Brain Network and Modulation

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Despite significant improvements in acute stroke management, numerous stroke patients continue to experience wide-ranging disabilities, posing a severe global healthcare problem. Effective neuro-rehabilitation is critical for reduction of disability and improvement of life quality after stroke. Rapid developments in several post-ischemic stroke rehabilitation techniques, including magnetic, ultrasonic, optogenetic and electronic modalities, have been achieved in recent years. Repetitive transcranial magnetic stimulation has shown promising therapeutic efficacy in ischemic stroke rehabilitation during the last two decades. This review provides a detailed summary of the development, safety and efficacy of transcranial magnetic stimulation devices, current experimental models and mechanisms of repetitive transcranial magnetic stimulation in the context of ischemic stroke rehabilitation.

Post-stroke cognitive impairment refers to the cognitive impairment caused by stroke. Unilateral spatial neglect is the main symptom and results in remarkably lower independence in activities of daily living and participation. Recent studies suggested that repetitive transcranial magnetic stimulation (rTMS) may have a positive effect on post-stroke cognitive impairment, but no relevant systematic review has been conducted on post-stroke cognitive impairment, especially unilateral spatial neglect. Therefore, relevant studies on rTMS in the treatment of post-stroke were collected and analyzed by systematic review and meta-analysis to determine whether rTMS can improve the cognitive function of patients, especially post-stroke unilateral spatial neglect, to provide reliable evidence for rTMS intervention. PubMed, Cochrane Central Register of Controlled Trials, Embase, PsycINFO databases, Web of Science and CINAHL were searched up to February 3, 2021. Three authors screened the reviews and independently assessed their methodological quality using the Jadad scale. The number of studies finally pooled was 28, and the sample size was 819. In the overall cognition function, the efficacy of the intervention group was superior to that of the control group. This meta-analysis result indicated that rTMS influences unilateral spatial neglect. rTMS was effective in improving patients’ activities of daily living. Subgroup analysis showed the preferred items in selecting frequency pulses and session. Furthermore, rTMS could not improve unilateral spatial neglect with an onset time of less than 1 month and over 1 month. This meta-analysis shows that rTMS intervention may be a promising way to treat post-stroke cognitive impairment.

Strokes are a leading cause of death, persistent neurological deficits, and physical disability worldwide. Exercise-mediated adaptations are an emerging form of therapies that aim to attenuate the severity of post-stroke physical disability; however, there are uncertainties regarding how specific parameters, such as time to initiation and intensity of exercise, affect rehabilitation outcomes. At the cellular level, physical rehabilitation after stroke may enhance post-stroke gluconeogenesis to promote neuroplasticity over cellular damage via hypoxia-inducible factor-1α and exosomes. Furthermore, there is thought to be an optimal time for the initiation of exercise after a stroke, but there is disagreement and uncertainty about this optimal time. This paper discusses the pathophysiology of physical rehabilitation after stroke and reviews current studies on the effects of physical exercise on stroke rehabilitation and plasticity.

Online since 13^th August 2021