Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke.
- Nicolo P Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland.
- Magnin C Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
- Pedrazzini E Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland.
- Plomp G Department of Psychology, University of Fribourg, Fribourg, Switzerland.
- Mottaz A Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland.
- Schnider A Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland; Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland.
- Guggisberg AG Laboratory of Cognitive Neurorehabilitation, Department of Clinical Neurosciences, Medical School, University of Geneva, Geneva, Switzerland; Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospital, Geneva, Switzerland. Electronic address: aguggis@gmail.com.
- 2017-12-11
Published in:
- Archives of physical medicine and rehabilitation. - 2018
Cathodal Stimulation tDCS
Electroencephalography
Rehabilitation
Repetitive
Stroke
Transcranial Magnetic Stimulation
Adult
Aged
Aged, 80 and over
Double-Blind Method
Electrodes
Female
Humans
Male
Middle Aged
Neuronal Plasticity
Paresis
Physical Therapy Modalities
Recovery of Function
Stroke
Stroke Rehabilitation
Theta Rhythm
Transcranial Direct Current Stimulation
Transcranial Magnetic Stimulation
Treatment Outcome
Upper Extremity
English
OBJECTIVE
To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.
DESIGN
Double-blinded, randomized, placebo-controlled study.
SETTING
University hospital rehabilitation unit.
PARTICIPANTS
Inpatients with stroke (N=41; mean age, 65y; range, 28-85y; mean weeks poststroke, 5; range, 2-10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3-48).
INTERVENTIONS
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy.
MAIN OUTCOME MEASURES
Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time.
RESULTS
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke.
CONCLUSIONS
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions.
To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.
DESIGN
Double-blinded, randomized, placebo-controlled study.
SETTING
University hospital rehabilitation unit.
PARTICIPANTS
Inpatients with stroke (N=41; mean age, 65y; range, 28-85y; mean weeks poststroke, 5; range, 2-10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3-48).
INTERVENTIONS
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy.
MAIN OUTCOME MEASURES
Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time.
RESULTS
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke.
CONCLUSIONS
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.apmr.2017.10.026
- PMID 29223708
- Persistent URL
- https://folia.unifr.ch/global/documents/216203
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