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Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation

The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with...

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Autores principales: D'Agata, Federico, Peila, Elena, Cicerale, Alessandro, Caglio, Marcella M., Caroppo, Paola, Vighetti, Sergio, Piedimonte, Alessandro, Minuto, Alice, Campagnoli, Marcello, Salatino, Adriana, Molo, Maria T., Mortara, Paolo, Pinessi, Lorenzo, Massazza, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919333/
https://www.ncbi.nlm.nih.gov/pubmed/27445730
http://dx.doi.org/10.3389/fnbeh.2016.00135
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author D'Agata, Federico
Peila, Elena
Cicerale, Alessandro
Caglio, Marcella M.
Caroppo, Paola
Vighetti, Sergio
Piedimonte, Alessandro
Minuto, Alice
Campagnoli, Marcello
Salatino, Adriana
Molo, Maria T.
Mortara, Paolo
Pinessi, Lorenzo
Massazza, Giuseppe
author_facet D'Agata, Federico
Peila, Elena
Cicerale, Alessandro
Caglio, Marcella M.
Caroppo, Paola
Vighetti, Sergio
Piedimonte, Alessandro
Minuto, Alice
Campagnoli, Marcello
Salatino, Adriana
Molo, Maria T.
Mortara, Paolo
Pinessi, Lorenzo
Massazza, Giuseppe
author_sort D'Agata, Federico
collection PubMed
description The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results.
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spelling pubmed-49193332016-07-21 Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation D'Agata, Federico Peila, Elena Cicerale, Alessandro Caglio, Marcella M. Caroppo, Paola Vighetti, Sergio Piedimonte, Alessandro Minuto, Alice Campagnoli, Marcello Salatino, Adriana Molo, Maria T. Mortara, Paolo Pinessi, Lorenzo Massazza, Giuseppe Front Behav Neurosci Neuroscience The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results. Frontiers Media S.A. 2016-06-24 /pmc/articles/PMC4919333/ /pubmed/27445730 http://dx.doi.org/10.3389/fnbeh.2016.00135 Text en Copyright © 2016 D'Agata, Peila, Cicerale, Caglio, Caroppo, Vighetti, Piedimonte, Minuto, Campagnoli, Salatino, Molo, Mortara, Pinessi and Massazza. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
D'Agata, Federico
Peila, Elena
Cicerale, Alessandro
Caglio, Marcella M.
Caroppo, Paola
Vighetti, Sergio
Piedimonte, Alessandro
Minuto, Alice
Campagnoli, Marcello
Salatino, Adriana
Molo, Maria T.
Mortara, Paolo
Pinessi, Lorenzo
Massazza, Giuseppe
Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title_full Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title_fullStr Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title_full_unstemmed Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title_short Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation
title_sort cognitive and neurophysiological effects of non-invasive brain stimulation in stroke patients after motor rehabilitation
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919333/
https://www.ncbi.nlm.nih.gov/pubmed/27445730
http://dx.doi.org/10.3389/fnbeh.2016.00135
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