Department of Exercise Sciences.
Centre for Brain Research.
Curr Opin Neurol. 2024 Dec 1;37(6):621-628. doi: 10.1097/WCO.0000000000001313. Epub 2024 Sep 2.
This review highlights recent developments in noninvasive brain stimulation (NIBS) techniques and applications for improving motor outcomes after stroke. Two promising areas of development relate to deep brain neuromodulation and the use of single-pulse transcranial magnetic stimulation (TMS) within a prediction tool for predicting upper limb outcome for individual patients.
Systematic reviews highlight the inconsistent effect sizes of interventional NIBS for motor outcome after stroke, as well as limited evidence supporting the interhemispheric competition model. To improve the therapeutic efficacy of NIBS, studies have leveraged metaplasticity and priming approaches. Transcranial temporal interference stimulation (tTIS) and low-intensity focused ultrasound stimulation (LIFUS) are emerging NIBS techniques with potential for modulating deeper brain structures, which may hold promise for stroke neurorehabilitation. Additionally, motor evoked potential (MEP) status obtained with single-pulse TMS is a prognostic biomarker that could be used to tailor NIBS for individual patients.
Trials of interventional NIBS to improve stroke outcomes may be improved by applying NIBS in a more targeted manner. This could be achieved by taking advantage of NIBS techniques that can be targeted to deeper brain structures, using biomarkers of structural and functional reserve to stratify patients, and recruiting patients in more homogeneous time windows.
本文重点介绍了非侵入性脑刺激（NIBS）技术的最新进展及其在改善中风后运动功能恢复方面的应用。两个很有前途的发展领域与深部脑神经调节以及在预测个体患者上肢功能结果的预测工具中使用单次经颅磁刺激（TMS）有关。
系统评价强调了干预性 NIBS 对中风后运动功能恢复的不一致效果大小，以及支持大脑两半球竞争模型的证据有限。为了提高 NIBS 的治疗效果，研究利用了易化和启动方法。经颅颞部干扰刺激（tTIS）和低强度聚焦超声刺激（LIFUS）是新兴的 NIBS 技术，具有调节深部脑结构的潜力，这可能为中风神经康复带来希望。此外，使用单次 TMS 获得的运动诱发电位（MEP）状态是一种预后生物标志物，可用于为个体患者定制 NIBS。
通过更有针对性地应用 NIBS，干预性 NIBS 改善中风结局的试验可能会得到改善。这可以通过利用能够靶向深部脑结构的 NIBS 技术、利用结构和功能储备的生物标志物对患者进行分层以及在更同质的时间窗内招募患者来实现。
