Efficacy of Neurostimulations for Upper Extremity Function Recovery after Stroke: A Systematic Review and Network Meta-Analysis

Abstract

Background: Neurostimulations for the post-stroke recovery of upper extremity function has been explored in previous research, but there remains a controversy about the superiority of different neurostimulations. Methods: Randomized controlled trials (RCTs) were searched in MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov, from 1 January 2000 to 1 June 2022. A conventional pair-wise meta-analysis with a random-effect model was used to evaluate direct evidence. Bayesian random effect models were used for network meta-analysis. The grading of the recommendations assessment, development and evaluation (GRADE) approach was applied to assess the clinical quality of the results. Results: A total of 88 RCTs, which enrolled 3491 participants, were included. For the Fugl-Meyer Assessment-Upper Extremity score change from the baseline to the longest follow-up, the following interventions showed a significant difference: VNS (MD = 4.12, 95%CrI: 0.54 to 7.80, moderate certainty), cNMES (MD = 3.98, 95%CrI: 1.05 to 6.92, low certainty), FES (MD = 7.83, 95%CrI: 4.42 to 11.32, very low certainty), drTMS (MD = 7.94, 95%CrI: 3.71 to 12.07, moderate certainty), LFrTMS (MD = 2.64, 95%CrI: 1.20 to 4.11, moderate certainty), HFrTMS (MD = 6.73, 95%CrI: 3.26 to 10.22, moderate certainty), and iTBS combined with LFrTMS (MD = 5.41, 95%CrI: 0.48 to 10.35, moderate certainty). Conclusions: The neurostimulations above the revealed significant efficacy for improving the upper limb function after stroke eased the suffering of the patient.

Combination of different noninvasive brain stimulation treatments for upper limb recovery in stroke patients: A systematic review

“…However, several studies have recently been performed to evaluate the possibility of applying both techniques one after the other (Chen et al., 2021 ). We found studies reflecting a greater effectiveness of HF‐rTMS than LF‐rTMS for the improvement of upper limb motor function (Xue et al., 2022 ). However, we also found a recent meta‐analysis suggesting that bilateral stimulation may be more effective in patients in the acute phase of stroke than single hemisphere stimulation when comparing the effectiveness according to the time of evolution of the patient.…”

“…Recent studies have shown inconclusive results when applying tDCS for motor skill improvement using scales such as the FMA (Chow et al., 2022 ); however, considering the ICF division, that same study and other systematic reviews with meta‐analyses have shown that all types of tDCS stimulation are effective, but it appears that ctDCS may have greater effectiveness in improving activities of daily living and independence (Chow et al., 2022 ; Elsner et al., 2020 , 2017 ). The atDCS approach appears to show more significant improvements in motor ability (Xue et al., 2022 ).…”

Transcranial Magnetic Stimulation, Connectome and Its Clinical Applications

“…Inhibitory rTMS or cTBS over motor cortex of the non-lesional side and facilitatory rTMS or iTBS over motor cortex of lesional side are the common choices. Systematic reviews and meta-analyses show that rTMS and TBS are effective in improvement of motor function after insult of the brain with 95% confidence interval 0.24-9.71 for upper limb Fugl Meyer assessment [36][37][38]. Spinal insults, including trauma and post tumor excision, can also lead to motor deficits.…”

Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

“…Actually, post‐stroke autonomic dysfunction had been supposed to be an independent predictor of poor neurological functional outcome, cardiac complications, blood pressure fluctuation, infection, and stroke recurrence 5,6,11–13 . Also, studies suggested that modulation of ANS function, such as blocking sympathetic activity and stimulating parasympathetic activity can promote the recovery of neurological function of stroke patients 14–17 . Therefore, targeting the ANS for risk stratification of patients according to autonomic functional activities, development of intervention approaches based on the restoration of sympathetic‐parasympathetic balance, and more precise management on these basis, would potentially improve clinical outcomes of ICH patients.…”