scholarly journals Noninvasive Brain Stimulation for Motor Recovery after Stroke: Mechanisms and Future Views

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Naoyuki Takeuchi ◽  
Shin-Ichi Izumi
Keyword(s):  
Brain Stimulation ◽  
Neural Plasticity ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Noninvasive Brain Stimulation ◽  
Interhemispheric Competition ◽  
Underlying Mechanisms

Repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive brain stimulation (NIBS) techniques that can alter excitability of the human cortex. Considering the interhemispheric competition occurring after stroke, improvement in motor deficits can be achieved by increasing the excitability of the affected hemisphere or decreasing the excitability of the unaffected hemisphere. Many reports have shown that NIBS application improves motor function in stroke patients by using their physiological peculiarity. For continuous motor improvement, it is important to impart additional motor training while NIBS modulates the neural network between both hemispheres and remodels the disturbed network in the affected hemisphere. NIBS can be an adjuvant therapy for developed neurorehabilitation strategies for stroke patients. Moreover, recent studies have reported that bilateral NIBS can more effectively facilitate neural plasticity and induce motor recovery after stroke. However, the best NIBS pattern has not been established, and clinicians should select the type of NIBS by considering the NIBS mechanism. Here, we review the underlying mechanisms and future views of NIBS therapy and propose rehabilitation approaches for appropriate cortical reorganization.

scholarly journals Motor Control and Neural Plasticity through Interhemispheric Interactions

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Naoyuki Takeuchi ◽  
Yutaka Oouchida ◽  
Shin-Ichi Izumi
Keyword(s):  
Corpus Callosum ◽  
Brain Stimulation ◽  
Neural Plasticity ◽  
Neurological Disorders ◽  
Hemispheric Asymmetry ◽  
Diffusion Tensor ◽  
Cortical Reorganization ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Noninvasive Brain Stimulation

The corpus callosum, which is the largest white matter structure in the human brain, connects the 2 cerebral hemispheres. It plays a crucial role in maintaining the independent processing of the hemispheres and in integrating information between both hemispheres. The functional integrity of interhemispheric interactions can be tested electrophysiologically in humans by using transcranial magnetic stimulation, electroencephalography, and functional magnetic resonance imaging. As a brain structural imaging, diffusion tensor imaging has revealed the microstructural connectivity underlying interhemispheric interactions. Sex, age, and motor training in addition to the size of the corpus callosum influence interhemispheric interactions. Several neurological disorders change hemispheric asymmetry directly by impairing the corpus callosum. Moreover, stroke lesions and unilateral peripheral impairments such as amputation alter interhemispheric interactions indirectly. Noninvasive brain stimulation changes the interhemispheric interactions between both motor cortices. Recently, these brain stimulation techniques were applied in the clinical rehabilitation of patients with stroke by ameliorating the deteriorated modulation of interhemispheric interactions. Here, we review the interhemispheric interactions and mechanisms underlying the pathogenesis of these interactions and propose rehabilitative approaches for appropriate cortical reorganization.

scholarly journals Maladaptive Plasticity for Motor Recovery after Stroke: Mechanisms and Approaches

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Naoyuki Takeuchi ◽  
Shin-Ichi Izumi
Keyword(s):  
Motor Function ◽  
Neural Plasticity ◽  
Motor Pattern ◽  
Movement Pattern ◽  
Competitive Interaction ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Stroke Patients ◽  
Compensatory Movement ◽  
Maladaptive Plasticity

Many studies in human and animal models have shown that neural plasticity compensates for the loss of motor function after stroke. However, neural plasticity concerning compensatory movement, activated ipsilateral motor projections and competitive interaction after stroke contributes to maladaptive plasticity, which negatively affects motor recovery. Compensatory movement on the less-affected side helps to perform self-sustaining activity but also creates an inappropriate movement pattern and ultimately limits the normal motor pattern. The activated ipsilateral motor projections after stroke are unable to sufficiently support the disruption of the corticospinal motor projections and induce the abnormal movement linked to poor motor ability. The competitive interaction between both hemispheres induces abnormal interhemispheric inhibition that weakens motor function in stroke patients. Moreover, widespread disinhibition increases the risk of competitive interaction between the hand and the proximal arm, which results in an incomplete motor recovery. To minimize this maladaptive plasticity, rehabilitation programs should be selected according to the motor impairment of stroke patients. Noninvasive brain stimulation might also be useful for correcting maladaptive plasticity after stroke. Here, we review the underlying mechanisms of maladaptive plasticity after stroke and propose rehabilitation approaches for appropriate cortical reorganization.

Interhemispheric Competition After Stroke: Brain Stimulation to Enhance Recovery of Function of the Affected Hand

2009 ◽  
Vol 23 (7) ◽  
pp. 641-656 ◽  
Author(s):  
Dennis A. Nowak ◽  
Christian Grefkes ◽  
Mitra Ameli ◽  
Gereon R. Fink
Keyword(s):  
Brain Stimulation ◽  
Motor Behavior ◽  
Cortical Excitability ◽  
Recovery Of Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Hand Function ◽  
Clinical Effects ◽  
Sensorimotor Network ◽  
Interhemispheric Competition ◽  
Plastic Changes

Background and purpose. Within the concept of interhemispheric competition, technical modulation of the excitability of motor areas in the contralesional and ipsilesional hemisphere has been applied in an attempt to enhance recovery of hand function following stroke. This review critically summarizes the data supporting the use of novel electrophysiological concepts in the rehabilitation of hand function after stroke. Summary of review. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are powerful tools to inhibit or facilitate cortical excitability. Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke. No significant adverse effects have been noted when applying brain stimulation in stroke patients. To date, however, the clinical effects are small to moderate and short lived. Future work should elucidate whether repetitive administration of rTMS or tDCS over several days and the combination of these techniques with behavioral training (ie, physiotherapy) could result in an enhanced effectiveness. Conclusion. Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

Dual-mode Noninvasive Brain Stimulation over Prefrontal Cortices on Working Memory in Stroke Patients

2015 ◽  
Vol 8 (2) ◽  
pp. 359
Author(s):  
Ahee Lee ◽  
Won Hyuk Chang ◽  
Min Ji Lee ◽  
Min-Su Kim ◽  
Yun-Hee Kim
Keyword(s):  
Working Memory ◽  
Brain Stimulation ◽  
Stroke Patients ◽  
Dual Mode ◽  
Noninvasive Brain Stimulation ◽  
Prefrontal Cortices

The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 33 (5) ◽  
pp. 847-864 ◽  
Author(s):  
Huifang Xiang ◽  
Jing Sun ◽  
Xiang Tang ◽  
Kebin Zeng ◽  
Xiushu Wu
Keyword(s):  
Motor Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Optimal Parameters ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Stimulation Parameters ◽  
Stroke Population

Objective: The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included. Data sources: The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018. Review methods: The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate. Results: For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup ( P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS. Conclusions: rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

Functional network reorganization by dual-mode noninvasive brain stimulation in stroke patients

2017 ◽  
Vol 10 (2) ◽  
pp. 439-440 ◽  
Author(s):  
J. Lee ◽  
E. Park ◽  
A. Lee ◽  
W.H. Chang ◽  
D.S. Kim ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Functional Network ◽  
Stroke Patients ◽  
Dual Mode ◽  
Noninvasive Brain Stimulation

Cortical reorganization associated with motor recovery in hemiparetic stroke patients

Neuroreport ◽  
2003 ◽  
Vol 14 (10) ◽  
pp. 1305-1310 ◽  
Author(s):  
Sung Ho Jang ◽  
Yun-Hee Kim ◽  
Sang-Hyun Cho ◽  
Yongmin Chang ◽  
Zee In Lee ◽  
...  
Keyword(s):  
Motor Recovery ◽  
Cortical Reorganization ◽  
Stroke Patients ◽  
Hemiparetic Stroke

scholarly journals Understanding diaschisis models of attention dysfunction with rTMS

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Javier O. Garcia ◽  
Lorella Battelli ◽  
Ela Plow ◽  
Zaira Cattaneo ◽  
Jean Vettel ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Brain Stimulation ◽  
Large Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Low Frequency ◽  
Preliminary Evidence ◽  
Noninvasive Brain Stimulation ◽  
Induced Changes ◽  
Attention Dysfunction ◽  
The Impact

Abstract Visual attentive tracking requires a balance of excitation and inhibition across large-scale frontoparietal cortical networks. Using methods borrowed from network science, we characterize the induced changes in network dynamics following low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) as an inhibitory noninvasive brain stimulation protocol delivered over the intraparietal sulcus. When participants engaged in visual tracking, we observed a highly stable network configuration of six distinct communities, each with characteristic properties in node dynamics. Stimulation to parietal cortex had no significant impact on the dynamics of the parietal community, which already exhibited increased flexibility and promiscuity relative to the other communities. The impact of rTMS, however, was apparent distal from the stimulation site in lateral prefrontal cortex. rTMS temporarily induced stronger allegiance within and between nodal motifs (increased recruitment and integration) in dorsolateral and ventrolateral prefrontal cortex, which returned to baseline levels within 15 min. These findings illustrate the distributed nature by which inhibitory rTMS perturbs network communities and is preliminary evidence for downstream cortical interactions when using noninvasive brain stimulation for behavioral augmentations.

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