Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials

Wang, Y.; Wan, Lei; Chen, Jiu; Bai, Jianling; Yu, Hui; Ma, Hui; Jiang, Rao; Xu, Guangxu

doi:10.1177/20406223231168754

Cited by 6 publications

(2 citation statements)

References 94 publications

(283 reference statements)

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“…Previous studies have shown that non-invasive stimulation of the DLPFC might serve as one innovative treatment approach to enhance functional recovery after stroke, particularly in the cognitive domain. 29 Herein, stimulation effects were more likely to affect memory, attentional and executive 30 than motor functions. 31 One study found that an increased functional connectivity between contralesional DLPFC and mid-ventrolateral prefrontal cortex was linked to better hand function in chronic stroke patients.…”

Section: Discussionmentioning

confidence: 92%

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

Olszówka,

Frey,

Frontzkowski

et al. 2024

Preprint

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White matter hyperintensities of presumed vascular origin (WMH), a manifestation of cerebral small vessel disease, are associated with various clinical sequelae. In stroke patients, total WMH burden is linked to recurrent cerebrovascular events and worse clinical outcome. As WMH also affect the integrity of structural large-scale brain networks, we hypothesize that the extent of WMH-related network damage carries relevant information to explain outcome variability in addition to global WMH volume. Clinical and structural brain imaging data of 33 severely affected acute stroke patients were analysed from two independent cohorts. Imaging data were acquired within the first two weeks after stroke. WMH-related localized and global network damage was derived, involving cortical and subcortical brain regions of an extended motor network. Using ordinal logistic regression analyses, network damage was associated with functional outcome, operationalized by the modified Rankin Scale, at follow-up after three to six months. WMH were linked to a significant disconnection of multiple ipsilesional and contralesional cortical and subcortical brain regions. Global as well as localized periventricular WMH-related network damage affecting distinct brain regions of both hemispheres, including the precentral and the inferior frontal gyrus, areas of the dorsolateral prefrontal cortex, the insula, and multiple subcortical nuclei, was independently associated with a worse outcome after adjustment for baseline symptom burden, age, brain infarct volume and total WMH volume. Total and deep WMH-related network disturbances did not show similar associations. This study shows that periventricular WMH-related network damage affecting specific brain regions of the frontal and insular lobe, and subcortical nuclei is linked to functional outcome in acute stroke patients. This supports the evolving concept of structural brain reserve and underscores the potential significance of pre-existing WMH-related network damage as a crucial factor in comprehending outcome variability after severe stroke.

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Section: Discussionmentioning

confidence: 92%

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

Olszówka,

Frey,

Frontzkowski

et al. 2024

Preprint

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“…GABA functions as the principal inhibitory neurotransmitter. The lack of GABA in the DLPFC disrupts the balance between neuronal excitation and inhibition, resulting in increased neural activity, potential harm to the brain, and a loss of cognitive function [ 19 , 20 ]. The interconnection between different regions and networks in the brain may help explain the neuronal pathways that are activated during rTMS stimulation.…”

Section: Discussionmentioning

confidence: 99%

The Simultaneous Application of Transcranial Magnetic Stimulation and Virtual Reality to Treat Cognitive Deficits Among Stroke Patients: A Randomized Controlled Trial

Chauhan,

Das,

Shahanawaz

2024

Cureus

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Background and objective Integrating virtual reality (VR) and transcranial magnetic stimulation (TMS) offers a promising strategy for stroke rehabilitation, as it specifically focuses on reorganizing neural connections and activating brain activity in the cortex. The main goal is to create equitable connections between the brain's two hemispheres to enhance the execution of voluntary movements by stimulating the central executive network (CEN) to strengthen both motor and cognitive abilities. This study aims to propose a therapeutic approach that can improve cognitive recovery and overall quality of life in patients after a stroke. Methods A total of 69 participants were enrolled in the study based on certain inclusion and exclusion criteria. The patients underwent pre-assessment and were randomly allocated into three groups: Group 1 received simultaneous repetitive TMS (rTMS) and virtual reality treatment (VRT), Group 2 received rTMS combined with sham VRT, and Group 3 received sham stimulation with VRT, in a 1:1:1 ratio using opaque, sealed, and stapled envelopes (SNOSE). Post-assessment was carried out using the same measures: the National Institutes of Health Stroke Scale (NIHSS), Addenbrooke's Cognitive Test (ACE III), and Montreal Cognitive Assessment (MOCA). Statistical analysis was conducted to determine the specific outcomes. Data analysis was carried out using IBM SPSS Statistics version 29 (IBM Corp., Armonk, NY), employing student's t-test for within-group comparisons and repeated measures ANOVA for between-group comparisons. The significance level was set at 5%. Results The results demonstrated statistical significance in NIHSS scores across all treatment groups (p<0.001). Regarding cognitive outcomes, improvements were observed in memory, language, and overall cognitive performance (ACE III) within all groups (p<0.05), with significant between-group outcomes (p = 0.009, p = 0.01, p = 0.004, respectively), suggesting variations in treatment effects across cognitive domains. However, no significant differences between groups were found in terms of fluency and visuospatial skills (p = 0.49, p = 0.13), indicating no treatment effects in these domains. Conclusions Based on our findings, the combined intervention involving rTMS and VRT, compared to sham treatments, demonstrates promising outcomes in alleviating stroke severity and improving specific cognitive functions such as memory, language, and overall cognitive performance. Additionally, the combined administration offers a more effective therapy than when they are administered separately.

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Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily

Godefroy,

Aarabi,

Béjot

et al. 2024

European Stroke Journal

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Purpose: Post-stroke (PS) cognitive impairment (CI) is frequent and its devastating functional and vital consequences are well known. Despite recent guidelines, they are still largely neglected. A large number of recent studies have re-examined the epidemiology, diagnosis, imaging determinants and management of PSCI. The aim of this update is to determine whether these new data answer the questions that are essential to reducing PSCI, the unmet needs, and steps still to be taken. Methods: Literature review of stroke unit-era studies examining key steps in the management of PSCI: epidemiology and risk factors, diagnosis (cognitive profile and assessments), imaging determinants (quantitative measures, voxelwise localization, the disconnectome and associated Alzheimer’s disease [AD]) and treatment (secondary prevention, symptomatic drugs, rehabilitation and noninvasive brain stimulation) of PSCI. Findings: (1) the prevalence of PSCI of approximately 50% is probably underestimated; (2) the sensitivity of screening tests should be improved to detect mild PSCI; (3) comprehensive assessment is now well-defined and should include apathy; (4) easily available factors can identify patients at high risk of PSCI; (5) key imaging determinants are the location and volume of the lesion and the resulting disconnection, associated AD and brain atrophy; WMH, ePVS, microhemorrhages, hemosiderosis, and cortical microinfarcts may contribute to cognitive impairment but are more likely to be markers of brain vulnerability or associated AD that reduce PS recovery; (6) remote and online assessment is a promising approach for selected patients; (7) secondary stroke prevention has not been proven to prevent PSCI; (8) symptomatic drugs are ineffective in treating PSCI and apathy; (9) in addition to cognitive rehabilitation, the benefits of training platforms and computerized training are yet to be documented; (10) the results and the magnitude of improvement of noninvasive brain stimulation, while very promising, need to be substantiated by large, high-quality, sham-controlled RCTs. Discussion and conclusion: These major advances pave the way for the reduction of PSCI. They include (1) the development of more sensitive screening tests applicable to all patients and (2) online remote assessment; crossvalidation of (3) clinical and (4) imaging factors to (5) identify patients at risk, as well as (6) factors that prompt a search for associated AD; (7) the inclusion of cognitive outcome as a secondary endpoint in acute and secondary stroke prevention trials; and (8) the validation of the benefit of noninvasive brain stimulation through high-quality, randomized, sham-controlled trials. Many of these objectives can be rapidly and easily attained.

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Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials

Cited by 6 publications

References 94 publications

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

Localized network damage related to white matter hyperintensities is linked to worse outcome after severe stroke

The Simultaneous Application of Transcranial Magnetic Stimulation and Virtual Reality to Treat Cognitive Deficits Among Stroke Patients: A Randomized Controlled Trial

Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily

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