Otal Begonya, Dutta Anirban, Foerster Águida, Ripolles Oscar, Kuceyeski Amy, Miranda Pedro C, Edwards Dylan J, Ilić Tihomir V, Nitsche Michael A, Ruffini Giulio
Neuroelectrics Barcelona , Barcelona , Spain.
INRIA (Sophia Antipolis), Université Montpellier , Montpellier , France.
Front Neurol. 2016 Feb 24;7:21. doi: 10.3389/fneur.2016.00021. eCollection 2016.
Stroke is a leading cause of serious long-term disability worldwide. Functional outcome depends on stroke location, severity, and early intervention. Conventional rehabilitation strategies have limited effectiveness, and new treatments still fail to keep pace, in part due to a lack of understanding of the different stages in brain recovery and the vast heterogeneity in the poststroke population. Innovative methodologies for restorative neurorehabilitation are required to reduce long-term disability and socioeconomic burden. Neuroplasticity is involved in poststroke functional disturbances and also during rehabilitation. Tackling poststroke neuroplasticity by non-invasive brain stimulation is regarded as promising, but efficacy might be limited because of rather uniform application across patients despite individual heterogeneity of lesions, symptoms, and other factors. Transcranial direct current stimulation (tDCS) induces and modulates neuroplasticity, and has been shown to be able to improve motor and cognitive functions. tDCS is suited to improve poststroke rehabilitation outcomes, but effect sizes are often moderate and suffer from variability. Indeed, the location, extent, and pattern of functional network connectivity disruption should be considered when determining the optimal location sites for tDCS therapies. Here, we present potential opportunities for neuroimaging-guided tDCS-based rehabilitation strategies after stroke that could be personalized. We introduce innovative multimodal intervention protocols based on multichannel tDCS montages, neuroimaging methods, and real-time closed-loop systems to guide therapy. This might help to overcome current treatment limitations in poststroke rehabilitation and increase our general understanding of adaptive neuroplasticity leading to neural reorganization after stroke.
中风是全球严重长期残疾的主要原因。功能结局取决于中风的位置、严重程度和早期干预。传统的康复策略效果有限,新的治疗方法仍未能跟上步伐,部分原因是对大脑恢复的不同阶段缺乏了解以及中风后人群存在巨大的异质性。需要创新的恢复性神经康复方法来减轻长期残疾和社会经济负担。神经可塑性参与中风后的功能障碍以及康复过程。通过非侵入性脑刺激来解决中风后的神经可塑性被认为是有前景的,但由于尽管患者存在病变、症状和其他因素的个体异质性,仍对患者进行相当统一的治疗,其疗效可能有限。经颅直流电刺激(tDCS)可诱导和调节神经可塑性,并且已被证明能够改善运动和认知功能。tDCS适合改善中风后的康复结局,但效应大小通常适中且存在变异性。实际上,在确定tDCS治疗的最佳位置时,应考虑功能网络连接中断的位置、范围和模式。在此,我们提出了基于神经成像引导的中风后tDCS康复策略的潜在机会,这些策略可以个性化。我们介绍了基于多通道tDCS电极布置、神经成像方法和实时闭环系统以指导治疗的创新多模式干预方案。这可能有助于克服当前中风后康复治疗的局限性,并增进我们对导致中风后神经重组的适应性神经可塑性的总体理解。