title: Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation.
abstract: 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.
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: D'Agata
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Peila
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicerale
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Marcella M
authors.initials: MM
authors.lastname: Caglio
authors.affiliation: Department of Neuroscience, University of TurinTurin, Italy; UO Neurology V - Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo BestaMilano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Caroppo
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Vighetti
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Piedimonte
authors.affiliation: Physical Medicine and Rehabilitation, University of Turin Turin, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Minuto
authors.affiliation: Physical Medicine and Rehabilitation, University of Turin Turin, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Campagnoli
authors.affiliation: Molo ONLUS Turin, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Salatino
authors.affiliation: Molo ONLUS Turin, Italy.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Molo
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mortara
authors.affiliation: Department of Neuroscience, University of Turin Turin, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pinessi
authors.affiliation: Physical Medicine and Rehabilitation, University of Turin Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Massazza
keywords: mirror-box therapy; non-invasive brain stimulation; stroke rehabilitation; transcranial direct current stimulation; transcranial magnetic stimulation