Noninvasive Brain Stimulation for Neurorehabilitation in Post-Stroke Patients

Clinical efficacy of NIBS in enhancing neuroplasticity for stroke recovery

BACKGROUND

For stroke patients, a therapeutic approach named Non-invasive brain stimulation (NIBS) was applied and it has gained attention. This NIBS approach enhances the neuroplasticity and facilitates in functional Stroke Rehabilitation (SR) through regulating the brain activity. This NIBS has several advantages, but, the variability in patient responses, poor personalized treatment plans, and challenges in predicting rehabilitation stages may limit its clinical application. The generalized approaches are usually employed by the current SR methods. Here, the Patient-Centric (PC) factors that impacts neuroplasticity fails to be considered by the current SR methods. Thus, Real-Time mechanisms in monitoring and adapting to neural responses are lacking in the current SR methods.

METHODS

A novel SR with Machine Learning (ML), (SR-ML) framework is suggested in this study. This suggested study integrates the patient-specific data, neuroimaging, and NIBS intervention models for the purpose of overcoming those issues. By optimising stimulation parameters based on patient profiles, the SR-ML framework uses ML algorithms. This integration will enhance the efficacy and facilitates the customized NIBS therapies. During NIBS sessions, the Time-Series (TS) neural data is analyzed and classified by the application of the Recurrent (NN) Neural Network (RNN). The temporal relationships and patterns indicating neuroplastic variations were effectively identified by this RNN.

RESULTS

The stroke patients neuroplasticity signs was improved, and effective rehabilitation outcomes was attained by the suggested SR-ML model, and it was demonstrated by the outcomes of the simulation. The accuracy and adaptability of NIBS interventions were enhanced by the potential of ML, and it is highlighted by the outcomes.

CONCLUSION

A revolutionized development in the customized SR was facilitated by the suggested SR-ML framework, as it integrates ML with NIBS. More effective and PC neurotherapeutic approaches was attained by RT classification and optimization of simulation protocols. Thus, the limitations in the current SR methods was addressed by the effective method.

Effects of speech rehabilitation training combined with repetitive transcranial magnetic stimulation on patients with post-stroke aphasia

OBJECTIVE

The study focused on effects of speech rehabilitation training combined with repetitive transcranial magnetic stimulation (rTMS) in patients with post-stroke aphasia (PSA).

METHODS

Ninety-six patients with PSA were divided into two groups. One group received speech rehabilitation training (ST group, n = 48) and one group received speech rehabilitation training combined with rTMS treatment (ST + rTMS group, n = 48), both of which were treated continuously for 4 weeks. The post-treatment effects of the two groups and the Boston Diagnostic Aphasia Examination (BDAE), Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE), Communicative Ability in Daily Life (CADL), Stroop Color and Word Test (SCWT), Montreal Cognitive Assessment (MoCA), and Barthel Index (BI) scores before and after treatment were compared in both groups.

RESULTS

After treatment, the total effective rate of the ST + rTMS group was higher than that of the ST group (p < 0.05). Both groups exhibited improved BDAE grade; CRRCAE, CADL, SCWT, MoCA, and BI scores increased in both groups, and were higher in the ST + rTMS group than in the ST group (all p < 0.05).

CONCLUSION

Speech rehabilitation training combined with rTMS can effectively improve speech function in PSA, with remarkable rehabilitation effects.

Frequency-specific modulation of motor cortical excitability by transcranial alternating current stimulation

BACKGROUND

Transcranial alternating current stimulation (tACS) is a non-invasive technique that modulates neural oscillations, yet its specific effects on cortical excitability are not well-understood. This study investigated the effects of tACS on neuroplasticity in the primary motor cortex (M1) across different frequencies.

METHODS

In this randomized, sham-controlled, crossover study, 18 healthy young adults received β-tACS γ-tACS, and sham stimulation over the M1. Neurophysiological responses were assessed using motor evoked potentials (MEPs), electroencephalograms (EEG), and transcranial evoked potentials (TEPs) to determine the frequency-specific effects of tACS on cortical excitability and neuroplasticity.

RESULTS

γ-tACS significantly enhanced cortical excitability, as reflected by larger MEP amplitudes compared to both β-tACS and sham stimulation. In addition, γ-tACS resulted in significantly smaller M1-P15 amplitudes in TEP than other stimulation conditions. In contrast, β-tACS did not produce significant changes in either MEPs or TEPs compared to sham stimulation.

CONCLUSION

These findings provide evidence that tACS induces frequency-dependent effects on cortical excitability and neuroplasticity within the M1. This selective modulation of cortical excitability with γ-tACS suggests its potential as a therapeutic intervention for optimizing motor function and rehabilitation.

TRIAL REGISTRATION

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2300074898, date of registration: 2023/08/18).

Non-invasive brain stimulation for treating visual defects: a systematic review and meta-analysis

OBJECTIVE

We evaluated the efficacy of applying repetitive transorbital alternating current stimulation (rTACS) to patients suffering from visual defects, especially homonymous hemianopia.

BACKGROUND

Stroke or optic neuropathy would result in vision loss or Visual field defect (VFD) and homonymous hemianopia. Recently, one of the commonly used procedures to relieve VFD is non-invasive brain stimulation (NIBS).

METHODS

A comprehensive search covering publications in PubMed, Embase, Cochrane, and Scopus, spanning until September 2023 was performed. Relevant Randomized controlled trials (RCTs) were selected, and their data were extracted and analyzed. Pooled mean difference (MD) was calculated for change in the high-resolution perimetry detection accuracy (HRP DA) and fixation accuracy (HRP FA), static automated perimetry foveal threshold (SAP FT), and visual acuity (VA) of near vision outcomes.

RESULTS

We pooled in our analysis 4 RCTs. Compared to the sham group, rTACS patients had a significantly higher HRP DA (SMD = 0.35; 95% CI [0.003,0.694] P = 0.048). However, the analysis did not favor any of the compared groups in HRP FA, SAP FT, VA of near vision, and mean threshold (SMD = 0.14; 95% CI [-0.21,0.48] P = 0.43], (SMD = 0.17; 95% CI [-0.11,0.45] P = 0.23), (SMD = 0.32; 95%CI [-0.24,0.88] P = 0.26), and (SMD = 0.31; 95% CI [-0.04,0.65] P = 0.08) respectively.

CONCLUSIONS

Current evidence suggests that rTACS exhibits a promising approach in homonymous hemianopia patients, where it significantly increased HRP DA. Despite the results' failure to attain statistical significance in some outcomes, it underscores the necessity for larger RCTs with longer follow-up periods.

The application of non-invasive neuromodulation in stuttering: Current status and future directions

Non-invasive neuromodulation methods such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), have been extensively utilized to enhance treatment efficacy for various neurogenic communicative disorders. Recently, these methods have gained attention for their potential to reveal more about the underlying nature of stuttering and serve as adjunct therapeutic approaches for stuttering intervention. In this review, we present existing research and discuss critical factors that might influence the efficacy of these interventions, such as location, polarity, intensity, and duration of stimulation, as well as the impact of combined behavioral training. Additionally, we explore implications for future studies, including the application of different neuromodulation methods to address various aspects of stuttering such as speech fluency and associated psychological and cognitive aspects in people who stutter.

Long-term effect of non-invasive brain stimulation on hemispatial neglect, functional outcomes, and mortality after stroke: ELETRON trial extend

INTRODUCTION

Our primary clinical trial indicated that anodal stimulation of the right posterior parietal region associated with specific and perceptual task training was superior to placebo in reducing stroke-induced hemispatial neglect (HN) immediately after the treatment protocol. However, our primary study did not investigate whether this benefit was maintained in the long term after stroke. Therefore, this study aimed to evaluate the long-term effects of the protocol applied in the ELETRON trial on outcomes associated with HN, functionality, and mortality.

METHODS

This was a pilot, multicenter, prospective, randomized, double-blind trial in patients with HN after stroke who underwent either active tDCS (anodal tDCS or C-tDCS) or sham tDCS in addition to specific and perceptual task training. The outcomes were evaluated on the last day of the session and after 1 year of stimulation (follow-up). Daily evolution rates were calculated as the difference between the values observed between the moments divided by the follow-up time for each individual. The primary outcome was the rate of HN evolution according to the BIT-C scale. The secondary outcome was CBS evolution rate. The exploratory outcomes were the evolution rate of functional disability and autonomy assessed by FIM and BI, quality of life assessed by EQ 5D, stroke severity using the NIHSS, and functional dependence assessed by mRS. Death was examined separately. A linear regression model with a time-adjusted identity link function was used to explain the evolution rates of each outcome of A-tDCS and C-tDCS as a function of sham tDCS. Survival models were adjusted to compare mortality groups.

RESULTS

The evolution rate of BIT-C was not different between A-tDCS (B = 3.18; CI: -4.84-11.19; p = 0.438) and C-tDCS (B = -0.95; CI: -8.97-7.07; p = 0.816) with sham. The secondary and exploratory outcomes showed the same pattern. In addition, there were no statistically significant differences in mortality over time between A-tDCS and S-tDCS (B = 0.322; 95 % CI 0.284-6.707; p = 0.689) and between C-tDCS and S-tDCS (B = -0.798; 95 % CI 0.063-3.195; p = 0.425).

CONCLUSION

The benefits of A-tDCS and C-tDCS were maintained for all long-term post-stroke outcomes.

TRIAL REGISTRATION

RBR-78jvzx - Brazilian Registry of Clinical Trials (Rebec), registered on March 13, 2016.

Research hotspots and frontiers of vagus nerve stimulation in stroke: a bibliometric analysis

Background

Vagus nerve stimulation (VNS) has emerged as a promising therapeutic approach for stroke treatment, drawing significant attention due to its potential benefits. However, despite this growing interest, a systematic bibliometric analysis of the research landscape is yet to be conducted.

Methods

We performed a comprehensive search of the Web of Science Core Collection (WoSCC) database for literature published between January 1, 2005, and August 31, 2024. CiteSpace and the Bibliometrix package in R software were used to generate knowledge maps and conduct a bibliometric analysis. This analysis focused on publication output, geographic distribution, institutional involvement, author and co-cited author networks, journal and co-cited journal relationships, co-cited references, and keyword trends.

Results

During the study period, 316 publications on VNS in stroke were identified, authored by 1,631 researchers from 1,124 institutions across 172 countries or regions. The number of publications showed steady growth, with the United States of America (USA) leading as the primary contributor. The University of Texas System emerged as the most active research institution. Frontiers in Neuroscience published the highest number of articles, while Stroke had the most citations. Professor Michael P. Kilgard authored the largest number of papers and was also the most frequently cited researcher. The main research trends focus on investigating VNS mechanisms via animal models and exploring its application in improving post-stroke sensorimotor function in the upper limbs. Moreover, VNS is showing promise in enhancing non-motor functions, such as swallowing, speech, and cognition, while addressing complications like post-stroke insomnia, depression, and disruptions in gut microbiota.

Conclusion

This bibliometric study offers a comprehensive overview of the research landscape and emerging trends in VNS for stroke rehabilitation, providing a solid foundation and reference point for future research directions in this field.

Effect of Dual-Site Non-Invasive Brain Stimulation on Upper-Limb Function After Stroke: A Systematic Review and Meta-Analysis

BACKGROUND

Non-invasive brain stimulation (NIBS) has attracted significant attention as it has been proven to be effective in facilitating upper limb motor recovery in patients with stroke. This meta-analysis evaluates the efficacy of dual-site non-invasive brain stimulation (DS-NIBS) in improving upper extremity motor function after stroke.

METHODS

A PRISMA systematic search was conducted for randomized controlled trials. Two authors independently extracted data, and the quality of included studies was assessed.

RESULTS

Ten studies were included in the current review. DS-NIBS demonstrated a significant effect on upper extremity motor function impairment. However, only two studies showed no clear effects of DS-tDCS on upper extremity motor function after stroke. Due to the limited number of studies, the effects of DS-NIBS remain inconclusive.

FINDING

This review found evidence for the relatively higher efficacy of DS-NIBS on post-stroke upper extremity motor function impairment, compared to the sham and SS-NIBS. Additionally, DS-TMS was found to generate better improvement than DS-tDCS.

Breaking the ice through an effective translationality in neurorehabilitation: are we heading to the right direction?

INTRODUCTION

Translational medicine has been facing a persistent crisis for decades, and the field of neurorehabilitation is no exception. The challenges and delays that prevent patients, caregivers, and clinicians from promptly benefiting from advancements in bioengineering and new technological discoveries are well-documented.

AREAS-COVERED

This perspective presents some ideas to underline the consolidated problems and highlight new obstacles to overcome in the context of translational neurorehabilitation, also considering the increasingly stringent laws for medical devices that are emerging throughout the world.

EXPERT OPINION

The objective of the entire medical-scientific community must be to ensure that patients and their loved ones receive the best care available with the most advanced systems. Bioengineers, healthcare policy makers, certifiers and clinicians must always take translational aspects into consideration and find solutions to mitigate possible problems and delays. The goal of the entire medical and scientific community should be to ensure that patients and their families receive the highest quality care through the most advanced systems. To achieve this, bioengineers, healthcare policymakers, certifiers, and clinicians must consistently address translational challenges and work collaboratively to find solutions that minimize potential problems and delays.

Effect of non-invasive brain stimulation on post-stroke cognitive impairment: a meta-analysis

Background

Previous studies have suggested that repetitive transcranial magnetic stimulation (rTMS) may be an effective and safe alternative treatment for post-stroke cognitive impairment (PSCI). Similarly, the application of transcranial direct current stimulation (tDCS) during stroke rehabilitation has been shown to improve cognitive function in PSCI patients. However, there have been conflicting results from some studies. Therefore, this study aims to conduct a meta-analysis to evaluate the effects of tDCS and rTMS on PSCI.

Methods

The meta-analysis search for articles published from the initial availability date to 5 February 2024 in databases. The extracted study data were entered into STATA 12.0 software for statistical analysis.

Results

This meta-analysis provides evidence that both rTMS and tDCS have a positive impact on general cognitive function in PSCI patients [immediate effect of rTMS: standard mean difference (SMD) = 2.58, 95% confidence interval (CI) = 1.44 to 3.71; long-term effect of rTMS: SMD = 2.33, 95% CI = 0.87-3.78; immediate effect of tDCS: SMD = 2.22, 95% CI = 1.31-3.12]. Specifically, rTMS was found to significantly improve attention, language, memory, and visuospatial functions, while it did not show a significant therapeutic effect on executive function (attention: SMD = 3.77, 95% CI = 2.30-5.24; executive function: SMD = -0.52, 95% CI = -3.17-2.12; language: SMD = 3.43, 95% CI = 1.50-5.36; memory: SMD = 3.52, 95% CI = 1.74-5.30; visuospatial function: SMD = 4.71, 95% CI = 2.61-6.80). On the other hand, tDCS was found to significantly improve executive and visuospatial functions but did not show a significant improvement in attention function and memory (attention: SMD = 0.63, 95% CI = -0.30-1.55; executive function: SMD = 2.15, 95% CI = 0.87-3.43; memory: SMD = 0.99, 95% CI = -0.81-2.80; visuospatial function: SMD = 2.64, 95% CI = 1.04-4.23).

Conclusion

In conclusion, this meta-analysis demonstrates that both rTMS and tDCS are effective therapeutic techniques for improving cognitive function in PSCI. However, more large-scale studies are needed to further investigate the effects of these techniques on different cognitive domains in PSCI.

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

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.

The Role of the Complement System in Synaptic Pruning after Stroke

Stroke is a serious disease that can lead to local neurological dysfunction and cause great harm to the patient's health due to blood cerebral circulation disorder. Synaptic pruning is critical for the normal development of the human brain, which makes the synaptic circuit completer and more efficient by removing redundant synapses. The complement system is considered a key player in synaptic loss and cognitive impairment in neurodegenerative disease. After stroke, the complement system is over-activated, and complement proteins can be labeled on synapses. Microglia and astrocytes can recognize and engulf synapses through corresponding complement receptors. Complement-mediated excessive synaptic pruning can cause post-stroke cognitive impairment (PSCI) and secondary brain damage. This review summarizes the latest progress of complement-mediated synaptic pruning after stroke and the potential mechanisms. Targeting complement-mediated synaptic pruning may be essential for exploring therapeutic strategies for secondary brain injury (SBI) and neurological dysfunction after stroke.

Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review

The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.

The impact of physical therapy on dysphagia in neurological diseases: a review

A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.

Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges

In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient's rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.

High-frequency repetitive transcranial magnetic stimulation promotes ipsilesional functional hyperemia and motor recovery in mice with ischemic stroke

Neurovascular decoupling plays a significant role in dysfunction following an ischemic stroke. This study aimed to explore the effect of low- and high-frequency repetitive transcranial magnetic stimulation on neurovascular remodeling after ischemic stroke. To achieve this goal, we compared functional hyperemia, cerebral blood flow regulatory factors, and neurochemical transmitters in the peri-infract cortex 21 days after a photothrombotic stroke. Our findings revealed that low- and high-frequency repetitive transcranial magnetic stimulation increased the real-time cerebral blood flow in healthy mice and improved neurobehavioral outcomes after stroke. Furthermore, high-frequency (5-Hz) repetitive transcranial magnetic stimulation revealed stronger functional hyperemia recovery and increased the levels of post-synaptic density 95, neuronal nitric oxide synthase, phosphorylated-endothelial nitric oxide synthase, and vascular endothelial growth factor in the peri-infract cortex compared with low-frequency (1-Hz) repetitive transcranial magnetic stimulation. The magnetic resonance spectroscopy data showed that low- and high-frequency repetitive transcranial magnetic stimulation reduced neuronal injury and maintained excitation/inhibition balance. However, 5-Hz repetitive transcranial magnetic stimulation showed more significant regulation of excitatory and inhibitory neurotransmitters after stroke than 1-Hz repetitive transcranial magnetic stimulation. These results indicated that high-frequency repetitive transcranial magnetic stimulation could more effectively promote neurovascular remodeling after stroke, and specific repetitive transcranial magnetic stimulation frequencies might be used to selectively regulate the neurovascular unit.

The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis

BACKGROUND

Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis.

METHODS

Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software.

RESULTS

Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions.

CONCLUSION

The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.

Effect of Repetitive Transcranial Magnetic Stimulation on Post-Stroke Comorbid Cognitive Impairment and Depression: A Randomized Controlled Trial

Background

There are currently no uniform treatments for post-stroke comorbid cognitive impairment and depression (PSCCID).

Objective

To verify whether repetitive transcranial magnetic stimulation (rTMS) can improve PSCCID symptoms and explore the underlying roles of resting-state functional magnetic resonance imaging (rs-fMRI).

Methods

Thirty PSCCID patients were randomized in a 1 : 1 ratio to receive 4 weeks of rTMS (intervention group) or sham rTMS (control group) over the left dorsolateral prefrontal cortex (DLPFC). rs-fMRI was acquired to analyze the functional plasticity of brain regions at baseline and immediately after the last intervention.

Results

Cognition, depression status, and neural electrophysiology were improved in both intervention and control groups after treatment (p = 0.015-0.042), and the intervention group had more significant improvement than the control group. Analysis of functional connectivities (FCs) within the default mood network (DMN) showed that the connection strength of the left temporal pole/left parahippocampal cortex and right lateral temporal cortex/right retrosplenial cortex in the intervention group were enhanced compared with its pre-intervention and that in the control group after treatment (p < 0.05), and the both FC values were positively correlated with MMSE scores (p < 0.001). The intervention group had stronger FCs within the DMN compared with the control group after treatment, and some of the enhanced FCs were correlated with the P300 latency and amplitude.

Conclusions

rTMS over the left DLPFC is an effective treatment for improving both cognitive impairment and depression among patients with PSCCID. The enhanced FCs within the DMN may serve as a compensatory functional recombination to promote clinical recovery.

Neuromodulation for Post-Stroke Motor Recovery: a Narrative Review of Invasive and Non‑Invasive Tools

PURPOSE OF REVIEW

Stroke remains a leading disabling condition, and many survivors have permanent disability despite acute stroke treatment and subsequent standard-of-care rehabilitation therapies. Adjunctive neuromodulation is an emerging frontier in the field of stroke recovery. In this narrative review, we aim to highlight and summarize various neuromodulation techniques currently being investigated to enhance recovery and reduce impairment in patients with stroke.

RECENT FINDINGS

For motor recovery, repetitive transcranial magnetic simulation (rTMS) and direct current stimulation (tDCS) have shown promising results in many smaller-scale trials. Still, their efficacy has yet to be proven in large-scale pivotal trials. A promising large-scale study investigating higher dose tDCS combined with constraint movement therapy to enhance motor recovery is currently underway. MRI-guided tDCS studies in subacute and chronic post-stroke aphasia showed promising benefits for picture-naming recovery. rTMS, particularly inhibitory stimulation over the contralesional homolog, could represent a pathway forward in post-stroke motor recovery in the setting of a well-designed and adequately powered clinical trial. Recently evidenced-based guideline actually supported Level A (definite efficacy) for the use of low-frequency rTMS of the primary motor cortex for hand motor recovery in the post-acute stage of stroke based on the meta-analysis result. Adjunctive vagal nerve stimulation has recently received FDA approval to enhance upper limb motor recovery in chronic ischemic stroke with moderate impairment, and progress has been made to implement it in real-world practice. Despite a few small and large-scale studies in epidural stimulation (EDS), further research on the utilization of EDS in post-stroke recovery is needed. Deep brain stimulation or stent-based neuromodulation has yet to be further tested regarding safety and efficacy. Adjunctive neuromodulation to rehabilitation therapy is a promising avenue for promoting post-stroke recovery and decreasing the overall burden of disability. The pipeline for neuromodulation technology remains strong as they span from the preclinical stage to the post-market stage. We are optimistic to see that more neuromodulation tools will be available to stroke survivors in the not-to-distant future.

Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation

Translational neuroscience is intended as a holistic approach in the field of brain disorders, starting from the basic research of cerebral morphology and with the function of implementing it into clinical practice. This concept can be applied to the rehabilitation field to promote promising results that positively influence the patient's quality of life. The last decades have seen great scientific and technological improvements in the field of neurorehabilitation. In this paper, we discuss the main issues related to translational neurorehabilitation, from basic research to current clinical practice, and we also suggest possible future scenarios.

Exploring the Frontiers of Neuroimaging: A Review of Recent Advances in Understanding Brain Functioning and Disorders

Neuroimaging has revolutionized our understanding of brain function and has become an essential tool for researchers studying neurological disorders. Functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) are two widely used neuroimaging techniques to review changes in brain activity. fMRI is a noninvasive technique that uses magnetic fields and radio waves to produce detailed brain images. An EEG is a noninvasive technique that records the brain's electrical activity through electrodes placed on the scalp. This review overviews recent developments in noninvasive functional neuroimaging methods, including fMRI and EEG. Recent advances in fMRI technology, its application to studying brain function, and the impact of neuroimaging techniques on neuroscience research are discussed. Advances in EEG technology and its applications to analyzing brain function and neural oscillations are also highlighted. In addition, advanced courses in neuroimaging, such as diffusion tensor imaging (DTI) and transcranial electrical stimulation (TES), are described, along with their role in studying brain connectivity, white matter tracts, and potential treatments for schizophrenia and chronic pain. Application. The review concludes by examining neuroimaging studies of neurodevelopmental and neurological disorders such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), Alzheimer's disease (AD), and Parkinson's disease (PD). We also described the role of transcranial direct current stimulation (tDCS) in ASD, ADHD, AD, and PD. Neuroimaging techniques have significantly advanced our understanding of brain function and provided essential insights into neurological disorders. However, further research into noninvasive treatments such as EEG, MRI, and TES is necessary to continue to develop new diagnostic and therapeutic strategies for neurological disorders.