Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial

Electroacupuncture preconditioning alleviates cortical neuronal injury in cerebral ischemia-reperfusion by rebalancing HES1 and NF-κB expression

The roles of Hairy Enhancer of Split 1 (HES1) and nuclear factor kappa B (NF-κB) in neuronal injury following cerebral ischemia have been well established. However, the relationship between electroacupuncture preconditioning-induced neuroprotection and these signaling pathways remains unclear. This study aimed to investigate the effects of electroacupuncture pretreatment on the expression of HES1 and NF-κB in the cortex of rats subjected to cerebral ischemia/reperfusion and to explore the underlying mechanisms. A total of 36 male Sprague-Dawley rats were randomized into three groups: sham, model, and electroacupuncture pretreatment ( n  = 12 per group). Cerebral ischemia/reperfusion was induced using the middle cerebral artery occlusion (MCAO) method. Rats in the electroacupuncture group received daily electroacupuncture stimulation at 'Baihui' and 'Dazhui' acupoints 1 week prior to MCAO. Neurological function scores, 2,3,5-triphenyltetrazolium chloride staining for cerebral infarction, Nissl staining for neuronal cell survival, and immunohistochemical detection of HES1 and NF-κB expression in the cerebral cortex were assessed. Compared to the sham group, the model group exhibited significant neurological deficits, extensive cerebral infarction, decreased neuronal survival, and increased expression of HES1 and NF-κB ( P  < 0.01). In contrast, electroacupuncture pretreatment significantly improved neurological function scores ( P  < 0.01), reduced cerebral infarction ( P  < 0.01), increased neuronal survival ( P  < 0.05), and decreased the expression of HES1 and NF-κB ( P  < 0.01). These findings suggest that electroacupuncture preconditioning may mitigate brain injury in cerebral ischemia/reperfusion rats by downregulating the expression of HES1 and NF-κB, thereby reducing inflammatory damage and enhancing cerebral ischemia tolerance.

Transcutaneous electrical acupoint stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis

Background

Transcutaneous electrical acupoint stimulation (TEAS) is an innovative, non-invasive therapy that stimulates the contraction of paralyzed muscles in the upper limbs, promoting functional recovery. Several studies have demonstrated the efficacy of TEAS in restoring upper limb function. This study aims to evaluate the impact of TEAS on upper limb motor recovery after stroke.

Objectives

This study aims to evaluate the influence of TEAS on upper limb motor recovery after stroke and improve the quality of life in such patients.

Methods

Eight databases were systematically searched from inception to 1st October 2024. Two independent reviewers conducted the screening and data extraction of the study. The primary outcome measure was the Fugl Meyer Assessment of the Upper Extremity (FMA-UE), which evaluates upper extremity motor function in stroke patients. Secondary outcomes included the Modified Ashworth Scale (MAS) for assessing spasticity and the Modified Barthel Index (MBI) to evaluate patients' abilities to perform activities of daily living. Data synthesis was conducted using RevMan 5.4 and Stata 14.0. The GRADE method was employed to assess the quality of evidence.

Results

A total of 16 trials involving 1,218 stroke patients were included in this meta-analysis. Meta-analysis showed that the TEAS significantly improved upper limb function (SMD = 1.70, 95CI% = 1.09 to 2.31, p < 0.00001, I 2 = 93%; low certainty of evidence), reduced spasticity (SMD = -1.18, 95CI% = -1.79 to -0.58, p < 0.00001, I 2 = 90%; very low certainty of evidence), and enhanced the ability to perform daily activities (SMD = 1.53, 95CI% = 0.85 to 2.20, p < 0.00001, I 2 = 95%; low certainty of evidence).

Conclusion

Our results indicated that TEAS improved motor function and functional activities and reduced muscle tone in the upper limbs after stroke. However, these results should be interpreted with caution due to the limited strength of the evidence. High-quality, larger sample, multi-center studies are needed to validate these preliminary findings.

Systematic review registration

This study was registered on PROSPERO with registration number CRD42024592509. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024592509.

Peripheral electrical stimulation on neuroplasticity and motor function in stroke patients: a systematic review and meta-analysis

INTRODUCTION

The use of electrotherapy has been presented as a great resource for the professional physiotherapist in the most diverse pathologies. Stroke is a neurological condition responsible for sequelae such as hemiplegia that directly impair the quality of life of patients.

OBJECTIVE

This study aimed to review the literature on the effects of electrotherapeutic resources on motor function and neuroplasticity in individuals with post-stroke sequelae.

MATERIALS AND METHODS

2427 articles were found in databases according to search criteria for each base according to the included descriptors (EndNote Web). After exclusion of duplicate articles, automatically and manually, Phase 1 was performed - reading of titles and abstracts of 1626 articles according to eligibility criteria by two blinded reviewers using the programme Rayyan QCRI (Qatar Computing Research Institute), conflicts were resolved in consensus between the two reviewers. Thus, 13 articles were selected for Phase 2-13 articles were selected for reading in full, leaving 8 articles in this review. To assess the quality of bias of the selected studies, the PEDro Scale was used.

RESULTS

In the assessment of neuroplasticity, statistically significant results were found in two studies (p < 0.05). However, the effects of electrostimulation stood out significantly in the motor function of these individuals (p < 0.05). It can be considered with neuroplasticity, since improved functionality can be related to electrostimulation-induced neuroplasticity. Conclusions Electrostimulation is able to promote neuroplasticity and increase motor function, generating positive effects in the treatment of individuals with post-stroke sequelae.

Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation?

Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.