The balance recovery bimodal model in stroke patients between evidence and speculation: Do recent studies support it?

Pino, Giovanni Di; Lazzaro, Vincenzo Di

doi:10.1016/j.clinph.2020.07.004

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…Severity of stroke may be one of the factors. Inhibitory rTMS may be less effective for those with severe stroke [ 23 , 47 , 48 ]. The vicariation model holds that activity in the unaffected hemisphere is likely to play an important role in motor recovery, especially among those with larger stroke lesions on the ipsilesional side [ 23 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

2022

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Objective. To determine the long-term effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional M1 preceding motor task practice on the interhemispheric asymmetry of the cortical excitability and the functional recovery in subacute stroke patients with mild to moderate arm paresis. Methods. Twenty-four subacute stroke patients were randomly allocated to either the experimental or control group. The experimental group underwent rTMS over the contralesional M1 (1 Hz), immediately followed by 30 minutes of motor task practice (10 sessions within 2 weeks). The controls received sham rTMS and the same task practice. Following the 2-week intervention period, the task practice was continued twice weekly for another 10 weeks in both groups. Outcomes were evaluated at baseline (T0), at the end of the 2-week stimulation period (T1), and at 12-week follow-up (T2). Results. The MEP (paretic hand) and interhemispheric asymmetry, Fugl-Meyer motor assessment, Action Research Arm Test, and box and block test scores improved more in the experimental group than controls at T1 ( p < 0.05 ). The beneficial effects were largely maintained at T2. Conclusion. LF-rTMS over the contralesional M1 preceding motor task practice was effective in enhancing the ipsilesional cortical excitability and upper limb function with reducing interhemispheric asymmetry in subacute stroke patients with mild to moderate arm paresis. Significance. Adding LF-rTMS prior to motor task practice may reduce interhemispheric asymmetry of cortical excitabilities and promote upper limb function recovery in subacute stroke with mild to moderate arm paresis.

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Section: Discussionmentioning

confidence: 99%

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

2022

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“…Activity in the unaffected hemisphere contributes to functional recovery after stroke, which is called vicariation mechanism ( Di Pino et al, 2014 ). From the results of DTI, not only competition mechanism, but also vicariation mechanism existed between the two hemispheres after rTMS intervention, which is called a bimodal balance-recovery model ( Di Pino et al, 2014 ; Di Pino and Di Lazzaro, 2020 ). This is inconsistent with the result of Li et al (2018) , who demonstrated that the FA increased in the contralesional corticocerebellar pathways might reflect the contralesional compensation by high-frequency rTMS.…”

Section: Discussionmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation Induces Quantified Functional and Structural Changes in Subcortical Stroke: A Combined Arterial Spin Labeling Perfusion and Diffusion Tensor Imaging Study

Jin

Bai²,

Jiang³

et al. 2022

Front. Hum. Neurosci.

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PurposeTo explore the changes of cerebral blood flow (CBF) and fractional anisotropy (FA) in stroke patients with motor dysfunction after repetitive transcranial magnetic stimulation (rTMS) treatment, and to better understand the role of rTMS on motor rehabilitation of subcortical stroke patients from the perfusion and structural level.Materials and MethodsIn total, 23 first-episode acute ischemic stroke patients and sixteen healthy controls (HCs) were included. The patients were divided into the rTMS and sham group. The rehabilitation assessments and examination of perfusion and structural MRI were performed before and after rTMS therapy for each patient. Voxel-based analysis was used to detect the difference in CBF and FA among all three groups. The Pearson correlation analysis was conducted to evaluate the relationship between the CBF/FA value and the motor scales.ResultsAfter rTMS, significantly increased CBF was found in the ipsilesional supplementary motor area, postcentral gyrus, precentral gyrus, pons, medulla oblongata, contralesional midbrain, superior cerebellar peduncle, and middle cerebellar peduncle compared to that during the prestimulation and in the sham group, these fasciculi comprise the cortex-pontine-cerebellum-cortex (CPC) loop. Besides, altered CBF in the ipsilesional precentral gyrus, postcentral gyrus, and pons was positively associated with the improved Fugl-Meyer assessment (FMA) scores. Significantly decreased FA was found in the contralesional precentral gyrus, increased FA was found in the ipsilesional postcentral gyrus, precentral gyrus, contralesional supplementary motor area, and bilateral cerebellum, these fasciculi comprise the corticospinal tract (CST). The change of FMA score was positively correlated with altered FA value in the ipsilesional postcentral gyrus and negatively correlated with altered FA value in the contralesional precentral gyrus.ConclusionOur results suggested that rTMS could facilitate the motor recovery of stroke patients. High frequency could promote the improvement of functional activity of ipsilesional CPC loop and the recovery of the microstructure of CST.

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“…The ability of short‐term immobilization to modulate IHI could be leveraged in individuals where a shift in IHI balance would be beneficial. For example, one model of stroke recovery posits that an imbalance in IHI may contribute to persistent motor dysfunction (Di Pino et al, 2014 ; Di Pino & Di Lazzaro, 2020 ; Murase et al, 2004 ). Thus, immobilization may hold promise as a noninvasive neuromodulation approach to rebalance activity between hemisphere to facilitate post‐stroke recovery in some patients.…”

Section: Discussionmentioning

confidence: 99%

Short‐term arm immobilization modulates excitability of inhibitory circuits within, and between, primary motor cortices

King

Edwards

Borich

2022

Physiological Reports

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The balance recovery bimodal model in stroke patients between evidence and speculation: Do recent studies support it?

Cited by 18 publications

References 26 publications

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

Repetitive Transcranial Magnetic Stimulation Induces Quantified Functional and Structural Changes in Subcortical Stroke: A Combined Arterial Spin Labeling Perfusion and Diffusion Tensor Imaging Study

Short‐term arm immobilization modulates excitability of inhibitory circuits within, and between, primary motor cortices

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