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Dawson J, Abdul-Rahim AH, Kimberley TJ. Neurostimulation for treatment of post-stroke impairments. Nat Rev Neurol 2024; 20:259-268. [PMID: 38570705 DOI: 10.1038/s41582-024-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation was approved by the FDA as an adjunct to intensive rehabilitation therapy for the treatment of chronic upper extremity deficits after ischaemic stroke. In 2024, pharyngeal electrical stimulation was conditionally approved by the UK National Institute for Health and Care Excellence for neurogenic dysphagia in people with stroke who have a tracheostomy. Many other approaches have also been tested in pivotal device trials and a number of approaches are in early-phase study. Typically, neurostimulation techniques aim to increase neuroplasticity in response to training and rehabilitation, although the putative mechanisms of action differ and are not fully understood. Neurostimulation techniques offer a number of practical advantages for use after stroke, such as precise dosing and timing, but can be invasive and costly to implement. This Review focuses on neurostimulation techniques that are now in clinical use or that have reached the stage of pivotal trials and show considerable promise for the treatment of post-stroke impairments.
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Affiliation(s)
- Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Institute of Health Professions, Massachusetts General Hospital, Boston, MA, USA
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de Lima-Pardini AC, Mikhail Y, Dominguez-Vargas AU, Dancause N, Scott SH. Transcranial magnetic stimulation in non-human primates: A systematic review. Neurosci Biobehav Rev 2023; 152:105273. [PMID: 37315659 DOI: 10.1016/j.neubiorev.2023.105273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/06/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
Transcranial magnetic stimulation (TMS) is widely employed as a tool to investigate and treat brain diseases. However, little is known about the direct effects of TMS on the brain. Non-human primates (NHPs) are a valuable translational model to investigate how TMS affects brain circuits given their neurophysiological similarity with humans and their capacity to perform complex tasks that approach human behavior. This systematic review aimed to identify studies using TMS in NHPs as well as to assess their methodological quality through a modified reference checklist. The results show high heterogeneity and superficiality in the studies regarding the report of the TMS parameters, which have not improved over the years. This checklist can be used for future TMS studies with NHPs to ensure transparency and critical appraisal. The use of the checklist would improve methodological soundness and interpretation of the studies, facilitating the translation of the findings to humans. The review also discusses how advancements in the field can elucidate the effects of TMS in the brain.
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Affiliation(s)
- Andrea C de Lima-Pardini
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada.
| | - Youstina Mikhail
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada; Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Adan-Ulises Dominguez-Vargas
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada; Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada; Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Numa Dancause
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada; Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada; Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada; Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
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Ploughman M, Melam GR, Buragadda S, Lohse KR, Clift F, Stefanelli M, Levin M, Donkers SJ. Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 127:107142. [PMID: 36878390 DOI: 10.1016/j.cct.2023.107142] [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: 10/21/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Physical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. METHODS AND ANALYSIS A parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. ETHICS AND DISSEMINATION The Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada.
| | - Ganeswara Rao Melam
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Syamala Buragadda
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Keith R Lohse
- Program in Physical Therapy, Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Fraser Clift
- Department of Neurology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michael Levin
- Department of Neurology and Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Using Logistic Multivariate Analysis to Explore the Effects of Nursing and Psychological Factors on Motor and Cognitive Rehabilitation in Patients with Stroke: Based on a Retrospective Case-Control Study. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1411670. [PMID: 36035851 PMCID: PMC9417779 DOI: 10.1155/2022/1411670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
Objective Based on a retrospective case-control study, logistic multivariate analysis was employed to explore the effects of nursing and psychological factors on the rehabilitation of motor and cognitive function in patients with stroke. Methods A total of 200 stroke patients treated from February 2019 to April 2020 were enrolled in our hospital. According to the results of exercise and cognitive rehabilitation, the patients with good rehabilitation were divided into the control group (n = 140) and the research group (n = 60). The effects of nursing and psychological factors on the rehabilitation of motor and cognitive function in patients with stroke were analyzed. Results First of all, we compared the general data. There were significant differences in terms of age, years of education, occupational status, payment methods of medical expenses, family income and the course of the disease, and the difference was statistically significant (P < 0.05). There was no significant difference in general data (P > 0.05). Secondly, we compared the nursing effective rates. The nursing effective rates of the study group were 10 cases, 15 cases, 12 cases, and 23 cases, and the nursing effective rate was 61.67%. In the control group, 78 cases were markedly effective, 33 cases were effective, 25 cases were general and 14 cases were ineffective, and the nursing effective rate was 90.00%. The effective rate of nursing in the study group was higher than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in anxiety and depression scores before nursing (P > 0.05), but they decreased after nursing. In addition, the scores of anxiety and depression in the study group were higher than those in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in motor function and cognitive function between prenursing and prenursing (P > 0.05); after nursing, the motor function increased and the score of cognitive function decreased. Furthermore, the motor function of the study group was lower compared to the control group, and the score of cognitive function of the study group was higher compared to the control group, and the difference was statistically significant (P < 0.05). The results of the Person correlation analysis showed that there was a significant correlation between nursing anxiety depression and the rehabilitation effect of motor cognitive function in stroke patients. The results of logistic regression analysis showed that age, family income, nursing efficiency, anxiety, and depression were the factors affecting the rehabilitation of motor and cognitive function in stroke patients. Conclusion Age and family income may be the risk factors affecting the psychological mood of patients. Medical staff should pay attention to the negative emotion of patients and strengthen the nursing intervention of patients.
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Hildesheim FE, Silver AN, Dominguez-Vargas AU, Andrushko JW, Edwards JD, Dancause N, Thiel A. Predicting Individual Treatment Response to rTMS for Motor Recovery After Stroke: A Review and the CanStim Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:795335. [PMID: 36188894 PMCID: PMC9397689 DOI: 10.3389/fresc.2022.795335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
Background Rehabilitation is critical for reducing stroke-related disability and improving quality-of-life post-stroke. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique used as stand-alone or adjunct treatment to physiotherapy, may be of benefit for motor recovery in subgroups of stroke patients. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) seeks to advance the use of these techniques to improve post-stroke recovery through clinical trials and pre-clinical studies using standardized research protocols. Here, we review existing clinical trials for demographic, clinical, and neurobiological factors which may predict treatment response to identify knowledge gaps which need to be addressed before implementing these parameters for patient stratification in clinical trial protocols. Objective To provide a review of clinical rTMS trials of stroke recovery identifying factors associated with rTMS response in stroke patients with motor deficits and develop research perspectives for pre-clinical and clinical studies. Methods A literature search was performed in PubMed, using the Boolean search terms stroke AND repetitive transcranial magnetic stimulation OR rTMS AND motor for studies investigating the use of rTMS for motor recovery in stroke patients at any recovery phase. A total of 1,676 articles were screened by two blinded raters, with 26 papers identified for inclusion in this review. Results Multiple possible factors associated with rTMS response were identified, including stroke location, cortical thickness, brain-derived neurotrophic factor (BDNF) genotype, initial stroke severity, and several imaging and clinical factors associated with a relatively preserved functional motor network of the ipsilesional hemisphere. Age, sex, and time post-stroke were generally not related to rTMS response. Factors associated with greater response were identified in studies of both excitatory ipsilesional and inhibitory contralesional rTMS. Heterogeneous study designs and contradictory data exemplify the need for greater protocol standardization and high-quality controlled trials. Conclusion Clinical, brain structural and neurobiological factors have been identified as potential predictors for rTMS response in stroke patients with motor impairment. These factors can inform the design of future clinical trials, before being considered for optimization of individual rehabilitation therapy for stroke patients. Pre-clinical models for stroke recovery, specifically developed in a clinical context, may accelerate this process.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Alexander N. Silver
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Adan-Ulises Dominguez-Vargas
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Justin W. Andrushko
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jodi D. Edwards
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Numa Dancause
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- *Correspondence: Alexander Thiel
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Potvin-Desrochers A, Paquette C. Potential Non-invasive Brain Stimulation Targets to Alleviate Freezing of Gait in Parkinson's Disease. Neuroscience 2021; 468:366-376. [PMID: 34102265 DOI: 10.1016/j.neuroscience.2021.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
Freezing of gait (FOG) is a common motor symptom in Parkinson's disease (PD). Although FOG reduces quality of life, affects mobility and increases the risk of falls, there are little to no effective treatments to alleviate FOG. Non-invasive brain stimulation (NIBS) has recently yielded attention as a potential treatment to reduce FOG symptoms however, stimulation parameters and protocols remain inconsistent and require further research. Specifically, targets for stimulation require careful review. Thus, with current neuroimaging and neuro-electrophysiological evidence, we consider potential cortical targets thought to be involved in the pathophysiology of FOG according to the Interference model, and within reach of NIBS. We note that the primary motor cortex, the supplementary motor area and the dorsolateral prefrontal cortex have already drawn attention as NIBS targets for FOG, but based on neuroimaging evidence the premotor cortex, the medial prefrontal cortex, the cerebellum, and more particularly, the posterior parietal cortex should be considered as potential regions for stimulation. We also discuss different methodological considerations, such as stimulation type, medication state, and hemisphere to target, and future perspectives for NIBS protocols in FOG.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, Currie Gymnasium, 475 Pine Avenue West, McGill University, Montréal, Québec H2W 1S4, Canada; Integrated Program in Neuroscience, Montreal Neurological Institute, 3801 University Street, McGill University, Montréal, Québec H3A 2B4, Canada; Centre for Interdisciplinary Research in Rehabilitation (Jewish Rehabilitation Hospital Research Site and CISSS Laval), 3205 Place Alton-Goldbloom, Laval, Québec H7V 1R2, Canada.
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