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Li LL, Wu JJ, Li KP, Jin J, Xiang YT, Hua XY, Zheng MX, Xu JG. Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis. Neurol Sci 2024; 45:3641-3681. [PMID: 38520639 DOI: 10.1007/s10072-024-07437-4] [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: 10/18/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
The objectives of the study were to systematically evaluate the rehabilitation effect of noninvasive brain stimulation (NIBS) on upper extremity motor function and activities of daily living in stroke patients and to prioritize various stimulation protocols for reliable evidence-based medical recommendations in patients with upper extremity motor dysfunction after stroke. Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched to collect all randomized controlled trials (RCTs) of NIBS to improve upper extremity motor function in stroke patients. The retrieval time was from the establishment of all databases to May 2023. According to the Cochrane system evaluation manual, the quality of the included studies was evaluated, and the data were extracted. Statistical analysis was carried out by using RevMan 5.3, R 4.3.0, and Stata 17.0 software. Finally, 94 RCTs were included, with a total of 5546 patients. Meta-analysis showed that NIBS improved the Fugl-Meyer assessment (FMA) score (mean difference (MD) = 6.51, 95% CI 6.20 ~ 6.82, P < 0.05), MBI score (MD = 7.69, 95% CI 6.57 ~ 8.81, P < 0.05), ARAT score (MD = 5.06, 95% CI 3.85 ~ 6.27, P < 0.05), and motor evoked potential (MEP) amplitude. The modified Ashworth scale score (MD = - 0.37, 95% CI - 0.60 to - 0.14, P < 0.05), National Institutes of Health Stroke Scale score (MD = - 2.17, 95% CI - 3.32 to - 1.11, P < 0.05), incubation period of MEP (MD = - 0.72, 95% CI - 1.06 to - 0.38, P < 0.05), and central motor conduction time (MD = - 0.90, 95% CI - 1.29 to - 0.50, P < 0.05) were decreased in stroke patients. Network meta-analysis showed that the order of interventions in improving FMA scores from high to low was anodal-transcranial direct current stimulation (tDCS) (surface under the cumulative ranking curve (SUCRA) = 83.7%) > cathodal-tDCS (SUCRA = 80.2%) > high-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (SUCRA = 68.5%) > low-frequency (LF)-rTMS (SUCRA = 66.5%) > continuous theta burst stimulation (cTBS) (SUCRA = 54.2%) > bilateral-tDCS (SUCRA = 45.2%) > intermittent theta burst stimulation (iTBS) (SUCRA = 34.1%) > sham-NIBS (SUCRA = 16.0%) > CR (SUCRA = 1.6%). In terms of improving MBI scores, the order from high to low was anodal-tDCS (SUCRA = 88.7%) > cathodal-tDCS (SUCRA = 85.4%) > HF-rTMS (SUCRA = 63.4%) > bilateral-tDCS (SUCRA = 56.0%) > LF-rTMS (SUCRA = 54.2%) > iTBS (SUCRA = 32.4%) > sham-NIBS (SUCRA = 13.8%) > CR (SUCRA = 6.1%). NIBS can effectively improve upper extremity motor function and activities of daily living after stroke. Among the various NIBS protocols, anodal-tDCS demonstrated the most significant intervention effect, followed by cathodal-tDCS and HF-rTMS.
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Affiliation(s)
- Ling-Ling Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jia-Jia Wu
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kun-Peng Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jing Jin
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yun-Ting Xiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xu-Yun Hua
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Mou-Xiong Zheng
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jian-Guang Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Pezoa-Peña I, Julio-Ramos T, Cigarroa I, Martella D, Solomons D, Toloza-Ramirez D. Neuropsychological and Anatomical-Functional Effects of Transcranial Magnetic Stimulation in Post-Stroke Patients with Cognitive Impairment and Aphasia: A Systematic Review. Neuropsychol Rev 2024:10.1007/s11065-024-09644-4. [PMID: 38867020 DOI: 10.1007/s11065-024-09644-4] [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: 07/08/2023] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Transcranial magnetic stimulation (TMS) has been found to be promising in the neurorehabilitation of post-stroke patients. Aphasia and cognitive impairment (CI) are prevalent post-stroke; however, there is still a lack of consensus about the characteristics of interventions based on TMS and its neuropsychological and anatomical-functional benefits. Therefore, studies that contribute to creating TMS protocols for these neurological conditions are necessary. To analyze the evidence of the neuropsychological and anatomical-functional TMS effects in post-stroke patients with CI and aphasia and determine the characteristics of the most used TMS in research practice. The present study followed the PRISMA guidelines and included articles from PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE databases, published between January 2010 and March 2023. In the 15 articles reviewed, it was found that attention, memory, executive function, language comprehension, naming, and verbal fluency (semantic and phonological) are the neuropsychological domains that improved post-TMS. Moreover, TMS in aphasia and post-stroke CI contribute to greater frontal activation (in the inferior frontal gyrus, pars triangularis, and opercularis). Temporoparietal effects were also found. The observed effects occur when TMS is implemented in repetitive modality, at a frequency of 1 Hz, in sessions of 30 min, and that last more than 2 weeks in duration. The use of TMS contributes to the neurorehabilitation process in post-stroke patients with CI and aphasia. However, it is still necessary to standardize future intervention protocols based on accurate TMS characteristics.
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Affiliation(s)
- Ignacio Pezoa-Peña
- Master's program in Neuroscience, Universidad Autonoma de Chile, Temuco, Chile
| | - Teresa Julio-Ramos
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- PhD Program in Health Sciences and Engineering, Universidad de Valparaiso, Valparaiso, Chile
| | - Igor Cigarroa
- Escuela de kinesiología, Facultad de Ciencias de la Salud, Universidad Católica Silva Henríquez, Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Arturo Prat, Victoria, Chile
| | - Diana Martella
- Departamento de Psicología, Facultad de Ciencias Sociales y Humanas, Universidad Loyola, Campus Sevilla, Sevilla, España
| | - Daniel Solomons
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millenium Institute for Intelligent Healthcare Engineering (iHEALTH), Santiago, Chile
| | - David Toloza-Ramirez
- Exercise and Rehabilitation Sciences Institute, School of Speech Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha 700, Las Condes, Santiago, 7591538, Chile.
- Interdisciplinary Center for Neuroscience, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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He Y, Zhang Q, Ma TT, Liang YH, Guo RR, Li XS, Liu QJ, Feng TY. Effect of repetitive transcranial magnetic stimulation-assisted training on lower limb motor function in children with hemiplegic cerebral palsy. BMC Pediatr 2024; 24:136. [PMID: 38383331 PMCID: PMC10882917 DOI: 10.1186/s12887-024-04605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To explore the effect of repetitive transcranial magnetic stimulation (rTMS)-assisted training on lower limb motor function in children with hemiplegic cerebral palsy (HCP). METHOD Thirty-one children with HCP who met the inclusion criteria were selected and randomly divided into a control group (n = 16) and an experimental group (n = 15). The control group received routine rehabilitation treatment for 30 min each time, twice a day, 5 days a week for 4 weeks. Based on the control group, the experimental group received rTMS for 20 min each time, once a day, 5 days a week for 4 weeks. The outcome measures included a 10-metre walk test (10MWT), a 6-minute walk distance (6MWD) test, D- and E-zone gross motor function measurements (GMFM), the symmetry ratio of the step length and stance time and the muscle tone of the triceps surae and the hamstrings (evaluated according to the modified Ashworth scale), which were obtained in both groups of children before and after treatment. RESULTS After training, the 10MWT (P < 0.05), 6MWD (P < 0.01), GMFM (P < 0.001) and the symmetry ratio of the step length and stance time of the two groups were significantly improved (P < 0.05), there was more of an improvement in the experimental group compared with the control group. There was no significant change in the muscle tone of the hamstrings between the two groups before and after treatment (P > 0.05). After treatment, the muscle tone of the triceps surae in the experimental group was significantly reduced (P < 0.05), but there was no significant change in the control group (P > 0.05). CONCLUSION Repetitive TMS-assisted training can improve lower limb motor function in children with HCP.
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Affiliation(s)
- Yan He
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qi Zhang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China.
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China.
| | - Ting-Ting Ma
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Yan-Hua Liang
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Rong-Rong Guo
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Xiao-Song Li
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
- Capital Medical University School of Rehabilitation Medicine, No. 10 of Jiaomen North Street, Fengtai District, Beijing, 100068, China
| | - Qian-Jin Liu
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
| | - Tian-Yang Feng
- Department of Paediatric Physiotherapy, China Rehabilitation Research Center, Beijing Bo'ai Hospital, No. 10 of Jiaomen North street, Fengtai District, Beijing, 100068, China
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Boccuni L, Abellaneda-Pérez K, Martín-Fernández J, Leno-Colorado D, Roca-Ventura A, Prats Bisbe A, Buloz-Osorio EA, Bartrés-Faz D, Bargalló N, Cabello-Toscano M, Pariente JC, Muñoz-Moreno E, Trompetto C, Marinelli L, Villalba-Martinez G, Duffau H, Pascual-Leone Á, Tormos Muñoz JM. Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol. Front Neurol 2023; 14:1243857. [PMID: 37849833 PMCID: PMC10577187 DOI: 10.3389/fneur.2023.1243857] [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: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Neurosurgery for brain tumors needs to find a complex balance between the effective removal of targeted tissue and the preservation of surrounding brain areas. Neuromodulation-induced cortical prehabilitation (NICP) is a promising strategy that combines temporary inhibition of critical areas (virtual lesion) with intensive behavioral training to foster the activation of alternative brain resources. By progressively reducing the functional relevance of targeted areas, the goal is to facilitate resection with reduced risks of neurological sequelae. However, it is still unclear which modality (invasive vs. non-invasive neuromodulation) and volume of therapy (behavioral training) may be optimal in terms of feasibility and efficacy. Methods and analysis Patients undertake between 10 and 20 daily sessions consisting of neuromodulation coupled with intensive task training, individualized based on the target site and neurological functions at risk of being compromised. The primary outcome of the proposed pilot, single-cohort trial is to investigate the feasibility and potential effectiveness of a non-invasive NICP protocol on neuroplasticity and post-surgical outcomes. Secondary outcomes investigating longitudinal changes (neuroimaging, neurophysiology, and clinical) are measured pre-NICP, post-NICP, and post-surgery. Ethics and dissemination Ethics approval was obtained from the Research Ethical Committee of Fundació Unió Catalana d'Hospitals (approval number: CEI 21/65, version 1, 13/07/2021). The results of the study will be submitted to a peer-reviewed journal and presented at scientific congresses. Clinical trial registration ClinicalTrials.gov, identifier NCT05844605.
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Affiliation(s)
- Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jesús Martín-Fernández
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
- Department of Neurosurgery, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
- Department of Basic Medical Sciences, Universidad de La Laguna, Tenerife, Spain
| | - David Leno-Colorado
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Alba Prats Bisbe
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Edgar Antonio Buloz-Osorio
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Morphological Sciences (Human Anatomy and Embriology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Bargalló
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Cabello-Toscano
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Emma Muñoz-Moreno
- Experimental 7T MRI Unit, Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Neuroscience, Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Neuroscience, Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Álvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Josep María Tormos Muñoz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Centro de Investigación Traslacional San Alberto Magno, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
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O'Dell MW. Stroke Rehabilitation and Motor Recovery. Continuum (Minneap Minn) 2023; 29:605-627. [PMID: 37039412 DOI: 10.1212/con.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Up to 50% of the nearly 800,000 patients who experience a new or recurrent stroke each year in the United States fail to achieve full independence afterward. More effective approaches to enhance motor recovery following stroke are needed. This article reviews the rehabilitative principles and strategies that can be used to maximize post-stroke recovery. LATEST DEVELOPMENTS Evidence dictates that mobilization should not begin prior to 24 hours following stroke, but detailed guidelines beyond this are lacking. Specific classes of potentially detrimental medications should be avoided in the early days poststroke. Patients with stroke who are unable to return home should be referred for evaluation to an inpatient rehabilitation facility. Research suggests that a substantial increase in both the dose and intensity of upper and lower extremity exercise is beneficial. A clinical trial supports vagus nerve stimulation as an adjunct to occupational therapy for motor recovery in the upper extremity. The data remain somewhat mixed as to whether robotics, transcranial magnetic stimulation, functional electrical stimulation, and transcranial direct current stimulation are better than dose-matched traditional exercise. No current drug therapy has been proven to augment exercise poststroke to enhance motor recovery. ESSENTIAL POINTS Neurologists will collaborate with rehabilitation professionals for several months following a patient's stroke. Many questions still remain about the ideal exercise regimen to maximize motor recovery in patients poststroke. The next several years will likely bring a host of new research studies exploring the latest strategies to enhance motor recovery using poststroke exercise.
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Wu X, Wang R, Wu Q, Liao C, Zhang J, Jiao H, Chen B, Wang S, Liu R. The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke. Front Neurosci 2023; 17:1100464. [PMID: 36845428 PMCID: PMC9951778 DOI: 10.3389/fnins.2023.1100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two. Objective This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery. Methods Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up. Results All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham. Conclusion Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2100048558.
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Affiliation(s)
- Xiaofang Wu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China,Graduate School of Xi’an Medical College, Xi’an, China
| | - Rui Wang
- Medical Department of Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Qunqiang Wu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Chunhua Liao
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Jianshe Zhang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Huiduo Jiao
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Baolin Chen
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Shuyan Wang
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Rui Liu
- Department of Rehabilitation, Tangdu Hospital, Air Force Medical University, Xi’an, China,*Correspondence: Rui Liu,
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Xie Y, Pan J, Chen J, Zhang D, Jin S. Acupuncture combined with repeated transcranial magnetic stimulation for upper limb motor function after stroke: A systematic review and meta-analysis. NeuroRehabilitation 2023; 53:423-438. [PMID: 38143390 DOI: 10.3233/nre-230144] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Upper limb motor dysfunction after stroke is an important factor affecting patients' motor function and daily life. Acupuncture and repetitive transcranial magnetic stimulation are effective methods for stroke rehabilitation. However, a systematic and comprehensive overview of the combined efficacy of the two is lacking. OBJECTIVE Through a systematic review and meta-analysis of randomized controlled trials, this study aimed to assess the effectiveness of acupuncture combined with repetitive transcranial magnetic stimulation on upper extremity motor function in post-stroke patients. METHODS The relevant randomized controlled trials on acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of upper limb motor disorders after stroke were searched in PubMed, Embase, Cochrane Library, Web of Science CNKI, VIP, Wanfang, and CBM databases. After screening clinical trials that met the inclusion criteria, data extraction was conducted independently by two investigators. Meta-analysis was performed using RevMan 5.4 software. RESULTS After the screening, 18 articles were included, with a total of 1083 subjects. The results of meta-analysis showed that combination therapy could effectively improve the patients' upper limb motor function (MD = 7.77, 95%CI [6.32, 9.22], P < 0.05), ability of daily living (MD = 8.53, 95%CI [6.28, 10.79], P < 0.05), and hemiplegic shoulder pain (MD = - 1.72, 95%CI [- 2.26, - 1.18], P < 0.05). Meanwhile, for neurophysiological indexes, combined treatment could significantly shorten the latency of motor evoked potential and central motor conduction time (MD = - 1.42, 95%CI [- 2.14, - 0.71], P < 0.05); (MD = - 0.47, 95%CI [- 0.66, - 0.29], P < 0.05), and also could increase the amplitude of motor evoked potential (SMD = 0.71, 95%CI [0.28, 1.14], P < 0.05). CONCLUSION According to the results of the meta-analysis, we can conclude that acupuncture combined with repeated transcranial magnetic stimulation can significantly improve the upper limb motor function and daily living ability of stroke patients.
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Affiliation(s)
- Yulong Xie
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - JuanHong Pan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Di Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song Jin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Study Protocol for a Multicenter, Randomized Controlled Trial to Improve Upper Extremity Hemiparesis in Chronic Stroke Patients by One-to-One Training (NEURO ®) with Repetitive Transcranial Magnetic Stimulation. J Clin Med 2022; 11:jcm11226835. [PMID: 36431312 PMCID: PMC9695575 DOI: 10.3390/jcm11226835] [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: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
During recovery from upper limb motor paralysis after stroke, it is important to (1) set the exercise difficulty level according to the motor paralysis severity, (2) provide adequate exercises, and (3) motivate the patient to achieve the goal. However, these factors have not been well-formulated. This multicenter, randomized controlled trial study aims to examine the therapeutic effects of these three factors on patients undergoing a novel intervention using repetitive transcranial magnetic stimulation and intensive one-to-one training (NEURO®) and to formulate a corresponding research protocol. The control group will receive conventional NEURO® occupational therapy. In the intervention group, four practice plans will be selected according to the Fugl-Meyer assessment (FMA-UE) scores of the upper extremity. The goal is to predict the post-treatment outcomes based on the pre-treatment FMA-UE scores. Based on the degree of difficulty and amount of practice required, we can formulate a practice plan to promote upper limb motor recovery. This occupational therapy plan will be less influenced by the therapist's skill, facilitating effective rehabilitation. The study findings may be utilized to promote upper limb motor paralysis recovery and provide a basis for proposing activities of daily living adapted to upper limb function.
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Xie H, Xiong D, Zhu P, Li H, Zhang H, Tan J, Zhao N. Effectiveness and safety of repetitive transcranial magnetic stimulation on memory disorder in stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30933. [PMID: 36221389 PMCID: PMC9542838 DOI: 10.1097/md.0000000000030933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Approximately 23% to 55% of patients have memory impairments with a greatly negative effect on daily life 3 months after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been widely used in the rehabilitation of stroke as it is safe, painless, and noninvasive. Moreover, few studies have investigated the effect of rTMS on poststroke memory disorder (PSMD). However, the efficacy of rTMS is not consistent and the optional stimulation frequency is unclear. Therefore, this protocol aims to evaluate the clinical effect and safety of rTMS on PSMD by analyzing results from randomized controlled trials. METHODS Search strategies will be performed on seven databases: PubMed, EMBASE, CENTRAL, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wan Fang, and Technology Periodical Database (VIP). Only randomized controlled trials registered before August 2021 will be included. Additionally, the language will be limited to English or Chinese. For the outcome, we will focus on the Rivermead Behavioral Memory Test. Additionally, the Montreal Cognitive Assessment, Mini-mental State Examination, Modified Barthel Index, and advent events will be included. Two authors will independently select the study, extract data, and assess quality. Moreover, disagreements will be resolved by the third author. STATA 14 and Review Manager 5.4 will be used to perform the analysis. We will evaluate bias risk in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. To assess the quality of evidence, the Grading of Recommendations Assessment, Development, and Evaluation method will be employed. RESULTS This study will provide a comprehensive analysis of the current evidence on rTMS for PSMD. CONCLUSION A reliable conclusion regarding whether rTMS is an effective and safe intervention for patients with PSMD and the effect of stimulation frequency and sham stimulation will be provided. This study will provide new insights for TMS in treating PSMD, and offer appropriate treatmentoptions to patients and clinicians. PROSPERO REGISTRATION NUMBER CRD42021282439.
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Affiliation(s)
- Haihua Xie
- College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha, China
- Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Dan Xiong
- College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha, China
- Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Pan Zhu
- College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha, China
- Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hao Li
- Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hong Zhang
- College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha, China
| | - Jie Tan
- College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Ning Zhao, Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518052, China (e-mail: ) and Jie Tan, College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
| | - Ning Zhao
- Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Ning Zhao, Department of Rehabilitation, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518052, China (e-mail: ) and Jie Tan, College of Acupuncture-Moxibustion and Tuina, Hunan University of Chinese Medicine, Changsha 410208, China (e-mail: )
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Gao B, Wang Y, Zhang D, Wang Z, Wang Z. Intermittent theta-burst stimulation with physical exercise improves poststroke motor function: A systemic review and meta-analysis. Front Neurol 2022; 13:964627. [PMID: 36110393 PMCID: PMC9468864 DOI: 10.3389/fneur.2022.964627] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intermittent theta-burst stimulation (iTBS) is an optimized rTMS modality that could modulate the excitability of neural structures. Several studies have been conducted to investigate the efficacy of iTBS in improving the motor function of stroke patients. However, the specific role of iTBS in motor function recovery after stroke is unclear. Hence, in our study, we performed a meta-analysis to investigate the efficacy of iTBS for the motor function improvement of stroke patients. Methods MEDLINE, Embase, and Cochrane Library were searched until May 2022 for randomized controlled trials (RCTs). Results Thirteen RCTs with 334 patients were finally included in our study. The primary endpoints were the Fugl-Meyer assessment scale (FMA) and Motor Assessment Scale (MAS) change from baseline. We found that iTBS led to a significant reduction in FMA score (P = 0.002) but not in MAS score (P = 0.24) compared with the sham group. Moreover, standard 600-pulse stimulation showed a better effect on motor function improvement than the sham group (P = 0.004), however, 1200-pulse iTBS showed no effect on motor function improvement after stroke (P = 0.23). The effect of iTBS for improving motor function only exists in chronic stroke patients (P = 0.02) but not in subacute patients (P = 0.27). Conclusion This study supports that iTBS has good efficacy for improving motor function in stroke patients. Therefore, standard 600-pulse stimulation iTBS therapy is proper management and treatment for chronic stroke.
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Affiliation(s)
- Bixi Gao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
| | - Yunjiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
- Department of Neurosurgery, Yancheng Third People's Hospital, Yancheng, China
| | - Dingding Zhang
- Department of Anesthesia, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zongqi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
- *Correspondence: Zongqi Wang
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Stroke Research, Soochow University, Suzhou, China
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Chen G, Lin T, Wu M, Cai G, Ding Q, Xu J, Li W, Wu C, Chen H, Lan Y. Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials. Front Neurol 2022; 13:940467. [PMID: 35968309 PMCID: PMC9372362 DOI: 10.3389/fneur.2022.940467] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for stroke rehabilitation. Several studies have demonstrated the effectiveness of rTMS in restoring motor function. This meta-analysis aimed to summarize the current evidence of the effect of rTMS in improving upper limb function and fine motor recovery in stroke patients. Methods Three online databases (Web of Science, PubMed, and Embase) were searched for relevant randomized controlled trials. A total of 45 studies (combined n = 2064) were included. Random effects model was used for meta-analysis and effect size was reported as standardized mean difference (SMD). Results rTMS was effective in improving fine motor function in stroke patients (SMD, 0.38; 95% CI 0.19–0.58; P = 0). On subgroup analyses, for post-stroke functional improvement of the upper extremity, bilateral hemisphere stimulation was more effective than unilateral stimulation during the acute phase of stroke, and a regimen of 20 rTMS sessions produced greater improvement than <20 sessions. In the subacute phase of stroke, affected hemispheric stimulation with a 40-session rTMS regimen was superior to unaffected hemispheric stimulation or bilateral hemispheric stimulation with <40 sessions. Unaffected site stimulation with a 10-session rTMS regimen produced significant improvement in the chronic phase compared to affected side stimulation and bilateral stimulation with >10 rTMS sessions. For the rTMS stimulation method, both TBS and rTMS were found to be significantly more effective in the acute phase of stroke, but TBS was more effective than rTMS. However, rTMS was found to be more effective than TBS stimulation in patients in the subacute and chronic phases of stroke. rTMS significantly improved upper limb and fine function in the short term (0–1-month post-intervention) and medium term (2–5 months), but not for upper limb function in the long term (6 months+). The results should be interpreted with caution due to significant heterogeneity. Conclusions This updated meta-analysis provides robust evidence of the efficacy of rTMS treatment in improving upper extremity and fine function during various phases of stroke. Systematic Review Registration https://inplasy.com/inplasy-2022-5-0121/, identifier: INPLASY202250121.
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Affiliation(s)
- Gengbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jiayue Xu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanqi Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hongying Chen
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China
- *Correspondence: Yue Lan
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Vabalaite B, Petruseviciene L, Savickas R, Kubilius R, Ignatavicius P, Lendraitiene E. Correction: Vabalaite et al. Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review. Medicina 2021, 57, 1215. Medicina (B Aires) 2022; 58:medicina58040533. [PMID: 35454397 PMCID: PMC9024861 DOI: 10.3390/medicina58040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
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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