Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients

被引:103
作者
Hummel, Friedhelm C. [1 ]
Ceinik, Pablo [2 ]
Pascual-Leone, Alvero [3 ,4 ]
Fregni, Felipe [3 ,4 ]
Byblow, Winston D. [5 ]
Buetefisch, Cathrin M.
Rothwell, John [6 ]
Cohen, Leonardo G. [7 ,8 ]
Gertoff, Christian [1 ]
机构
[1] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Brain Imaging & Neurostimulat Lab, D-20246 Hamburg, Germany
[2] Johns Hopkins Univ, Dept Neurol, Dept Phys Med & Rehabil, Baltimore, MD 21218 USA
[3] Harvard Univ, Sch Med, Berenson Allen Ctr Noninvas Brain Stimulat, Boston, MA USA
[4] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[5] Univ Auckland, Movement Neurosci Lab, Dept Sport & Exercise Sci, Auckland 1, New Zealand
[6] W Virginia Univ, Dept Physiol, Dept Neurol, Morgantown, WV 26506 USA
[7] NINDS, Human Cort Physiol Sect, NIH, Bethesda, MD 20892 USA
[8] NINDS, Stroke Neurorehabil Clin, NIH, Bethesda, MD 20892 USA
关键词
stroke; plasticity; recovery; rehabilitation;
D O I
10.1016/j.brs.2008.09.003
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Stroke is the leading cause of disability in the adult Population of western industrialized Countries. Despite significant improvements of acute stroke care, two thirds of stroke survivors have to cope with persisting neurologic deficits. Adjuvant brain stimulation is a novel approach to improving the treatment of residual deficits after stroke. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS). and epidural electrical stimulation have been used in first trials on small cohorts of stroke patients. Effect sizes in the order of 8% to 30% Of functional improvement have been reported. but a publication bias toward presenting "promising" but not negative results is likely. Many questions regarding underlying mechanisms, optimal stimulation parameters, combination with other types of interventions, among others, are open. This review addresses six controversies related to the experimental application of brain stimulation techniques to stroke patients. Cortical stimulation after stroke will need to be individually tailored and a thorough patient stratification according to type and extent of clinical deficit. lesion location, lesion size. comorbidities, time in the recovery process. and perhaps also age and gender will be necessary. There is consensus that cortical stimulation in stroke patients is still experimental and should only be applied in the frame of scientific studies. (C) 2008 Elsevier Inc. All rights reserved.
引用
收藏
页码:370 / 382
页数:13
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