Document Detail

Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients.
MedLine Citation:
PMID:  20633395     Owner:  NLM     Status:  MEDLINE    
Stroke is the leading cause of disability in the adult population of western industrialized countries. Despite significant improvements of acute stroke care, two thirds of stroke survivors have to cope with persisting neurologic deficits. Adjuvant brain stimulation is a novel approach to improving the treatment of residual deficits after stroke. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and epidural electrical stimulation have been used in first trials on small cohorts of stroke patients. Effect sizes in the order of 8% to 30% of functional improvement have been reported, but a publication bias toward presenting "promising" but not negative results is likely. Many questions regarding underlying mechanisms, optimal stimulation parameters, combination with other types of interventions, among others, are open. This review addresses six controversies related to the experimental application of brain stimulation techniques to stroke patients. Cortical stimulation after stroke will need to be individually tailored and a thorough patient stratification according to type and extent of clinical deficit, lesion location, lesion size, comorbidities, time in the recovery process, and perhaps also age and gender will be necessary. There is consensus that cortical stimulation in stroke patients is still experimental and should only be applied in the frame of scientific studies.
Friedhelm C Hummel; Pablo Celnik; Alvero Pascual-Leone; Felipe Fregni; Winston D Byblow; Cathrin M Buetefisch; John Rothwell; Leonardo G Cohen; Christian Gerloff
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-10-09
Journal Detail:
Title:  Brain stimulation     Volume:  1     ISSN:  1935-861X     ISO Abbreviation:  Brain Stimul     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2010-07-16     Completed Date:  2010-10-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101465726     Medline TA:  Brain Stimul     Country:  United States    
Other Details:
Languages:  eng     Pagination:  370-82     Citation Subset:  IM    
Brain Imaging and Neurostimulation Lab, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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MeSH Terms
Behavior / physiology
Cerebral Cortex / physiology,  physiopathology
Electric Stimulation Therapy / methods*
Neuronal Plasticity / physiology
Recovery of Function / physiology
Stroke / pathology,  physiopathology,  therapy*
Synapses / physiology
Transcranial Magnetic Stimulation / methods*
Treatment Outcome

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