Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis

Abstract

Background In recent years, non-invasive brain stimulation (NIBS) has been used for motor function recovery. However, the effects of NIBS in populations with spinal cord injury (SCI) remain unclear. This study aims to conduct a meta-analysis of the existing evidence on the effects and safety of NIBS against sham groups for motor dysfunction after SCI to provide a reference for clinical decision-making. Methods Two investigators systematically screened English articles from PubMed, MEDLINE, Embase, and Cochrane Library for prospective randomized controlled trials regarding the effects of NIBS in motor function recovery after SCI. Studies with at least three sessions of NIBS were included. We assessed the methodological quality of the selected studies using the evidence-based Cochrane Collaboration’s tool. A meta-analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). Results A total of 14 randomized control trials involving 225 participants were included. Nine studies used repetitive transcranial magnetic stimulation (rTMS) and five studies used transcranial direct current stimulation (tDCS). The meta-analysis showed that NIBS could improve the lower extremity strength (SMD = 0.58, 95% CI = 0.02–1.14, P = 0.004), balance (SMD = 0.64, 95% CI = 0.05–1.24, P = 0.03), and decrease the spasticity (SMD = − 0.64, 95% CI = − 1.20 to − 0.03, P = 0.04). However, the motor ability of the upper extremity in the NIBS groups was not statistically significant compared with those in the control groups (upper-extremity strength: P = 0.97; function: P = 0.56; and spasticity: P = 0.12). The functional mobility in the NIBS groups did not reach statistical significance when compared with the sham NIBS groups (sham groups). Only one patient reported seizures that occurred during stimulation, and no other types of serious adverse events were reported. Conclusion NIBS appears to positively affect the motor function of the lower extremities in SCI patients, despite the marginal P-value and the high heterogeneity. Further high-quality clinical trials are needed to support or refute the use and optimize the stimulation parameters of NIBS in clinical practice.

Intervention and assessment of executive dysfunction in patients with stroke: A scoping review

“…Cognitive rehabilitation was common, as described in a previous systematic review (17,18). This scoping review extracted, for the first time, the articles related to VR and NIBS, which have recently been used in several rehabilitation areas [49][50][51][52][53][54][55][56].…”

Sistema Nervoso E a Lesão Medular

“…A fase crônica é caracterizada por uma perda quase total da atividade motora abaixo do nível da lesão, com ou sem atividade reflexa. [22][23][24] Tratamento e reabilitação O tratamento da lesão medular pode variar de acordo com a gravidade e o tipo da lesão. A cirurgia é uma opção para estabilizar a coluna vertebral, corrigir deformidades e aliviar a compressão da medula espinhal.…”

Transcranial direct current stimulation-mediated miR-298-5p downregulation enhances autophagy by targeting LC3 to promote motor recovery after spinal cord injury

“…Transcranial direct current stimulation (tDCS) is considered a promising non-invasive neuromodulation approach, and its effects on improving motor function in persons with SCI conditions have been universally supported [25,26]. In particular, the latest research emphasizes that tDCS can induce plasticity among the residual neural circuits at the lesion site to facilitate motor output after an SCI; however, knowledge of the inner molecular mechanisms at play here has yet to be obtained [5,27].…”