Interhemispheric Competition After Stroke: Brain Stimulation to Enhance Recovery of Function of the Affected Hand

Nowak, Dennis A.; Grefkes, Christian; Ameli, Mitra; Fink, Gereon R.

doi:10.1177/1545968309336661

Cited by 443 publications

(340 citation statements)

References 53 publications

(188 reference statements)

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“…Increasing cortical excitability in the ipsilesional hemisphere (via anodal tDCS and high frequency rTMS) and decreasing cortical excitability in the contralesional hemisphere (via cathodal tDCS and low frequency rTMS) improved paretic limb force production. These findings are interpreted as support for an assumption of the interhemispheric competition theory for stroke motor recovery [20,21]. That is, balanced cortical activities between hemispheres after NIBS techniques may contribute to motor improvements (e.g., force production capabilities)…”

Section: Discussionsupporting

confidence: 57%

“…For stroke patients, the interhemispheric competition model assumes that the ipsilesional hemisphere may be doubledisabled because of ipsilateral damage and/or greater interhemispheric inhibition from the contralesional hemisphere. Moreover, balancing asymmetrical brain activation between M1 (i.e., primary motor cortex) of the two hemispheres contributes to restoring motor functions in paretic limbs [20,21]. Despite the debate surrounding the interhemispheric competition model (e.g., inter-individual variability issue) [22,23], many rehabilitation protocols using tDCS or rTMS are prevalent: (a) anodal tDCS or high frequency rTMS (> 1 Hz) on M1 of the ipsilesional hemisphere for increasing cortical excitability, (b) cathodal tDCS or low frequency rTMS (≤ 1 Hz) on M1 of the contralesional hemisphere for decreasing cortical excitability, and (c) bilateral tDCS (anodal tDCS + cathodal tDCS) or rTMS (high frequency rTMS + low frequency rTMS) on M1 of both hemispheres [19,20,24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

2016

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

2016

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“…The interhemispheric competition model, which supports this potential for contralesional activation to adversely affect stroke recovery ( Fig. 1) [48,49], states that in a normal nonstroke brain each cortical hemisphere maintains independent processing, and each inhibits the other through transcallosal fibers [49,50]. However, stroke disrupts this interhemispheric balance when the ipsilesional cortex fails to maintain its inhibition on the contralesional cortex.…”

Section: Current Brain Stimulation Techniques Used To Study Stroke Rementioning

confidence: 99%

“…However, stroke disrupts this interhemispheric balance when the ipsilesional cortex fails to maintain its inhibition on the contralesional cortex. This results in an excessive inhibition from the contralesional cortex to the ipsilesional cortex through the transcallosal fibers, which further reduces motor output of the affected limb and results in worsened recovery [49][50][51].…”

Section: Current Brain Stimulation Techniques Used To Study Stroke Rementioning

confidence: 99%

Optogenetic Approaches to Target Specific Neural Circuits in Post-stroke Recovery

2016

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Stroke is a leading cause of death and disability in the USA, yet treatment options are very limited. Functional recovery can occur after stroke and is attributed, in part, to rewiring of neural connections in areas adjacent to or remotely connected to the infarct. A better understanding of neural circuit rewiring is thus an important step toward developing future therapeutic strategies for stroke recovery. Because stroke disrupts functional connections in peri-infarct and remotely connected regions, it is important to investigate brain-wide network dynamics during post-stroke recovery. Optogenetics is a revolutionary neuroscience tool that uses bioengineered lightsensitive proteins to selectively activate or inhibit specific cell types and neural circuits within milliseconds, allowing greater specificity and temporal precision for dissecting neural circuit mechanisms in diseases. In this review, we discuss the current view of post-stroke remapping and recovery, including recent studies that use optogenetics to investigate neural circuit remapping after stroke, as well as optogenetic stimulation to enhance stroke recovery. Multimodal approaches employing optogenetics in conjunction with other readouts (e.g., in vivo neuroimaging techniques, behavior assays, and next-generation sequencing) will advance our understanding of neural circuit reorganization during post-stroke recovery, as well as provide important insights into which brain circuits to target when designing brain stimulation strategies for future clinical studies.

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“…13,14 Based on these data, our aim was to conduct a preliminary open-label study to assess the effects from modulating plasticity by means of excitability-diminishing cathodal transcranial direct current stimulation over the unaffected primary motor cortex, in order to obtain preliminary efficacy and safety data on its effects on language.…”

Section: 11mentioning

confidence: 99%

Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study

Santos¹,

Gagliardi²,

Mac-Kay³

et al. 2013

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Previous animal and human studies have shown that transcranial direct current stimulation can induce significant and lasting neuroplasticity and may improve language recovery in patients with aphasia. The objective of the study was to describe a cohort of patients with aphasia after stroke who were treated with transcranial direct current stimulation. DESIGN AND SETTING: Prospective cohort study developed in a public university hospital. METHODS: Nineteen patients with chronic aphasia received 10 transcranial direct current stimulation sessions lasting 20 minutes each on consecutive days, using a current of 2 mA. The anode was positioned over the supraorbital area and the cathode over the contralateral motor cortex. The following variables were analyzed before and after the 10 neuromodulation sessions: oral language comprehension, copying, dictation, reading, writing, naming and verbal fluency. RESULTS: There were no adverse effects in the study. We found statistically significant differences from before to after stimulation in relation to simple sentence comprehension (P = 0.034), naming (P = 0.041) and verbal fluency for names of animals (P = 0.038). Improved scores for performing these three tasks were seen after stimulation. CONCLUSIONS: We observed that excitability of the primary motor cortex through transcranial direct current stimulation was associated with effects on different aspects of language. This can contribute towards future testing in randomized controlled trials.RESUMO CONTEXTO E OBJETIVO: Estudos prévios em animais e humanos mostram que a estimulação transcraniana por corrente contínua pode induzir neuroplasticidade significante e duradoura e pode melhorar a recuperação de linguagem na afasia. O objetivo do estudo foi descrever uma coorte de pacientes com afasia após acidente vascular cerebral que foi tratada com estimulação transcraniana por corrente contínua. TIPO DO ESTUDO E LOCAL: Estudo de coorte único prospectivo realizado em um hospital público universitário. MÉTODO: Dezenove pacientes com afasia crônica receberam 10 sessões de estimulação transcraniana por corrente contínua com duração de 20 minutos de cada, corrente de 2 mA em dias consecutivos (anodo posicionado em área supraorbital e catodo no cortes motor contraleral). Foram analisadas as seguintes variáveis antes e depois de 10 sessões de neuromodulação: compreensão de linguagem oral, cópia, ditado, leitura, escrita, nomeação e fluência verbal. RESULTADOS: Não houve efeitos adversos no estudo. Encontramos diferença estatisticamente significante pré e pós-estimulação para compreensão de frases simples (P = 0.034), nomeação (P = 0.041) e fluência verbal para nomes de animais (P = 0.038). Houve melhora no desempenho em três tarefas após estimulação. CONCLUSÃO: Observamos que a excitabilidade no córtex motor primário através de estimulação transcraniana por corrente contínua está associada a efeitos em diferentes aspectos da linguagem, além de contribuir para futuras testagens em estudos randomizados.

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Interhemispheric Competition After Stroke: Brain Stimulation to Enhance Recovery of Function of the Affected Hand

Abstract: Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.

Cited by 443 publications

References 53 publications

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis

Optogenetic Approaches to Target Specific Neural Circuits in Post-stroke Recovery

Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study

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