Ugur Kilic, Charlotte Smets, Zhengdao Deng, Alexandra Boogers, Myles Mc Laughlin, Philippe De Vloo, Derek D George, Bart Nuttin
{"title":"A Narrative Review on the Current Landscape of Invasive Neuromodulation for Poststroke Motor Recovery: Mechanisms, Challenges, and Future Directions.","authors":"Ugur Kilic, Charlotte Smets, Zhengdao Deng, Alexandra Boogers, Myles Mc Laughlin, Philippe De Vloo, Derek D George, Bart Nuttin","doi":"10.1016/j.neurom.2025.06.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Stroke is a leading cause of disability. Despite rehabilitation efforts, most survivors of stroke do not fully recover. Invasive neuromodulation has shown promise but has not yet become standard of care in poststroke rehabilitation. Given the inherent drawbacks of invasive modalities, a critical evaluation is warranted. This review examines invasive neuromodulation strategies for poststroke recovery, focusing on their mechanisms of action, clinical evidence, and technical challenges.</p><p><strong>Materials and methods: </strong>A structured search was conducted using PubMed for studies from 2000 to 2025, with the terms (\"Stroke\"[MeSH] OR \"Stroke Rehabilitation\"[MeSH]) and (\"Neurostimulation\" OR \"Invasive Electrical Stimulation\" OR \"Deep Brain Stimulation\" OR \"Epidural Stimulation\" OR \"Spinal Cord Stimulation\" OR \"Cortical Stimulation\" OR \"Cerebellar Stimulation\"). Only human studies were included. Moreover, clinical trials from ClinicalTrials.gov and the European Union Clinical Trials Register were cross-referenced, and preclinical studies underpinning selected clinical trials were integrated.</p><p><strong>Results: </strong>Vagal nerve stimulation has received Food and Drug Administration approval, whereas motor cortex stimulation, cerebellar stimulation, and spinal cord stimulation remain investigational. These methods aim to recruit residual motor networks and promote plasticity. However, narrow cohorts, variability in stroke location and timing, differences in rehabilitation intensity, and inconsistencies in outcome measures present significant challenges to achieving consistent and broadly applicable therapeutic outcomes across trials.</p><p><strong>Conclusions: </strong>Given the risks associated with invasive techniques, a deeper understanding of their mechanisms is essential to maximizing their therapeutic potential. Nevertheless, advances in electrode technology, adaptive stimulation, and multimodal approaches hold promise for optimizing the effectiveness of invasive neuromodulation and improving patient outcomes.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuromodulation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.neurom.2025.06.004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Stroke is a leading cause of disability. Despite rehabilitation efforts, most survivors of stroke do not fully recover. Invasive neuromodulation has shown promise but has not yet become standard of care in poststroke rehabilitation. Given the inherent drawbacks of invasive modalities, a critical evaluation is warranted. This review examines invasive neuromodulation strategies for poststroke recovery, focusing on their mechanisms of action, clinical evidence, and technical challenges.
Materials and methods: A structured search was conducted using PubMed for studies from 2000 to 2025, with the terms ("Stroke"[MeSH] OR "Stroke Rehabilitation"[MeSH]) and ("Neurostimulation" OR "Invasive Electrical Stimulation" OR "Deep Brain Stimulation" OR "Epidural Stimulation" OR "Spinal Cord Stimulation" OR "Cortical Stimulation" OR "Cerebellar Stimulation"). Only human studies were included. Moreover, clinical trials from ClinicalTrials.gov and the European Union Clinical Trials Register were cross-referenced, and preclinical studies underpinning selected clinical trials were integrated.
Results: Vagal nerve stimulation has received Food and Drug Administration approval, whereas motor cortex stimulation, cerebellar stimulation, and spinal cord stimulation remain investigational. These methods aim to recruit residual motor networks and promote plasticity. However, narrow cohorts, variability in stroke location and timing, differences in rehabilitation intensity, and inconsistencies in outcome measures present significant challenges to achieving consistent and broadly applicable therapeutic outcomes across trials.
Conclusions: Given the risks associated with invasive techniques, a deeper understanding of their mechanisms is essential to maximizing their therapeutic potential. Nevertheless, advances in electrode technology, adaptive stimulation, and multimodal approaches hold promise for optimizing the effectiveness of invasive neuromodulation and improving patient outcomes.
期刊介绍：
Neuromodulation: Technology at the Neural Interface is the preeminent journal in the area of neuromodulation, providing our readership with the state of the art clinical, translational, and basic science research in the field. For clinicians, engineers, scientists and members of the biotechnology industry alike, Neuromodulation provides timely and rigorously peer-reviewed articles on the technology, science, and clinical application of devices that interface with the nervous system to treat disease and improve function.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
