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Zhang JJ, Sui Y, Sack AT, Bai Z, Kwong PWH, Sanchez Vidana DI, Xiong L, Fong KNK. Theta burst stimulation for enhancing upper extremity motor functions after stroke: a systematic review of clinical and mechanistic evidence. Rev Neurosci 2024; 35:679-695. [PMID: 38671584 DOI: 10.1515/revneuro-2024-0030] [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: 02/25/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
This systematic review aimed to evaluate the effects of different theta burst stimulation (TBS) protocols on improving upper extremity motor functions in patients with stroke, their associated modulators of efficacy, and the underlying neural mechanisms. We conducted a meta-analytic review of 29 controlled trials published from January 1, 2000, to August 29, 2023, which investigated the effects of TBS on upper extremity motor, neurophysiological, and neuroimaging outcomes in poststroke patients. TBS significantly improved upper extremity motor impairment (Hedge's g = 0.646, p = 0.003) and functional activity (Hedge's g = 0.500, p < 0.001) compared to controls. Meta-regression revealed a significant relationship between the percentage of patients with subcortical stroke and the effect sizes of motor impairment (p = 0.015) and functional activity (p = 0.018). Subgroup analysis revealed a significant difference in the improvement of upper extremity motor impairment between studies using 600-pulse and 1200-pulse TBS (p = 0.002). Neurophysiological studies have consistently found that intermittent TBS increases ipsilesional corticomotor excitability. However, evidence to support the regional effects of continuous TBS, as well as the remote and network effects of TBS, is still mixed and relatively insufficient. In conclusion, TBS is effective in enhancing poststroke upper extremity motor function. Patients with preserved cortices may respond better to TBS. Novel TBS protocols with a higher dose may lead to superior efficacy compared with the conventional 600-pulse protocol. The mechanisms of poststroke recovery facilitated by TBS can be primarily attributed to the modulation of corticomotor excitability and is possibly caused by the recruitment of corticomotor networks connected to the ipsilesional motor cortex.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | - Youxin Sui
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Zhongfei Bai
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), School of Medicine, Tongji University, Shanghai, China
| | - Patrick W H Kwong
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
| | | | - Li Xiong
- Clinical Trials Centre, 26469 The Eighth Affiliated Hospital of Sun Yat-Sen University , Shenzhen, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, 26680 The Hong Kong Polytechnic University , Hong Kong SAR, China
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Patel D, Banerjee R, Farooque K, Gupta D, Garg B, Kumar N, Thukral GH, Kochhar KP, Jain S. Restoring initial steps by intermittent theta burst stimulation in complete spinal cord injury patient: a case report. Spinal Cord Ser Cases 2024; 10:56. [PMID: 39098854 PMCID: PMC11298536 DOI: 10.1038/s41394-024-00669-8] [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: 02/19/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) causes damage to neurons and results in motor and sensory dysfunction. Intermittent theta burst stimulation (iTBS) has been used to induce neuronal and synaptic plasticity by applying a magnetic field in the brain. The plasticity induced in the cortex has an imperative role in the recovery of motor and sensory functioning. However, the effect of iTBS in complete SCI patients is still elusive. CASE PRESENTATION We report here the case of a 27-year-old female who sustained an L1 complete spinal cord injury (SCI) with an ASIA score of A. The patient lost all the sensory and motor functions below the level of injury. Intermittent theta burst stimulation (iTBS) was administered at 80% of the resting motor threshold over the M1 motor cortex, along with intensive rehabilitation training to promote sensorimotor function. DISCUSSION There was a partial recovery in functional, electrophysiological, and neurological parameters. The case report also demonstrates the safety and efficacy of iTBS in complete SCI patients. No adverse event has been observed in the patient during intervention sessions.
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Affiliation(s)
- Deeksha Patel
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Rohit Banerjee
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Gita H Thukral
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Kanwal Preet Kochhar
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Suman Jain
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India.
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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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Liu M, Yu C, Shi J, Xu Y, Li Z, Huang J, Si Z, Yao L, Yin K, Zhao Z. Effects of one-week bilateral cerebellar iTBS on resting-state functional brain network and multi-task attentional performance in healthy individuals: A randomized, sham-controlled trial. Neuroimage 2024; 295:120648. [PMID: 38761882 DOI: 10.1016/j.neuroimage.2024.120648] [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: 02/26/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Cerebellar intermittent theta burst stimulation (iTBS) modulates the excitability of the cerebral cortex and may enhance attentional performance. To date, few studies have conducted iTBS on healthy subjects for one week and used electroencephalography (EEG) to investigate the effect of multiple stimulation sessions on resting-state functional brain networks and the daily stimulation effect on attentional performance. METHODS 16 healthy subjects participated in a one-week experiment, receiving bilateral cerebellar iTBS or sham stimulation and engaging in multi-task attentional training. The primary measures were the one-week attentional performance and pre- and post-experiment resting-state EEG activities. Amplitude Envelope Correlation (AEC) was used to construct the functional connectivity in the eye-open (EO) and eye-closed (EC) phases. RESULTS At least three sessions of iTBS were required to enhance multi-task performance significantly, whereas only one or two sessions failed to elicit the improvement. Compared with the control group, iTBS induced significant changes in PSD, AEC functional connectivity, and AEC network properties during the EO phase, while it had little effect during the EC phase. During the EO phase, the network property changes of the iTBS subject were correlated with improved attentional performance. CONCLUSION The multi-task performance requires multiple stimulations to enhance. iTBS affects the resting-state alpha band brain activities during the EO rather than the EC phase. The AEC network properties may serve as a biomarker to assess the attentional potential of healthy subjects.
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Affiliation(s)
- Meiliang Liu
- School of Artificial Intelligence, Beijing Normal University, Beijing, China.
| | - Chao Yu
- Nanjing Research Institute of Electronics Technology, Nanjing, China.
| | - Jinping Shi
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yunfang Xu
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Zijin Li
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Junhao Huang
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Zhengye Si
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Li Yao
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Kuiying Yin
- Nanjing Research Institute of Electronics Technology, Nanjing, China.
| | - Zhiwen Zhao
- School of Artificial Intelligence, Beijing Normal University, Beijing, China; Advanced Institute of Natural Sciences, Beijing Normal University, Zhuhai, China.
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Li M, Zou F, Zheng T, Zou W, Li H, Lin Y, Peng L, Zheng S. Electroacupuncture alters brain network functional connectivity in subacute stroke: A randomised crossover trial. Medicine (Baltimore) 2024; 103:e37686. [PMID: 38579054 PMCID: PMC10994512 DOI: 10.1097/md.0000000000037686] [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: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Electroacupuncture (EA) is a promising rehabilitation treatment for upper-limb motor recovery in stroke patients. However, the neurophysiological mechanisms underlying its clinical efficacy remain unclear. This study aimed to explore the immediate modulatory effects of EA on brain network functional connectivity and topological properties. METHODS The randomized, single-blinded, self-controlled two-period crossover trial was conducted among 52 patients with subacute subcortical stroke. These patients were randomly allocated to receive either EA as the initial intervention or sham electroacupuncture (SEA) as the initial intervention. After a washout period of 24 hours, participants underwent the alternate intervention (SEA or EA). Resting state electroencephalography signals were recorded synchronously throughout both phases of the intervention. The functional connectivity (FC) of the parietofrontal network and small-world (SW) property indices of the whole-brain network were compared across the entire course of the two interventions. RESULTS The results demonstrated that EA significantly altered ipsilesional parietofrontal network connectivity in the alpha and beta bands (alpha: F = 5.05, P = .011; beta: F = 3.295, P = .047), whereas no significant changes were observed in the SEA group. When comparing between groups, EA significantly downregulated ipsilesional parietofrontal network connectivity in both the alpha and beta bands during stimulation (alpha: t = -1.998, P = .049; beta: t = -2.342, P = .022). Significant differences were also observed in the main effects of time and the group × time interaction for the SW index (time: F = 5.516, P = .026; group × time: F = 6.892, P = .01). In terms of between-group comparisons, the EA group exhibited a significantly higher SW index than the SEA group at the post-stimulation stage (t = 2.379, P = .018). CONCLUSION These findings suggest that EA downregulates ipsilesional parietofrontal network connectivity and enhances SW properties, providing a potential neurophysiological mechanism for facilitating motor performance in stroke patients.
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Affiliation(s)
- Mingfen Li
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Fei Zou
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tingting Zheng
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Weigeng Zou
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Haifeng Li
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yifang Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Peng
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
| | - Su Zheng
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Ding Q, Ou Z, Yao S, Wu C, Chen J, Shen J, Lan Y, Xu G. Cortical activation and brain network efficiency during dual tasks: An fNIRS study. Neuroimage 2024; 289:120545. [PMID: 38367652 DOI: 10.1016/j.neuroimage.2024.120545] [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: 08/30/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE Dual task (DT) is a commonly used paradigm indicative of executive functions. Brain activities during DT walking is usually measured by portable functional near infrared spectroscopy (fNIRS). Previous studies focused on cortical activation in prefrontal cortex and overlooked other brain regions such as sensorimotor cortices. This study is aimed at investigating the modulations of cortical activation and brain network efficiency in multiple brain regions from single to dual tasks with different complexities and their relationships with DT performance. METHODS Forty-two healthy adults [12 males; mean age: 27.7 (SD=6.5) years] participated in this study. Participants performed behavioral tasks with portable fNIRS simultaneous recording. There were three parts of behavioral tasks: cognitive tasks while standing (serial subtraction of 3's and 7's), walking alone and DT (walk while subtraction, including serial subtraction of 3's and 7's). Cognitive cost, walking cost and cost sum (i.e., sum of cognitive and walking costs) were calculated for DT. Cortical activation, local and global network efficiency were calculated for each task. RESULTS The cognitive cost was greater and the walking cost was less during DT with subtraction 3's compared with 7's (P's = 0.032 and 0.019, respectively). Cortical activation and network efficiency were differentially modulated among single and dual tasks (P's < 0.05). Prefrontal activation during DT was positively correlated with DT costs, while network efficiency was negatively correlated with DT costs (P's < 0.05). CONCLUSIONS Our results revealed prefrontal over-activation and reduced network efficiency in individuals with poor DT performance. Our findings suggest that reduced network efficiency could be a possible mechanism contributing to poor DT performance, which is accompanied by compensatory prefrontal over-activation.
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Affiliation(s)
- Qian Ding
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zitong Ou
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Rehabilitation Medicine, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shantong Yao
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Rehabilitation Medicine, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Chen
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Junhui Shen
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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Cai G, Xu J, Ding Q, Lin T, Chen H, Wu M, Li W, Chen G, Xu G, Lan Y. Electroencephalography oscillations can predict the cortical response following theta burst stimulation. Brain Res Bull 2024; 208:110902. [PMID: 38367675 DOI: 10.1016/j.brainresbull.2024.110902] [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: 11/30/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Continuous theta burst stimulation and intermittent theta burst stimulation are clinically popular models of repetitive transcranial magnetic stimulation. However, they are limited by high variability between individuals in cortical excitability changes following stimulation. Although electroencephalography oscillations have been reported to modulate the cortical response to transcranial magnetic stimulation, their association remains unclear. This study aims to explore whether machine learning models based on EEG oscillation features can predict the cortical response to transcranial magnetic stimulation. METHOD Twenty-three young, healthy adults attended two randomly assigned sessions for continuous and intermittent theta burst stimulation. In each session, ten minutes of resting-state electroencephalography were recorded before delivering brain stimulation. Participants were classified as responders or non-responders based on changes in resting motor thresholds. Support vector machines and multi-layer perceptrons were used to establish predictive models of individual responses to transcranial magnetic stimulation. RESULT Among the evaluated algorithms, support vector machines achieved the best performance in discriminating responders from non-responders for intermittent theta burst stimulation (accuracy: 91.30%) and continuous theta burst stimulation (accuracy: 95.66%). The global clustering coefficient and global characteristic path length in the beta band had the greatest impact on model output. CONCLUSION These findings suggest that EEG features can serve as markers of cortical response to transcranial magnetic stimulation. They offer insights into the association between neural oscillations and variability in individuals' responses to transcranial magnetic stimulation, aiding in the optimization of individualized protocols.
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Affiliation(s)
- Guiyuan Cai
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Jiayue Xu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Qian Ding
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China; Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 519041 China
| | - Tuo Lin
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Hongying Chen
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Wanqi Li
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China
| | - Gengbin Chen
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China; Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, 510500 China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 519041 China.
| | - Yue Lan
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510013 China; Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou 510013, China.
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Ding Q, Chen J, Zhang S, Chen S, Li X, Peng Y, Chen Y, Chen J, Chen K, Cai G, Xu G, Lan Y. Neurophysiological characterization of stroke recovery: A longitudinal TMS and EEG study. CNS Neurosci Ther 2024; 30:e14471. [PMID: 37718708 PMCID: PMC10916444 DOI: 10.1111/cns.14471] [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: 07/05/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
AIMS Understanding the neural mechanisms underlying stroke recovery is critical to determine effective interventions for stroke rehabilitation. This study aims to systematically explore how recovery mechanisms post-stroke differ between individuals with different levels of functional integrity of the ipsilesional corticomotor pathway and motor function. METHODS Eighty-one stroke survivors and 15 age-matched healthy adults participated in this study. We used transcranial magnetic stimulation (TMS), electroencephalography (EEG), and concurrent TMS-EEG to investigate longitudinal neurophysiological changes post-stroke, and their relationship with behavioral changes. Subgroup analysis was performed based on the presence of paretic motor evoked potentials and motor function. RESULTS Functional connectivity was increased dramatically in low-functioning individuals without elicitable motor evoked potentials (MEPs), which showed a positive effect on motor recovery. Functional connectivity was increased gradually in higher-functioning individuals without elicitable MEP during stroke recovery and influence from the contralesional hemisphere played a key role in motor recovery. In individuals with elicitable MEPs, negative correlations between interhemispheric functional connectivity and motor function suggest that the influence from the contralesional hemisphere may be detrimental to motor recovery. CONCLUSION Our results demonstrate prominent clinical implications for individualized stroke rehabilitation based on both functional integrity of the ipsilesional corticomotor pathway and motor function.
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Affiliation(s)
- Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
- Guangzhou Key Laboratory of Aging Frailty and NeurorehabilitationGuangzhouChina
| | - Jixiang Chen
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Shunxi Zhang
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Songbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Xiaotong Li
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Yuan Peng
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Yujie Chen
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Junhui Chen
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Kang Chen
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's HospitalSouth China University of TechnologyGuangzhouChina
- Guangzhou Key Laboratory of Aging Frailty and NeurorehabilitationGuangzhouChina
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Xu R, Zhang H, Liu S, Meng L, Ming D. cTBS over primary motor cortex increased contralateral corticomuscular coupling and interhemispheric functional connection. J Neural Eng 2024; 21:016012. [PMID: 38211343 DOI: 10.1088/1741-2552/ad1dc4] [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: 05/29/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Objective.Transcranial magnetic stimulation is a non-invasive brain stimulation technique that changes the activity of the cerebral cortex. Contralesional continuous theta burst stimulation (cTBS) has been proposed and verified beneficial to stroke motor recovery. However, the underlying mechanism is still unclear.Approach.20 healthy right-handed subjects were recruited in this study, receiving real-cTBS over their left primary motor cortex or sham-cTBS. We designed the finger tapping task (FTT) before and after stimulation and recorded the accuracy and reaction time (RT) of the task. The electroencephalogram and surface electromyogram signals were recorded during the left finger pinching task (FPT) before and after stimulation. We calculated cortico-muscular coherence (CMC) in the contralateral hemisphere and cortico-cortical coherence (CCC) in the bilateral hemisphere. The two-way repeated measures analysis of variance was used to analyze the effect of cTBS.Main results.In the FTT, there was a significant main effect of 'time' on RT (F(1, 38) = 24.739,p< 0.001). In the FPT, the results showed that there was a significant interaction effect on the CMC peak and area in the beta band (peak:F(1, 38) = 8.562,p= 0.006; area:F(1, 38) = 5.273,p= 0.027), on the CCC peak in the alpha band (F(1, 38) = 4.815,p= 0.034) and area in the beta band (F(1, 38) = 4.822,p= 0.034). The post hoc tests showed that the CMC peak (W= 20,p= 0.002), the CMC area (W= 13,p= 0.003) and the CCC peak (t= -2.696,p= 0.014) increased significantly after real-cTBS. However, there was no significant decrease or increase after sham-cTBS.Significance.Our study found that cTBS can improve CMC of contralateral hemisphere and CCC of bilateral hemisphere, indicating that cTBS can strengthen cortico-muscular and cortico-cortical coupling.
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Affiliation(s)
- Rui Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Haichao Zhang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Shizhong Liu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, People's Republic of China
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Chen S, Zhang S, Yang W, Chen Y, Wang B, Chen J, Li X, Xie L, Huang H, Zeng Y, Tian L, Ji W, Wei X, Lan Y, Li H. The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. Front Neurosci 2023; 17:1272003. [PMID: 37901439 PMCID: PMC10602812 DOI: 10.3389/fnins.2023.1272003] [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: 08/03/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Intermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke. Objective The purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life. Method A literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD). Results Ten studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: -0.56; 95% CI: -0.85 to -0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: -0.21 to 0.90; SMD: 0.35, 95% CI: -0.18 to 0.87; SMD: 0.03, 95% CI: -0.49 to 0.55; respectively). Conclusion Our results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.
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Affiliation(s)
- Songbin Chen
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shunxi Zhang
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wenqing Yang
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yujie Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bingshui Wang
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jixiang Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaotong Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Lanfang Xie
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Huangjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangkang Zeng
- Department of Rehabilitation Medicine, Shenzhen University General Hospital, Shenzhen, China
| | - Lingling Tian
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenxue Ji
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xijun Wei
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hai Li
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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Tang Z, Liu T, Liu Y, Han K, Su W, Zhao J, Chi Q, Zhang X, Zhang H. Different doses of intermittent theta burst stimulation for upper limb motor dysfunction after stroke: a study protocol for a randomized controlled trial. Front Neurosci 2023; 17:1259872. [PMID: 37869516 PMCID: PMC10585036 DOI: 10.3389/fnins.2023.1259872] [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: 07/20/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Background Upper limb motor recovery is one of the important goals of stroke rehabilitation. Intermittent theta burst stimulation (iTBS), a new type of repetitive transcranial magnetic stimulation (rTMS), is considered a potential therapy. However, there is still no consensus on the efficacy of iTBS for upper limb motor dysfunction after stroke. Stimulus dose may be an important factor affecting the efficacy of iTBS. Therefore, we aim to investigate and compare the effects and neural mechanisms of three doses of iTBS on upper limb motor recovery in stroke patients, and our hypothesis is that the higher the dose of iTBS, the greater the improvement in upper limb motor function. Methods This prospective, randomized, controlled trial will recruit 56 stroke patients with upper limb motor dysfunction. All participants will be randomized in a 1:1:1:1 ratio to receive 21 sessions of 600 pulses active iTBS, 1,200 pulses active iTBS, 1,800 pulses active iTBS, or 1,800 pulses sham iTBS in addition to conventional rehabilitation training. The primary outcome is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score from baseline to end of intervention, and the secondary outcomes are the Wolf Motor Function Test (WMFT), Grip Strength (GS), Modified Barthel Index (MBI), and Stroke Impact Scale (SIS). The FMA-UE, MBI, and SIS are assessed pre-treatment, post-treatment, and at the 3-weeks follow-up. The WMFT, GS, and resting-state functional magnetic resonance imaging (rs-fMRI) data will be obtained pre- and post-treatment. Discussion The iTBS intervention in this study protocol is expected to be a potential method to promote upper limb motor recovery after stroke, and the results may provide supportive evidence for the optimal dose of iTBS intervention.
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Affiliation(s)
- Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Tianhao Liu
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Ying Liu
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Kaiyue Han
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Wenlong Su
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Jingdu Zhao
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Qianqian Chi
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Xiaonian Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- China Rehabilitation Research Center, Beijing Bo'ai Hospital, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
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12
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Li M, Zheng S, Zou W, Li H, Wang C, Peng L. Electroencephalography-based parietofrontal connectivity modulated by electroacupuncture for predicting upper limb motor recovery in subacute stroke. Medicine (Baltimore) 2023; 102:e34886. [PMID: 37682180 PMCID: PMC10489200 DOI: 10.1097/md.0000000000034886] [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: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Predicting motor recovery in stroke patients is essential for effective rehabilitation planning and goal setting. However, intervention-specific biomarkers for such predictions are limited. This study investigates the potential of electroacupuncture (EA) - induced brain network connectivity as a prognostic biomarker for upper limb motor recovery in stroke. METHODS A randomized crossover and prospective observational study was conducted involving 40 stroke patients within 30 days of onset. Patients underwent both EA and sham electroacupuncture (SEA) interventions. Simultaneously, resting electroencephalography signals were recorded to assess brain response. Patients' motor function was monitored for 3 months and categorized into Poor and proportional (Prop) recovery groups. The correlations between the targeted brain network of parietofrontal (PF) functional connectivity (FC) during the different courses of the 2 EA interventions and partial least squares regression models were constructed to predict upper limb motor recovery. RESULTS Before the EA intervention, only ipsilesional PF network FC in the beta band correlated with motor recovery (r = -0.37, P = .041). Post-EA intervention, significant correlations with motor recovery were found in the beta band of the contralesional PF network FC (r = -0.43, P = .018) and the delta and theta bands of the ipsilesional PF network FC (delta: r = -0.59, P = .0004; theta: r = -0.45, P = .0157). No significant correlations were observed for the SEA intervention (all P > .05). Specifically, the delta band ipsilesional PF network FC after EA stimulation significantly differed between Poor and Prop groups (t = 3.474, P = .002, Cohen's d = 1.287, Poor > Prop). Moreover, the partial least squares regression model fitted after EA stimulation exhibited high explanatory power (R2 = 0.613), predictive value (Q2 = 0.547), and the lowest root mean square error (RMSE = 0.192) for predicting upper limb proportional recovery compared to SEA. CONCLUSION EA-induced PF network FC holds potential as a robust prognostic biomarker for upper limb motor recovery, providing valuable insights for clinical decision-making.
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Affiliation(s)
- Mingfen Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan City, China
- Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Su Zheng
- Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Weigeng Zou
- Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Haifeng Li
- Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Chan Wang
- Taihe Hospital, Hubei University of Medicine, Shiyan City, China
| | - Li Peng
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan City, China
- Shiyan Hospital of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Shiyan City, China
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13
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Ding Q, Lin T, Cai G, Ou Z, Yao S, Zhu H, Lan Y. Individual differences in beta-band oscillations predict motor-inhibitory control. Front Neurosci 2023; 17:1131862. [PMID: 36937674 PMCID: PMC10014589 DOI: 10.3389/fnins.2023.1131862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Objective The ability of motor-inhibitory control is critical in daily life. The physiological mechanisms underlying motor inhibitory control deficits remain to be elucidated. Beta band oscillations have been suggested to be related to motor performance, but whether they relate to motor-inhibitory control remains unclear. This study is aimed at systematically investigating the relationship between beta band oscillations and motor-inhibitory control to determine whether beta band oscillations were related to the ability of motor-inhibitory control. Methods We studied 30 healthy young adults (age: 21.6 ± 1.5 years). Stop-signal reaction time (SSRT) was derived from stop signal task, indicating the ability of motor-inhibitory control. Resting-state electroencephalography (EEG) was recorded for 12 min. Beta band power and functional connectivity (including global efficiency) were calculated. Correlations between beta band oscillations and SSRT were performed. Results Beta band EEG power in left and right motor cortex (MC), right somatosensory cortex (SC), and right inferior frontal cortex (IFC) was positively correlated with SSRT (P's = 0.031, 0.021, 0.045, and 0.015, respectively). Beta band coherence between bilateral MC, SC, and IFC was also positively correlated with SSRT (P's < 0.05). Beta band global efficiency was positively correlated with SSRT (P = 0.01). Conclusion This is the first study to investigate the relationship between resting-state cortical beta oscillations and response inhibition. Our findings revealed that individuals with better ability of motor inhibitory control tend to have less cortical beta band power and functional connectivity. This study has clinical significance on the underlying mechanisms of motor inhibitory control deficits.
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Affiliation(s)
- Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, Guangdong, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Zitong Ou
- Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Shantong Yao
- Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Hongxiang Zhu
- Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- *Correspondence: Hongxiang Zhu,
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, Guangdong, China
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, Guangdong, China
- Yue Lan,
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Effect of music stimuli on corticomuscular coupling and the brain functional connectivity network. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Leonardi G, Ciurleo R, Cucinotta F, Fonti B, Borzelli D, Costa L, Tisano A, Portaro S, Alito A. The role of brain oscillations in post-stroke motor recovery: An overview. Front Syst Neurosci 2022; 16:947421. [PMID: 35965998 PMCID: PMC9373799 DOI: 10.3389/fnsys.2022.947421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/13/2022] [Indexed: 11/25/2022] Open
Abstract
Stroke is the second cause of disability and death worldwide, highly impacting patient’s quality of life. Several changes in brain architecture and function led by stroke can be disclosed by neurophysiological techniques. Specifically, electroencephalogram (EEG) can disclose brain oscillatory rhythms, which can be considered as a possible outcome measure for stroke recovery, and potentially shaped by neuromodulation techniques. We performed a review of randomized controlled trials on the role of brain oscillations in patients with post-stroke searching the following databases: Pubmed, Scopus, and the Web of Science, from 2012 to 2022. Thirteen studies involving 346 patients in total were included. Patients in the control groups received various treatments (sham or different stimulation modalities) in different post-stroke phases. This review describes the state of the art in the existing randomized controlled trials evaluating post-stroke motor function recovery after conventional rehabilitation treatment associated with neuromodulation techniques. Moreover, the role of brain pattern rhythms to modulate cortical excitability has been analyzed. To date, neuromodulation approaches could be considered a valid tool to improve stroke rehabilitation outcomes, despite more high-quality, and homogeneous randomized clinical trials are needed to determine to which extent motor functional impairment after stroke can be improved by neuromodulation approaches and which one could provide better functional outcomes. However, the high reproducibility of brain oscillatory rhythms could be considered a promising predictive outcome measure applicable to evaluate patients with stroke recovery after rehabilitation.
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Affiliation(s)
- Giulia Leonardi
- Department of Physical and Rehabilitation Medicine and Sports Medicine, Policlinico “G. Martino,”Messina, Italy
| | | | | | - Bartolo Fonti
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Daniele Borzelli
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Lara Costa
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Simona Portaro
- Department of Physical and Rehabilitation Medicine and Sports Medicine, Policlinico “G. Martino,”Messina, Italy
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- *Correspondence: Angelo Alito,
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16
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Huang W, Chen J, Zheng Y, Zhang J, Li X, Su L, Li Y, Dou Z. The Effectiveness of Intermittent Theta Burst Stimulation for Stroke Patients With Upper Limb Impairments: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:896651. [PMID: 35873775 PMCID: PMC9298981 DOI: 10.3389/fneur.2022.896651] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Upper limb impairments are one of the most common health problems of stroke, affecting both motor function and independence in daily life. It has been demonstrated that intermittent theta burst stimulation (iTBS) increases brain excitability and improves upper limb function. Our study sought to determine the role of iTBS in stroke recovery. Objective The purpose of this study was to determine the efficacy of iTBS in individuals with upper limb impairments following stroke. Methods The databases used included Cumulative Index to PubMed, EMBASE, ESCBOhost, The Cochrane Library, Chinese Biomedical Database, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Technology Periodical Database (VIP), and WanFang Database. Studies published before November 2021 were included. Each participant received an iTBS-based intervention aimed at improving activity levels or impairment, which was compared to usual care, a sham intervention, or another intervention. The primary outcome measure was a change in upper limb function assessment. Secondary outcomes included impairment, participation, and quality of life measures. Result A total of 18 studies (n = 401 participants) that met the inclusion criteria were included in this study. There was a slight change in the upper limb function of the iTBS group compared with the control group, as measured by the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (mean difference 2.70, 95% CI −0.02 to 5.42, p = 0.05). Significant improvement in resting motor threshold (RMT) and motor-evoked potential (MEP) was also observed in the meta-analysis of iTBS (MD 3.46, 95% CI 2.63 to 4.28, p < 0.00001); (MD 1.34, 95% CI 1.17 to 1.51, P < 0.00001). In addition, we got similar results when the studies were using the Modified Barthel Index (MBI) assessment (mean difference of 7.34, 95% CI 0.47 to 14.21, p = 0.04). Conclusion Our study established the efficacy of iTBS in improving motor cortical plasticity, motor function, and daily functioning in stroke patients. However, the review requires evidence from additional randomized controlled trials and high-quality research. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/
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Affiliation(s)
- Wenhao Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiayi Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jin Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liujie Su
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinying Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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17
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Ding Q, Chen S, Chen J, Zhang S, Peng Y, Chen Y, Chen J, Li X, Chen K, Cai G, Xu G, Lan Y. Intermittent Theta Burst Stimulation Increases Natural Oscillatory Frequency in Ipsilesional Motor Cortex Post-Stroke: A Transcranial Magnetic Stimulation and Electroencephalography Study. Front Aging Neurosci 2022; 14:818340. [PMID: 35197845 PMCID: PMC8859443 DOI: 10.3389/fnagi.2022.818340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Intermittent theta burst stimulation (iTBS) has been widely used as a neural modulation approach in stroke rehabilitation. Concurrent use of transcranial magnetic stimulation and electroencephalography (TMS-EEG) offers a chance to directly measure cortical reactivity and oscillatory dynamics and allows for investigating neural effects induced by iTBS in all stroke survivors including individuals without recordable MEPs. Here, we used TMS-EEG to investigate aftereffects of iTBS following stroke. Methods We studied 22 stroke survivors (age: 65.2 ± 11.4 years; chronicity: 4.1 ± 3.5 months) with upper limb motor deficits. Upper-extremity component of Fugl-Meyer motor function assessment and action research arm test were used to measure motor function of stroke survivors. Stroke survivors were randomly divided into two groups receiving either Active or Sham iTBS applied over the ipsilesional primary motor cortex. TMS-EEG recordings were performed at baseline and immediately after Active or Sham iTBS. Time and time-frequency domain analyses were performed for quantifying TMS-evoked EEG responses. Results At baseline, natural frequency was slower in the ipsilesional compared with the contralesional hemisphere (P = 0.006). Baseline natural frequency in the ipsilesional hemisphere was positively correlated with upper limb motor function following stroke (P = 0.007). After iTBS, natural frequency in the ipsilesional hemisphere was significantly increased (P < 0.001). Conclusions This is the first study to investigate the acute neural adaptations after iTBS in stroke survivors using TMS-EEG. Our results revealed that natural frequency is altered following stroke which is related to motor impairments. iTBS increases natural frequency in the ipsilesional motor cortex in stroke survivors. Our findings implicate that iTBS holds the potential to normalize natural frequency in stroke survivors, which can be utilized in stroke rehabilitation.
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Affiliation(s)
- Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Songbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Jixiang Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Shunxi Zhang
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Yuan Peng
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Yujie Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Junhui Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Xiaotong Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Kang Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Guangqing Xu,
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- Yue Lan,
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18
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Páscoa dos Santos F, Verschure PFMJ. Excitatory-Inhibitory Homeostasis and Diaschisis: Tying the Local and Global Scales in the Post-stroke Cortex. Front Syst Neurosci 2022; 15:806544. [PMID: 35082606 PMCID: PMC8785563 DOI: 10.3389/fnsys.2021.806544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/29/2021] [Indexed: 12/28/2022] Open
Abstract
Maintaining a balance between excitatory and inhibitory activity is an essential feature of neural networks of the neocortex. In the face of perturbations in the levels of excitation to cortical neurons, synapses adjust to maintain excitatory-inhibitory (EI) balance. In this review, we summarize research on this EI homeostasis in the neocortex, using stroke as our case study, and in particular the loss of excitation to distant cortical regions after focal lesions. Widespread changes following a localized lesion, a phenomenon known as diaschisis, are not only related to excitability, but also observed with respect to functional connectivity. Here, we highlight the main findings regarding the evolution of excitability and functional cortical networks during the process of post-stroke recovery, and how both are related to functional recovery. We show that cortical reorganization at a global scale can be explained from the perspective of EI homeostasis. Indeed, recovery of functional networks is paralleled by increases in excitability across the cortex. These adaptive changes likely result from plasticity mechanisms such as synaptic scaling and are linked to EI homeostasis, providing a possible target for future therapeutic strategies in the process of rehabilitation. In addition, we address the difficulty of simultaneously studying these multiscale processes by presenting recent advances in large-scale modeling of the human cortex in the contexts of stroke and EI homeostasis, suggesting computational modeling as a powerful tool to tie the meso- and macro-scale processes of recovery in stroke patients.
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Affiliation(s)
- Francisco Páscoa dos Santos
- Eodyne Systems SL, Barcelona, Spain
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Department of Information and Communications Technologies (DTIC), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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