Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.
Defitech 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, Switzerland.
Cerebellum. 2018 Jun;17(3):359-371. doi: 10.1007/s12311-017-0906-1.
Non-invasive brain stimulation (NIBS) combined with behavioral training is a promising strategy to augment recovery after stroke. Current research efforts have been mainly focusing on primary motor cortex (M1) stimulation. However, the translation from proof-of-principle to clinical applications is not yet satisfactory. Possible reasons are the heterogeneous properties of stroke, generalization of the stimulation protocols, and hence the lack of patient stratification. One strategy to overcome these limitations could be the evaluation of alternative stimulation targets, like the cerebellum. In this regard, first studies provided evidence that non-invasive cerebellar stimulation can modulate cerebellar processing and linked behavior in healthy subjects. The cerebellum provides unique plasticity mechanisms and has vast connections to interact with neocortical areas. Moreover, the cerebellum could serve as a non-lesioned entry to the motor or cognitive system in supratentorial stroke. In the current article, we review mechanisms of plasticity in the cortico-cerebellar system after stroke, methods for non-invasive cerebellar stimulation, and possible target symptoms in stroke, like fine motor deficits, gait disturbance, or cognitive impairments, and discuss strategies for multi-focal stimulation.
非侵入性脑刺激（NIBS）结合行为训练是一种很有前途的策略，可以促进中风后的恢复。目前的研究工作主要集中在初级运动皮层（M1）刺激上。然而，从原理验证到临床应用的转化并不令人满意。可能的原因是中风的异质性、刺激方案的推广，以及因此缺乏患者分层。克服这些限制的一种策略可以是评估替代刺激靶点，如小脑。在这方面，初步研究提供了证据，表明非侵入性小脑刺激可以调节健康受试者的小脑处理和相关行为。小脑提供了独特的可塑性机制，并与大脑皮层区域有广泛的联系。此外，小脑可以作为上矢状窦中风中运动或认知系统的未损伤入口。在本文中，我们综述了中风后皮质-小脑系统的可塑性机制、非侵入性小脑刺激的方法，以及中风可能的目标症状，如精细运动缺陷、步态障碍或认知障碍，并讨论了多焦点刺激的策略。
