Department of Neurology, Clinical Hospital of Neuropsychiatry, 200349 Craiova, Romania.
Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Neural Plast. 2023 Feb 28;2023:5044065. doi: 10.1155/2023/5044065. eCollection 2023.
Stroke is a major health problem worldwide, with numerous health, social, and economic implications for survivors and their families. One simple answer to this problem would be to ensure the best rehabilitation with full social reintegration. As such, a plethora of rehabilitation programs was developed and used by healthcare professionals. Among them, modern techniques such as transcranial magnetic stimulation and transcranial direct current stimulation are being used and seem to bring improvements to poststroke rehabilitation. This success is attributed to their capacity to enhance cellular neuromodulation. This modulation includes the reduction of the inflammatory response, autophagy suppression, antiapoptotic effects, angiogenesis enhancement, alterations in the blood-brain barrier permeability, attenuation of oxidative stress, influence on neurotransmitter metabolism, neurogenesis, and enhanced structural neuroplasticity. The favorable effects have been demonstrated at the cellular level in animal models and are supported by clinical studies. Thus, these methods proved to reduce infarct volumes and to improve motor performance, deglutition, functional independence, and high-order cerebral functions (i.e., aphasia and heminegligence). However, as with every therapeutic method, these techniques can also have limitations. Their regimen of administration, the phase of the stroke at which they are applied, and the patients' characteristics (i.e., genotype and corticospinal integrity) seem to influence the outcome. Thus, no response or even worsening effects were obtained under certain circumstances both in animal stroke model studies and in clinical trials. Overall, weighing up risks and benefits, the new transcranial electrical and magnetic stimulation techniques can represent effective tools with which to improve the patients' recovery after stroke, with minimal to no adverse effects. Here, we discuss their effects and the molecular and cellular events underlying their effects as well as their clinical implications.
中风是全球范围内的一个主要健康问题，对幸存者及其家庭的健康、社会和经济都有重大影响。解决这个问题的一个简单方法是确保通过全面的社会重新融入实现最佳康复。因此，许多康复计划由医疗保健专业人员开发和使用。其中，现代技术，如经颅磁刺激和经颅直流电刺激，正在被使用，并似乎为中风后的康复带来了改善。这种成功归因于它们增强细胞神经调节的能力。这种调节包括减少炎症反应、抑制自噬、抗细胞凋亡作用、促进血管生成、改变血脑屏障通透性、减轻氧化应激、影响神经递质代谢、神经发生和增强结构神经可塑性。这些有利影响在动物模型中已经在细胞水平上得到了证明，并得到了临床研究的支持。因此，这些方法被证明可以减少梗死体积，改善运动功能、吞咽功能、功能独立性和高级脑功能（即失语症和偏侧忽略）。然而，与每一种治疗方法一样，这些技术也可能存在局限性。它们的给药方案、应用于中风的阶段以及患者的特征（即基因型和皮质脊髓完整性）似乎会影响结果。因此，在某些情况下，无论是在动物中风模型研究还是临床试验中，都没有得到反应甚至出现恶化的效果。总的来说，权衡风险和收益，新的经颅电和磁刺激技术可以成为改善中风后患者康复的有效工具，副作用最小或没有。在这里，我们讨论它们的作用以及它们作用背后的分子和细胞事件及其临床意义。
