Repetitive transcranial magnetic stimulation and transcranial direct current stimulation in motor rehabilitation after stroke: An update

Abstract

Stroke is a leading cause of adult motor disability. The number of stroke survivors is increasing in industrialized countries, and despite available treatments used in rehabilitation, the recovery of motor functions after stroke is often incomplete. Studies in the 1980s showed that non-invasive brain stimulation (mainly repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) could modulate cortical excitability and induce plasticity in healthy humans. These findings have opened the way to the therapeutic use of the 2 techniques for stroke. The mechanisms underlying the cortical effect of rTMS and tDCS differ. This paper summarizes data obtained in healthy subjects and gives a general review of the use of rTMS and tDCS in stroke patients with altered motor functions. From 1988 to 2012, approximately 1400 publications were devoted to the study of non-invasive brain stimulation in humans. However, for stroke patients with limb motor deficit, only 141 publications have been devoted to the effects of rTMS and 132 to those of tDCS. The Cochrane review devoted to the effects of rTMS found 19 randomized controlled trials involving 588 patients, and that devoted to tDCS found 18 randomized controlled trials involving 450 patients. Without doubt, rTMS and tDCS contribute to physiological and pathophysiological studies in motor control. However, despite the increasing number of studies devoted to the possible therapeutic use of non-invasive brain stimulation to improve motor recovery after stroke, further studies will be necessary to specify their use in rehabilitation.

Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: A one‐year longitudinal randomized trial

“…Noninvasive brain stimulation, such as rTMS, could not only modulate cortical excitability but also change the function of the subcortex and spinal cord. From 1998 to 2012, approximately 1400 articles were published reporting the effectiveness of noninvasive brain stimulation, among which 141 articles described the use of rTMS in motor recovery after stroke . These research studies included high‐frequency rTMS applied over the ipsilesional hemisphere to increase its excitability, low‐frequency rTMS applied over the contralesional hemisphere to decrease its inhibitory connections with the lesioned cortex, and both types of rTMS combined, with or without traditional rehabilitation.…”

“…From 1998 to 2012, approximately 1400 articles were published reporting the effectiveness of noninvasive brain stimulation, among which 141 articles described the use of rTMS in motor recovery after stroke. 18 These research studies included high-frequency rTMS applied over the ipsilesional hemisphere to increase its excitability, low-frequency rTMS applied over the contralesional hemisphere to decrease its inhibitory connections with the lesioned cortex, and both types of rTMS combined, with or without traditional rehabilitation. Clinical measurements, such as motor functional scores, muscle force, and appreciation of daily living, were used to assess the paralyzed limb.…”

Spasticity Management: The Current State of Transcranial Neuromodulation

“…Based on the accumulated data from the literature survey, we can highlight 2 main points on the use of NINM for spasticity management: (1) NINM is useful in reducing spasticity, but its effects critically depend on the applied hemisphere and the underlying pathology [45]; and (2) NINM is more effective in reducing spasticity when coupled with another form of medical and/or physical therapy rather than used as a stand‐alone therapy [39,46‐48,56,58,65,70‐72].…”

Dysphagia Practice in 2035: Beyond Fluorography, Thickener, and Electrical Stimulation

“…Commonly used techniques are transcranial direct current stimulation (tDCS), which imparts low-intensity electrical current between two electrodes placed on the skull, and repetitive transcranial magnetic stimulation (rTMS), where the stimulation is produced by a high-current pulse sent through a copper coil that is placed on the skull. 183 Applied to the motor cortex, tDCS and rTMS can either enhance or reduce the excitability of the stimulated region, thus facilitating or hindering the corresponding corticospinal or corticobulbar tracts and motor neurons. 183 These techniques have been used for treatment of chronic pain, 184 anxiety and depression, 185,186 aphasia after stroke, 187 and for motor rehabilitation, 183 in-cluding swallowing treatment.…”