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

Cai, Ming; Zhang, Jia-ling; Wang, Xiao-jun; Cai, Ke-ren; Li, Shu-yao; Du, Xin-lin; Wang, Li-yan; Yang, Ruo-yu; Han, Jia; Hu, Jing-yun; Lyu, Jie

doi:10.1007/s10072-023-07217-6

Cited by 4 publications

(2 citation statements)

References 75 publications

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“…Hence, concerns may arise regarding whether the use of current rTMS protocols is a valid approach to restore lateralized epigenetic alterations in deeper brain structures, as most major mental illnesses exhibit a distributed pathology throughout different brain areas and circuits, rather than being confined to a single brain area or specific sets of synapses and pathways [ 180 ]. The long-term safety, efficacy, as well as sustained epigenetic and gene-expression changes, and brain-function modulation after the discontinuation of therapy with this technique, are also unclear due to the lack of long-term follow-up studies [ 181 ]. It is also important to note that current rTMS treatment protocols are not well-designed to target lateralized brain functional alterations in mental illnesses.…”

Section: Challenges In Applying Brain Laterality Research To Clinical...mentioning

confidence: 99%

Epigenome Defines Aberrant Brain Laterality in Major Mental Illnesses

Abdolmaleky,

Nohesara,

Thiagalingam

2024

Brain Sciences

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Brain-hemisphere asymmetry/laterality is a well-conserved biological feature of normal brain development. Several lines of evidence, confirmed by the meta-analysis of different studies, support the disruption of brain laterality in mental illnesses such as schizophrenia (SCZ), bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and autism. Furthermore, as abnormal brain lateralization in the planum temporale (a critical structure in auditory language processing) has been reported in patients with SCZ, it has been considered a major cause for the onset of auditory verbal hallucinations. Interestingly, the peripheral counterparts of abnormal brain laterality in mental illness, particularly in SCZ, have also been shown in several structures of the human body. For instance, the fingerprints of patients with SCZ exhibit aberrant asymmetry, and while their hair whorl rotation is random, 95% of the general population exhibit a clockwise rotation. In this work, we present a comprehensive literature review of brain laterality disturbances in mental illnesses such as SCZ, BD, ADHD, and OCD, followed by a systematic review of the epigenetic factors that may be involved in the disruption of brain lateralization in mental health disorders. We will conclude with a discussion on whether existing non-pharmacological therapies such as rTMS and ECT may be used to influence the altered functional asymmetry of the right and left hemispheres of the brain, along with their epigenetic and corresponding gene-expression patterns.

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Section: Challenges In Applying Brain Laterality Research To Clinical...mentioning

confidence: 99%

Epigenome Defines Aberrant Brain Laterality in Major Mental Illnesses

Abdolmaleky,

Nohesara,

Thiagalingam

2024

Brain Sciences

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“…One promising novel strategy is the combination of behavioral training with noninvasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial focused ultrasound stimulation (tFUS), transcranial unfocused ultrasound stimulation (tUUS), and transcutaneous vagus nerve stimulation (tVNS), etc. [ 7 , 8 , 9 ]. Several meta-analyses have indicated the positive effects of NIBS on functional recovery in stroke patients [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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

Liu,

Zhang

2024

Biomedicines

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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.

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

Li,

Mo,

et al. 2024

Journal of Alzheimer’s Disease

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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.

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

Cited by 4 publications

References 75 publications

Epigenome Defines Aberrant Brain Laterality in Major Mental Illnesses

Epigenome Defines Aberrant Brain Laterality in Major Mental Illnesses

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

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

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