Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation

Abstract

The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results.

<p>Unilateral Spatial Neglect After Stroke: Current Insights</p>

“…NIBS may be effective in ameliorating cognitive and motor disorders in individuals affected by stroke 99,100 or by other neurological disorders. [101][102][103] The first attempts to treat neuropsychological symptoms using NIBS were made in individuals with USN.…”

Updated Technique for Reliable, Easy, and Tolerated Transcranial Electrical Stimulation Including Transcranial Direct Current Stimulation

“…The modern technique, by providing a more secure fixation of the electrodes (e.g. compared to ad hoc elastic straps in the conventional technique) would enhance combination with adjunct behavioral therapies such as mirror therapy 36,37,38 , visual imagery and virtual reality 39,40,41 , or physical therapy 34,42,43,44,45 . tDCS is considered a safe and convenient form of noninvasive brain stimulation 5,11 .…”

Transcranial direct current stimulation (tDCS) in patients with aphasia after cerebral stroke

“…Badania prowadzone u 24 osób z afazją, w przewlekłej fazie udaru, wykazały, że dzięki stymulacji anodowej po stronie uszkodzonej kory ruchowej (pole C3/C4) oprócz zamierzonej poprawy motorycznej występuje również poprawa kognitywna (w zakresie pamięci, uwagi, uczenia się). U badanych osób poprawiły się wyniki w MMSE oraz w zmodyfikowanej wersji Kart Wisconsin [52]. W innych badaniach z kolei odnotowano poprawę w zakresie pamięci roboczej (w porównaniu do grupy, która otrzymywała placebo) u 10 osób z afazją [53].…”