title: Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients.
abstract: 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.
authors.affiliation: Brain Imaging and Neurostimulation Lab, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Friedhelm C
authors.initials: FC
authors.lastname: Hummel
authors.forename: Pablo
authors.initials: P
authors.lastname: Celnik
authors.forename: Alvero
authors.initials: A
authors.lastname: Pascual-Leone
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Winston D
authors.initials: WD
authors.lastname: Byblow
authors.forename: Cathrin M
authors.initials: CM
authors.lastname: Buetefisch
authors.forename: John
authors.initials: J
authors.lastname: Rothwell
authors.forename: Leonardo G
authors.initials: LG
authors.lastname: Cohen
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
mesh_terms: D001519:Behavior / Q000502:physiology; D002540:Cerebral Cortex / Q000502:physiology / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D009473:Neuronal Plasticity / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D013569:Synapses / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome