Koch Philipp J, Hummel Friedhelm C
aDefitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva bDefitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion cClinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland.
Curr Opin Neurol. 2017 Aug;30(4):388-397. doi: 10.1097/WCO.0000000000000462.
To support the recovery of disability and the reduced functional capacity influencing the independence of daily life after focal brain lesions like stroke, the application of noninvasive brain stimulation (NIBS) by repetitive transcranial magnetic stimulation or transcranial electric stimulation has been found useful in the last decades. Still, a positive influence on the recovery seems to be restricted to specific subgroups of patients. Therefore, a closer look on individual parameters influencing the recovery course and the effect of NIBS is needed.
Neuroimaging studies investigated alterations in neuronal network settings during the recovery process from stroke and can explain a relevant amount of variance in residual motor function. In this regard for instance, the microstructural integrity of the corticospinal tract and its influence on cortical and subcortical functional and structural connectivity alterations shows a relevant impact on individual recovery from the acute to the chronic state.
Based on this understanding, a 'one-suits-all' NIBS strategy for clinical application appears insufficient and understanding of therapeutic susceptibility to NIBS gained from structural and functional imaging studies will help to develop patient-tailored NIBS-based interventional strategies towards precision medicine, as a promising future prospective within this field.
为支持残疾恢复以及改善影响中风等局灶性脑损伤后日常生活独立性的功能能力下降问题，在过去几十年中，经颅重复磁刺激或经颅电刺激等非侵入性脑刺激（NIBS）的应用已被证明是有用的。然而，对恢复的积极影响似乎仅限于特定亚组的患者。因此，需要更深入地研究影响恢复过程和NIBS效果的个体参数。
神经影像学研究调查了中风恢复过程中神经网络设置的变化，并能解释残余运动功能中相当一部分的差异。例如，在这方面，皮质脊髓束的微观结构完整性及其对皮质和皮质下功能及结构连接改变的影响，对从急性期到慢性期的个体恢复具有重要影响。
基于这一认识，临床应用中“一刀切”的NIBS策略似乎并不充分，从结构和功能成像研究中获得的对NIBS治疗易感性的理解，将有助于制定基于NIBS的个性化干预策略，朝着精准医学方向发展，这是该领域未来一个有前景的方向。
