Noninvasive brain stimulation to improve motor outcomes after stroke.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY

Current Opinion in Neurology Pub Date : 2024-09-03 DOI:10.1097/WCO.0000000000001313

Emma C J Savelon, Harry T Jordan, Cathy M Stinear, Winston D Byblow

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引用次数: 0

Abstract

Purpose of review: This review highlights recent developments in noninvasive brain stimulation (NIBS) techniques and applications for improving motor outcomes after stroke. Two promising areas of development relate to deep brain neuromodulation and the use of single-pulse transcranial magnetic stimulation (TMS) within a prediction tool for predicting upper limb outcome for individual patients.

Recent findings: Systematic reviews highlight the inconsistent effect sizes of interventional NIBS for motor outcome after stroke, as well as limited evidence supporting the interhemispheric competition model. To improve the therapeutic efficacy of NIBS, studies have leveraged metaplasticity and priming approaches. Transcranial temporal interference stimulation (tTIS) and low-intensity focused ultrasound stimulation (LIFUS) are emerging NIBS techniques with potential for modulating deeper brain structures, which may hold promise for stroke neurorehabilitation. Additionally, motor evoked potential (MEP) status obtained with single-pulse TMS is a prognostic biomarker that could be used to tailor NIBS for individual patients.

Summary: Trials of interventional NIBS to improve stroke outcomes may be improved by applying NIBS in a more targeted manner. This could be achieved by taking advantage of NIBS techniques that can be targeted to deeper brain structures, using biomarkers of structural and functional reserve to stratify patients, and recruiting patients in more homogeneous time windows.

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无创脑部刺激改善中风后的运动效果。

综述目的：本综述重点介绍了无创脑刺激（NIBS）技术的最新发展以及在改善中风后运动功能方面的应用。两个有发展前景的领域涉及脑深部神经调控和在预测工具中使用单脉冲经颅磁刺激（TMS）来预测个别患者的上肢预后：系统综述强调，介入性 NIBS 对中风后运动预后的影响大小不一致，支持半球间竞争模型的证据也很有限。为了提高 NIBS 的疗效，研究利用了元弹性和引物法。经颅颞部干扰刺激（tTIS）和低强度聚焦超声刺激（LIFUS）是新兴的 NIBS 技术，具有调节更深层大脑结构的潜力，可能会为中风神经康复带来希望。此外，通过单脉冲 TMS 获得的运动诱发电位 (MEP) 状态是一种预后生物标志物，可用于为个别患者量身定制 NIBS。要做到这一点，可以利用可针对更深层脑结构的 NIBS 技术，使用结构和功能储备的生物标志物对患者进行分层，并在更均匀的时间窗口招募患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Neurology 医学-临床神经学

CiteScore

8.60

自引率

0.00%

发文量

174

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Neurology is a highly regarded journal offering insightful editorials and on-the-mark invited reviews; covering key subjects such as cerebrovascular disease, developmental disorders, neuroimaging and demyelinating diseases. Published bimonthly, each issue of Current Opinion in Neurology introduces world renowned guest editors and internationally recognized academics within the neurology field, delivering a widespread selection of expert assessments on the latest developments from the most recent literature.