. The effect and optimal parameters of repetitive transcranial magnetic stimulation on lower extremity motor function in stroke patient: a systematic review and meta-analysis. Disabil Rehabil 2023:1-12. [PMID: 37991330 DOI: 10.1080/09638288.2023.2283605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE This study aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treating lower limb motor dysfunction after stroke and explore the optimal stimulation parameters. METHODS PubMed, Embase, Cochrane Library, and other relevant databases were systematically queried for randomised controlled trials (RCTs) investigating the efficacy of rTMS in addressing lower limb motor dysfunction post-stroke. The search encompassed records from inception to July 2022. The assessed outcomes encompassed parameters such as the Fugl-Meyer motor function score for lower limbs, balance function, and Barthel index (BI). Three independent researchers were responsible for research selection, data extraction, and quality assessment. Study screening, data extraction, and bias evaluation were performed independently by two reviewers. Data synthesis was undertaken using Review Manager 5.3, while Stata version 14.0 software was employed for generating the funnel plot. RESULTS A total of 13 studies and 428 patients were included. The meta-analysis indicated that rTMS had a positive effect on the BI (MD = 5.87, 95% CI [0.99, 10.76], p = 0.02, I2 = 86%, N of studies = 8, N of participants = 248). Subgroup analysis was performed on the stimulation frequency, treatment duration, and different stroke stages (stimulation frequency was low-frequency (LF)-rTMS (MD = 4.45, 95% CI [1.05, 7.85], p = 0.01, I2 = 0%, N of studies = 4, N of participants = 120); treatment time ≤ 15 d: (MD = 4.41, 95% CI [2.63, 6.18], p < 0.00001, I2 = 0%, N of studies = 4, N of participants = 124); post-stroke time ≤6 months: (MD = 4.37, 95% CI [2.42, 6.32], p < 0.0001, I2 = 0%, N of studies = 5, N of participants = 172). CONCLUSION LF-rTMS had a significant improvement effect on BI score, while high-frequency (HF)-rTMS and iTBS had no significant effect. And stroke time ≤6 months in patients with treatment duration ≤15 d had the best treatment effect.
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Affiliation(s)
- Wanying Zhang
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Lei Dai
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Wentan Liu
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Xiang Li
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Jianer Chen
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
- Geriatric rehabilitation Department, Zhejiang Rehabilitation Medical Center, Hangzhou, PR China
| | - Huihang Zhang
- The Third Clinical College, Zhejiang Chinese Medical University, Hangzhou, PR China
- Rehabilitation Department, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Weihai Chen
- College of Automation Science and Electrical Engineering, Beihang University, Hangzhou, PR China
| | - Wen Duan
- College of Automation Science and Electrical Engineering, Beihang University, Hangzhou, PR China
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Hofmeijer J, Ham F, Kwakkel G. Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope? Stroke 2023; 54:2500-2511. [PMID: 37747964 DOI: 10.1161/strokeaha.123.043159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Evidence of efficacy of repetitive transcranial magnetic stimulation (rTMS) for stroke recovery is hampered by an unexplained variability of reported effect sizes and an insufficient understanding of mechanisms of action. We aimed to (1) briefly summarize evidence of efficacy, (2) identify critical factors to explain the reported variation in effects, and (3) provide mechanism-based recommendations for future trials. METHODS We performed a systematic review of the literature according to Cochrane and PRISMA Protocols. We included trials with ≥10 patients per treatment group. We classified outcome measures according to the International Classification of Functioning, Disability, and Health. Meta-analysis was done when at least 3 trials were reported on the same construct. In case of significant summary effect sizes with significant heterogeneity, we used sensitivity analyses to test for correlations and differences between found individual effect sizes and possible effect modifiers such as patient-, repetitive transcranial magnetic stimulation-, and trial characteristics. RESULTS We included 57 articles (N=2595). Funnel plots showed no publication bias. We found significant effect sizes at the level of body function (upper limb synergies, muscle strength, language functioning, global cognitive functioning, visual/spatial inattention) with repetitive transcranial magnetic stimulation within or beyond 3 months after stroke. We also found significant effect sizes at the level of activities. We found no subgroup differences or significant correlations between individual summary effect sizes and any tested possible effect modifier. CONCLUSIONS Repetitive transcranial magnetic stimulation holds the potential to benefit a range of motor and cognitive outcomes after stroke, but the evidence of efficacy is challenged by unexplained heterogeneity across many small sampled trials. We propose large trials with the collection of individual patient data on baseline severity and brain network integrity with sufficiently powered subgroup analyses, as well as protocolized time-locked training of the target behavior. Additional neurophysiological and biomechanical data may help in understanding mechanisms and identifying biomarkers of treatment efficacy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: CRD42022300330.
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Affiliation(s)
- Jeannette Hofmeijer
- Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands (J.H.)
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (J.H.)
| | - Florien Ham
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (J.H.)
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands (G.K.)
- Department of Acquired Brain Injuries, Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, the Netherlands (G.K.)
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.)
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12
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Lima E, de Souza Neto JMR, Andrade SM. Effects of transcranial direct current stimulation on lower limb function, balance and quality of life after stroke: a systematic review and meta-analysis. Neurol Res 2023; 45:843-853. [PMID: 37183510 DOI: 10.1080/01616412.2023.2211457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This systematic review with meta-analysis aimed to evaluate the effectiveness of tDCS on lower limb function, balance and quality of life in stroke patients. METHODS The search included PubMed, CENTRAL, PEDro, Web of Science, SCOPUS, PsycINFO Ovid, CINAHL EBSCO, EMBASE, ScienceDirect, reference lists of relevant reviews, clinical trials registries and academic google, in June and July 2021. Randomized controlled trials were selected, which present the effect of tDCS on lower limb motor function recovery in stroke patients, comparing any type of active tDCS versus sham; parallel or crossover study design; adult patients; stimulation on the primary motor cortex; articles published in any language; without restriction of publication period. RESULTS Nineteen studies were included. The treatment with active tDCS did not improve motor function (Chi2 = 32,87, I2 = 76%, SMD = 0,36 e 95% CI -0,18-0,90). Subgroup analyzes showed a significant effect favorable to tDCS, in relation to motor function, in the acute and subacute post stroke phases. However, the quality of evidence for this outcome was very low. Regarding balance outcome, a meta-analysis showed a significant difference in favor of active tDCS, but the quality of the evidence was considered very low. As for the quality of life outcome, no statistically significant difference was found in favor of tDCS. DISCUSSION There is a lack of evidence in recommending the use of tDCS in isolation in the treatment of patients after stroke, aiming at improving motor function, balance and quality of life. However, it is possible that tDCS can be beneficial when associated with other therapies or interventions.
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Affiliation(s)
- Eloise Lima
- Aging and Neuroscience Laboratory, Federal University of Paraíba, João Pessoa, Brazil
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13
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Parreira RB, Oliveira CS. Improvement of motor control in neurological patients through motor evoked potential changes induced by transcranial direct current stimulation therapy: A meta-analysis study. Gait Posture 2023; 106:53-64. [PMID: 37660514 DOI: 10.1016/j.gaitpost.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) seems to facilitate and/or inhibit neural activity and improve motor function in neurological patients. However, it is important to confirm such improvements as well as determine the association between neurophysiological changes and the enhancement of motor control. RESEARCH QUESTION Does the improvement of motor control in neurological patients after transcranial direct current stimulation translate into changes in the motor evoked potential? METHODS A systematic electronic search strategy was employed to identify studies indexed in the PubMed, BIREME, and COCHRANE databases using a combination of search terms adapted to each database: transcranial direct current stimulation; evoked potential motor; and motor control. Relevant data was extracted from each selected article and methodological quality was assessed using the PEDro scale. Standard mean differences with 95% confidence intervals were pooled using a random-effects model. Moreover, standard methods were employed for assessment of the heterogeneity of the studies. RESULTS Thirteen articles were included in this review. Anodal tDCS was found to increase the amplitude and diminish the latency of the MEP, which correlated positively with improvements in motor control. However, the improvement in MEP did not persist over time. SIGNIFICANCE Despite the paucity of studies, positive effects are found when combining anodal tDCS and a therapeutic intervention, such as an improvement in MEP and better motor control in neurological patients. Future studies should include neurophysiological measures other than MEP and consider a homogenous analysis.
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Affiliation(s)
- Rodolfo Borges Parreira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Doutor Cesário Motta Júnior st. #61, zip code 01221-020, São Paulo, SP, Brazil; PostureLab, 20 rue du rendez-vous, 75012 Paris, France; Universidade Evangelica de Goias, Universitária av. 3,5 - Cidade Universitária, zip code: 75083-515, Anápolis, GO, Brazil.
| | - Claudia Santos Oliveira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Doutor Cesário Motta Júnior st. #61, zip code 01221-020, São Paulo, SP, Brazil; Universidade Evangelica de Goias, Universitária av. 3,5 - Cidade Universitária, zip code: 75083-515, Anápolis, GO, Brazil.
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14
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Hu AM, Huang CY, He JG, Wu L. Effect of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on post-stroke dysmnesia: A preliminary study. Clin Neurol Neurosurg 2023; 231:107797. [PMID: 37263069 DOI: 10.1016/j.clineuro.2023.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study examined the effect of repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) as a bimodal neuromodulatory approach for post-stroke dysmnesia. METHODS Thirty-four patients with post-stroke dysmnesia were randomly allocated into a sham group treated with neither rTMS nor tDCS, a group treated with rTMS, and a group treated with a combination of rTMS and tDCS. All three groups received cognitive rehabilitation training for 4 weeks. The memory function of each group before and after the intervention was assessed using the Montreal Cognitive Assessment (MoCA) and Rivermead Behavioral Memory Test (RBMT) scales, as well as in terms of the Mismatch Negativity(MMN)and P300 of event-related potentials. RESULTS The sham, rTMS, and rTMS-tDCS groups all showed improvement in the total MoCA score after the intervention. Delayed recall, a MoCA item, scored better in the rTMS-tDCS group than in the rTMS and sham groups. Delayed processing, an RBMT item, scored better in the rTMS-tDCS combination group than in the rTMS and sham groups. MMN and P300 latency was significantly shorter in the rTMS-tDCS combination group. CONCLUSION rTMS-tDCS bimodal stimulation was more effective than cognitive rehabilitation or rTMS alone in treating patients with post-stroke dysmnesia, offering new possibilities for enhancing cognitive function and treating post-stroke dysmnesia.
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Affiliation(s)
- An-Ming Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Cui-Ying Huang
- Affiliated Hospital of Jining Medical University, Shandong 272007, China
| | - Jian-Gen He
- Beijing Xiaotangshan Hospital, Beijing 102211, China
| | - Liang Wu
- Beijing Xiaotangshan Hospital, Beijing 102211, China.
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15
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Zhou K, Zhou Y, Zeng Y, Zhang J, Cai X, Qin J, Li Z, Yan F. Research Hotspots and Global Trends of Transcranial Direct Current Stimulation in Stroke: A Bibliometric Analysis. Neuropsychiatr Dis Treat 2023; 19:601-613. [PMID: 36950717 PMCID: PMC10025138 DOI: 10.2147/ndt.s400923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023] Open
Abstract
Purpose Transcranial direct current stimulation has been widely used in the clinical treatment of stroke. The purpose of this study was to perform a bibliometric analysis of scientific literature in this field. Methods Articles and reviews regarding transcranial direct current stimulation in stroke from January 01, 2004 to May 31, 2022 were identified from the Science Citation Index-Expanded of the Web of Science Core Collection database. CiteSpace 6.1.R2, Bibliometrix and the Bibliometric Online Analysis Platform were used to analyze data. Results A total of 905 papers were obtained, with the highest number of publications coming from the USA. The institutions and authors with the most publications were Harvard Medical School and Fregni F respectively. Nitsche MA had the most co-citations, followed by Fregni F. Neurosciences was the most fruitful research area and Brain Stimulation had the highest H-index. The research topics could be divided into three sections: mechanisms of treatment, comparison of efficacy with transcranial magnetic stimulation, clinical application of post-stroke dysfunction. The field of "walking", "strength" and "virtual reality therapy" are the future research hotspots of transcranial direct current stimulation. Conclusion The overall research showed a slow growth trend, and the outstanding contribution of the USA in this field cannot be ignored. Relevant researchers are suggested to focus on international collaboration and actively conduct high-quality randomized controlled clinical trials on research hotspots and frontiers in order to identify the optimal stimulation paradigm for clinical purposes.
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Affiliation(s)
- Kebing Zhou
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Yu Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Yuena Zeng
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Jiahui Zhang
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Xiaoyan Cai
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Jieying Qin
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Zhiying Li
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Fengxia Yan
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
- Correspondence: Fengxia Yan; Jiahui Zhang, School of Nursing, Jinan University, 601 Huangpu Avenue West, Tianhe District, Guangzhou, 510632, People’s Republic of China, Tel +86-20-85225836, Fax +86-20-8522227, Email ;
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Yasaroglu S, Liepert J. Transcranial direct current stimulation in stroke - Motor excitability and motor function. Clin Neurophysiol 2022; 144:16-22. [PMID: 36208617 DOI: 10.1016/j.clinph.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/28/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterize motor excitability changes and changes of motor performance induced by a single anodal and cathodal transcranial direct current stimulation (tDCS) session in stroke patients. METHODS Twenty subacute stroke patients participated. Motor performance was tested with the Box and Block Test [BBT]. Motor cortex excitability (short interval intracortical inhibition [SICI], intracortical facilitation [ICF], long interval intracortical inhibition [LICI]) was examined by paired pulse transcranial magnetic stimulation before and after a single tDCS session (20 minutes, 1,0 mA). On two different occasions, patients received anodal and cathodal tDCS over the affected hemisphere. TMS recordings were taken from both hands consecutively. RESULTS Anodal tDCS significantly reduced SICI without changing ICF or LICI. Cathodal tDCS did not change motor excitability. Both types of tDCS did not alter motor performance. Even prior to anodal tDCS, SICI in the affected hemisphere was lower than in the unaffected hemisphere and was correlated with BBT changes after anodal tDCS. CONCLUSIONS Anodal, but not cathodal tDCS specifically modulated intracortical inhibitory circuits, leading to a disinhibition. SIGNIFICANCE The results amplify our knowledge on excitability modulations of tDCS in stroke patients.
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Kashoo FZ, Al-Baradie RS, Alzahrani M, Alanazi A, Manzar MD, Gugnani A, Sidiq M, Shaphe MA, Sirajudeen MS, Ahmad M, Althumayri B, Aljandal A, Almansour A, Alshewaier SA, Chahal A. Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15199. [PMID: 36429924 PMCID: PMC9690138 DOI: 10.3390/ijerph192215199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. METHODS A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. RESULTS Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. CONCLUSIONS Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.
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Affiliation(s)
- Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Raid Saleem Al-Baradie
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzahrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Anchit Gugnani
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Sidiq
- NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India
| | - Mohammad Abu Shaphe
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Mohamed Sherif Sirajudeen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Bader Althumayri
- Department of Physical Therapy, Security Forces Hospital, Riyadh 11564, Saudi Arabia
| | - Abdullah Aljandal
- Department of Physical Therapy and Rehabilitation, Al Fayha Club, Al Majmmah 11952, Saudi Arabia
| | - Ahmed Almansour
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Shady Abdullah Alshewaier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia
| | - Aksh Chahal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar, Mullana 133207, Haryana, India
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Zhi JF, Liao QH, He YB, Xu WW, Zhu DW, Shao LH. Superior treatment efficacy of neuromodulation rehabilitation for upper limb recovery after stroke: a meta-analysis. Expert Rev Neurother 2022; 22:875-888. [PMID: 36242781 DOI: 10.1080/14737175.2022.2137405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aims to explore the treatment efficacy of different motor rehabilitation interventions for upper limb impairment recovery. RESEARCH DESIGN & METHODS Publications were searched in PubMed and Embase. 4 grouped motor rehabilitation treatments (training, technological intervention, pharmacological intervention, and neuromodulation) were compared. The change of the Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) was applied to assess upper limb function after stroke. RESULTS 56 studies including 5292 patients were identified. A significant difference was found among the 4 groups (P = 0.02). Neuromodulation interventions had the best treatment efficacy among the 4 types of interventions (P < 0.01). Among neuromodulation interventions, acupuncture, electric, or magnetic intervention all had therapeutic efficacy for stroke upper limb recovery, without significant subgroup difference (P = 0.34). Stroke patients with mild upper limb impairment might not benefit from motor rehabilitation (P = 0.14). CONCLUSION Neuromodulation interventions might have the best therapeutic efficacy among motor rehabilitation treatments for upper limb impairment after stroke. It is a potential treatment direction for upper limb recovery among stroke patients. However, since a large proportion of the original studies are low to very low-quality evidence, large-scale RCTs should be conducted in the future to validate current findings and assess treatment effects based on patient characteristics.
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Affiliation(s)
- Jian-Feng Zhi
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Qing-Hong Liao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yu-Bo He
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Wen-Wen Xu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Dan-Wei Zhu
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Lin-Hong Shao
- Department of Rehabilitation Medicine, the First People's Hospital of Jiashan/Jiashan Branch of the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
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Kim YW. Update on Stroke Rehabilitation in Motor Impairment. BRAIN & NEUROREHABILITATION 2022; 15:e12. [PMID: 36743199 PMCID: PMC9833472 DOI: 10.12786/bn.2022.15.e12] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/08/2022] Open
Abstract
Motor impairment due to stroke limits patients' mobility, activities of daily living, and negatively affects their return to the workplace. It also reduces patients' quality of life and increases the socioeconomic burden of stroke. Therefore, optimizing the recovery of motor impairment after stroke is a very important goal for both individuals and society as a whole. The emergence and improvement of various technologies in the Fourth Industrial Revolution have exerted a major influence on the development of new rehabilitation methods and efficiency enhancements for existing methods. This review categorizes rehabilitation methods that promote the recovery of motor function into upper limb function and lower limb function and summarizes recent advances in stroke rehabilitation. Although debate continues regarding the effects of some rehabilitation therapies, it is hoped that the evidence will be improved through ongoing research so that clinicians can treat patients with a higher level of evidence.
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Affiliation(s)
- Yeong Wook Kim
- Department of Rehabilitation Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
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Zhong M. Effect of Core Muscle Strength Training Combined with Taijiquan on Bone Mineral Density Measured by Quantitative CT Scanning in the Elderly. SCANNING 2022; 2022:6942081. [PMID: 35795616 PMCID: PMC9152348 DOI: 10.1155/2022/6942081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Learn about the benefits of muscle strength training combined with tai chi for adult skeletal muscle in multiple CT scanning. The study included 182 people over the age of 60 with no long-term history of physical activity and exercise. They were divided into the Taijiquan group (52 people), student muscle strength group (45 people), student muscle group combined with Taijiquan group (45 people), and control group (40 people). The board of directors did not attend. The other three groups received tai chi (more than 4 times a week), muscle strength training, and muscle training combined with tai chi for 6 months. Lumbar spine (L1-4) BMD and Berg scores were approximately the same as those measured in adults before exercise and at 3 and 6 months after exercise. The results showed that there were significant differences in the scores of lumbar spine BMD and Berg Balance Scale between the Taijiquan group and students before and after exercise combined with muscle strength training (P < 0.05 or <0.01). The difference was statistically significant (P < 0.05). The scores of lumbar BMD and Berg Balance Scale in the core muscle strength training combined with Taijiquan group after 6 months of exercise were higher than those after 3 months of exercise (P < 0.05), and the CT value of lumbar vertebral bone calcium was significantly positively correlated with BMD (Pearson correlation coefficients of L5 vertebral body were r = 0.704, 0.683, 0.728, 0.673, and 0.686, P < 0.01). Single or combined training of core muscle strength or Taijiquan can improve lumbar bone mineral density and balance function in the elderly.
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Affiliation(s)
- Mingliang Zhong
- Zhengzhou Preschool Education College, Zhengzhou, Henan 450000, China
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21
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Bai Z, Zhang J, Fong KNK. Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2022; 19:24. [PMID: 35193624 PMCID: PMC8862292 DOI: 10.1186/s12984-022-00999-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke. Methods A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols—low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses. Results Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals’ resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures. Conclusions Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00999-4.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China.,Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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22
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Vabalaite B, Petruseviciene L, Savickas R, Kubilius R, Ignatavicius P, Lendraitiene E. Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111215. [PMID: 34833433 PMCID: PMC8617907 DOI: 10.3390/medicina57111215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/26/2022]
Abstract
Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.
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Affiliation(s)
- Birute Vabalaite
- Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania; (L.P.); (R.S.); (R.K.); (E.L.)
- Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-3732-7182
| | - Laura Petruseviciene
- Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania; (L.P.); (R.S.); (R.K.); (E.L.)
- Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania; (L.P.); (R.S.); (R.K.); (E.L.)
- Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
| | - Raimondas Kubilius
- Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania; (L.P.); (R.S.); (R.K.); (E.L.)
- Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
| | - Povilas Ignatavicius
- Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania;
| | - Egle Lendraitiene
- Department of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eiveniu Str. 2, LT-50161 Kaunas, Lithuania; (L.P.); (R.S.); (R.K.); (E.L.)
- Department of Rehabilitation, Lithuanian University of Health Sciences, Mickeviciaus Str. 7, LT-44307 Kaunas, Lithuania
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