Posts Tagged rTMS

[WEB SITE] Depression: Brain stimulation may be a good alternative treatment

A new review, which appears in The BMJ journal, examines the benefits of non-invasive brain stimulation for treating major depression and finds that the technique is a valid alternative to existing treatments.

doctor talking to patient

Doctors should consider brain stimulation as an alternative treatment for people living with severe depression, finds a new review

Over 17 million adults in the United States have had an episode of major depression at one point in their lives.

Some of these people have treatment-resistant depression, which means common prescription drugs do not alleviate the symptoms.

Recent studies have pointed to alternative treatment methods for major depression, such as non-invasive brain stimulation techniques.

For instance, a study that appeared at the end of last year showed that using small electric currents to stimulate a brain area called the orbitofrontal cortex significantly improves the mood of people who did not benefit from conventional antidepressants.

An even more recent trial of a form of brain stimulation called “transcranial alternating current stimulation” (tACS) found that the technique halved depression symptoms in almost 80 percent of the study participants.

Despite such promising results, doctors do not use these techniques widely, as there is not enough data available on their efficacy.

So, a team of researchers led by Julian Mutz at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, United Kingdom, set out to review some clinical trials that have examined the benefits of non-invasive brain stimulation techniques for people living with depression.

Brain stimulation as additional treatment

Specifically, Mutz and team examined the results of 113 clinical trials. Overall, these trials included 6,750 participants who were 48 years old, on average, and were living with major depressive disorder or bipolar depression.

The original clinical trials involved randomly assigning these participants to 18 treatment interventions or “sham” therapies. The reviewers focussed on the response, or “efficacy” of the treatment, as well as the “discontinuation of treatment for any reason” — or “acceptability” of the therapies. Mutz and colleagues also rated the trials’ risk of bias.

The therapies included in the review were “electroconvulsive therapy (ECT), transcranial magnetic stimulation (repetitive (rTMS), accelerated, priming, deep, and synchronized), theta burst stimulation, magnetic seizure therapy, transcranial direct current stimulation (tDCS), or sham therapy.”

Of these, the treatments that the researchers in the original trial examined most often were high frequency left rTMS and tDCS, which they tested against sham therapy. On the other hand, not many trials covered more recent forms of brain stimulation, such as magnetic seizure therapy and bilateral theta burst stimulation, the review found.

Kutz and his team deemed 34 percent of the trials they reviewed as having a low risk of bias. They considered half of the trials to have an “unclear” risk of bias, and finally, 17 percent to have a high risk of bias. The newer the treatments, the higher was the uncertainty of the trials’ results.

The review found that bitemporal ECT, high dose right unilateral ECT, high frequency left rTMS and tDCS were all significantly more effective than sham therapy both in terms of efficacy and acceptability.

When considering “discontinuation of treatment for any reason,” the researchers found that the participants were not any likelier to discontinue brain stimulation treatments than they were sham therapy. Mutz and colleagues conclude:

These findings provide evidence for the consideration of non-surgical brain stimulation techniques as alternative or add-on treatments for adults with major depressive episodes.”

“These findings also highlight important research priorities in the specialty of brain stimulation, such as the need for further well-designed randomized controlled trials comparing novel treatments, and sham-controlled trials investigating magnetic seizure therapy,” the authors add.

Finally, the researchers also note that their results have clinical implications, “in that they will inform clinicians, patients, and healthcare providers on the relative merits of multiple non-surgical brain stimulation techniques.”

via Depression: Brain stimulation may be a good alternative treatment

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[Abstract] Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

The aim of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on the post-stroke recovery of lower limb motor function.

We searched the databases of PubMed, Cochrane Library, and Embase. The randomized controlled trials were published by 25 January 2019.

We included randomized controlled trials that evaluated the effects of rTMS on lower limb motor recovery in patients with stroke. Two reviewers independently screened the searched records, extracted data, and assessed the risk of bias. The treatment effect sizes were pooled in a meta-analysis by using the RevMan 5.3 software. The internal validity was assessed using topics suggested by the Physiotherapy Evidence Database (PEDro).

Eight studies with 169 participants were included in the meta-analysis. Pooled estimates demonstrated that rTMS significantly improved the body function of the lower limbs (standardized mean difference (SMD) = 0.66; P < 0.01), lower limb activity (SMD = 0.66; P < 0.01), and motor-evoked potential (SMD = 1.13; P < 0.01). The subgroup analyses results also revealed that rTMS improved walking speed (SMD = 1.13) and lower limb scores on the Fugl-Meyer Assessment scale (SMD = 0.63). We found no significant differences between the groups in different mean post-stroke time or stimulation mode over lower limb motor recovery. Only one study reported mild adverse effects.

rTMS may have short-term therapeutic effects on the lower limbs of patients with stroke. Furthermore, the application of rTMS is safe. However, this evidence is limited by a potential risk of bias.

 

via Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials – Yi-Chun Tung, Chien-Hung Lai, Chun-De Liao, Shih-Wei Huang, Tsan-Hon Liou, Hung-Chou Chen, 2019

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[Abstract] The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included.

The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018.

The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate.

For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup (P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS.

rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

via The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials – Huifang Xiang, Jing Sun, Xiang Tang, Kebin Zeng, Xiushu Wu, 2019

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[Abstract] Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report

Introduction/Background

Motor dysfunction of the hand and upper limb is a major cause of physical disability for patients with chronic stroke. Our aim was to investigate the effectiveness of a peripheral plus central repetitive transcranial magnetic stimulation (rTMS) treatment for upper limb motor rehabilitation in chronic stroke patients.

Material and method

We reported the case of a patient WLX, who had one ischemic stroke more than 3 years ago, and had underwent intermittent rehabilitation since then. He still had profound right upper limb paralysis and moderate spasm, accompanied with non-fluent aphasia when came to our department; and complained that his recovery had been rather slow for about two years. In addition to the custom rehabilitation, we applied a peripheral plus central rTMS paradigm to him, which included 3 sessions of peripheral magnetic stimulation to his paralyzed right forearm, followed by a session of high frequency rTMS to the bilateral sensorimotor cortex region. The total magnetic stimulation therapy lasted about 30 min a day, and was applied 5 days/week for 4 weeks.

Results

After 4 weeks’ treatment, the patient’s Fulg–Meyer upper limb assessment (FMA) score was obviously improved (from 27 to 37 points), and the spasm was largely relieved in his right hand and arm.

Conclusion

Peripheral plus central rTMS might be an effective treatment for motor dysfunction of chronic stroke patients.

via Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report – ScienceDirect

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[Abstract] Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report

Highlights

  • 1-Hz repetitive transcranial magnetic stimulation with rehabilitation immediately after botulinum toxin type A injection in a stroke patient.
  • The spasticity, motor function, and usefulness of the paretic hand improved.
  • This is a possibility of shortening the intervention period of combined therapy.

Abstract

Study Design

Single case report.

Introduction

A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients.

Purpose of the Case Report

The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient.

Methods

A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge.

Results

For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge.

Conclusions

The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

via Combined effects of botulinum toxin type A and repetitive transcranial magnetic stimulation with intensive motor training immediately after injection in a patient with chronic stroke: A case report – Journal of Hand Therapy

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[ARTICLE] Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges – Full Text

Abstract

A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.

1. Introduction

Significant advances have been made in the management of stroke (including prevention, acute management, and rehabilitation); however cerebrovascular diseases remain the third most common cause of death and the first cause of disability worldwide [16]. Stroke causes brain damage, leading to loss of motor function. Upper limb (UL) function is particularly reduced, resulting in disability. Many rehabilitation techniques have been developed over the last decades to facilitate motor recovery of the UL in order to improve functional ability and quality of life [710]. They are commonly based on principles of motor skill learning to promote plasticity of motor neural networks. These principles include intensive, repetitive, task-oriented movement-based training [1119]. A better understanding of the neural substrates of motor relearning has led to the development of innovative strategies and tools to deliver exercise that meets these requirements. Treatments mostly target the neurological impairment (paresis, spasticity, etc.) through the activation of neural circuits or by acting on peripheral effectors. Robotic devices provide exercises that incorporate key elements of motor learning. Advanced robotic systems can offer highly repetitive, reproducible, interactive forms of training for the paretic limb, which are quantifiable. Robotic devices also enable easy and objective assessment of motor performance in standardized conditions by the recording of biomechanical data (i.e., speed, forces) [2022]. This data can be used to analyze and assess motor recovery in stroke patients [2326]. Since the 1990s, many other technology-based approaches and innovative pharmaceutical treatments have also been developed for rehabilitation, including virtual reality- (VR-) based systems, botulinum neurotoxin (BoNT) injections, and noninvasive brain stimulation (NIBS) (Direct Current Stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS)). There is currently no high-quality evidence to support any of these innovative interventions, despite the fact that some are used in routine practice [27]. By their respective mechanisms of action, each of these treatments could potentiate the effects of robotic therapy, leading to greater improvements in motor capacity. The aim of this paper is to review studies of combined treatments based on robotic rehabilitation and to analyze the rationale behind such approaches.[…]

 

Continue —> Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges

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[Poster] Repetitive Transcranial Magnetic Stimulation (rTMS) application in cognitive deficits after Traumatic Brain Injury (TBI)/concussion

Objective: The objective of this study is to review current literature for the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) treatment for cognitive deficits after Traumatic Brain Injury (TBI)/concussion.

Background: TBI is a major public health problem and can cause substantial disability. TBI can lead to Post Concussive Syndrome (PCS) which consists of neuro-motor, cognitive, behavioral/affective, and emotional symptoms. Cognitive deficits can significantly impact functionality. The outcome of neuropsychopharmacological treatment is limited, with risk for side effects. TMS is a form of non-invasive neuromodulation which is FDA-approved for treatment-resistant depression. However, there is limited understanding about its application in addressing cognitive deficits after TBI. We therefore sought to examine current research pertaining to the application of TMS in post-TBI cognitive deficits.

Methods: We searched the PubMed research database with the specific terms “TMS in cognitive deficits after TBI”, “rTMS” and “post concussive syndrome.” We assessed clinical trials where cognition was measured either as a primary or secondary variable. Case studies/reports were excluded.

Results: One non-controlled, pilot study was found that assessed cognition after TMS as a secondary variable in TBI. The aim of the study was to assess safety, tolerability and efficacy of repetitive TMS for treatment of PCS after mild TBI (mTBI). Patients who had sustained mTBI over three months prior and had a PCS Symptom Scale score of over 21 were selected. Repetitive TMS (rTMS) was used as the intervention with 20 sessions of rTMS using a figure-8 coil attached to MagPro stimulator. Cognitive symptoms were assessed using subjective self-report scales and objective tests for attention and speed of processing domains. Neuropsychological tests that were used include Trails A & B, Ruff’s 2 & 7 Automatic speed test, Stroop test, Language test for phonemic, and category fluency, Rey AVLT test. The study showed a reduction in overall severity of PCS symptoms but no significant changes on the cognitive symptoms questionnaire or on the majority of neuropsychological test scores.

Conclusion: Despite the limitation in this study with the lack of a control group, there appears to be a good signal for the clinical application of TMS for post-concussive syndrome after TBI/concussion. A more robust, large well-controlled study may be very reasonable approach in the future to evaluate efficacy of rTMS.

References

1. Koski L1, Kolivakis T, Yu C, Chen JK, Delaney S, Ptito A. Noninvasive brain stimulation for persistent postconcussion symptoms in mild traumatic brain injury. J Neurotrauma. 2015 Jan 1;32(1):38-44. https://doi.org/10.1089/neu.2014.3449.

2. Bashir S1, Vernet M, Yoo WK, Mizrahi I, Theoret H, Pascual-Leone A. Changes in cortical plasticity after mild traumatic brain injury. Restor Neurol Neurosci. 2012;30(4):277-82. https://doi.org/10.3233/RNN-2012-110207.

3. Demirtas-Tatlidede A1, Vahabzadeh-Hagh AM, Bernabeu M, Tormos JM, Pascual-Leone A.Noninvasive brain stimulation in traumatic brain injury. J Head Trauma Rehabil. 2012 Jul-Aug;27(4):274-92. https://doi.org/10.1097/HTR.0b013e318217df55.

4. Neville IS, Hayashi CY, El Hajj SA, Zaninotto AL, Sabino JP, Sousa LM Jr, Nagumo MM, Brunoni AR, Shieh BD, Amorim RL, Teixeira MJ, Paiva WS. Repetitive Transcranial Magnetic Stimulation (rTMS) for the cognitive rehabilitation of traumatic brain injury (TBI) victims: study protocol for a randomized controlled trial. Trials. 2015 Oct 5;16:440. https://doi.org/10.1186/s13063-015-0944-2.

via Repetitive Transcranial Magnetic Stimulation (rTMS) application in cognitive deficits after Traumatic Brain Injury (TBI)/concussion – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[WEB SITE] Stroke survivors may benefit from magnetic brain stimulation

A new meta-analysis of existing studies shows that a technique called repetitive transcranial magnetic stimulation might be a useful tool to help stroke survivors regain the ability to walk independently.

senior woman learning to walk again after stroke

A brain stimulation technique may help stroke survivors walk faster and more easily.

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique; magnetic coils are placed on a person’s scalp, and short electromagnetic pulses are delivered to specific brain areas through the coil.

Although these pulses only cause an almost imperceptible “knocking or tapping” sensation for the patient undergoing the procedure, they reach into the brain, triggering electric currents that stimulate neurons.

rTMS has mainly been used to treat psychosisdepressionanxiety, and other mood disorders with a fair degree of success. In a recent study, more than one third of people living with auditory verbal hallucinations — a marker of schizophrenia — reported a reduction in their symptoms following the procedure.

But researchers have also been delving into the potential that the technique has for improving life after stroke. Four years ago, for instance, a team of researchers at The Ohio State University Wexner Medical Center in Columbus used rTMS to improve arm movement in people who had experienced a stroke, and more studies have explored this therapeutic potential since.

Now, a team of researchers — jointly led by Dr. Chengqi He, of Sichuan University in the People’s Republic of China, and Shasha Li, of Massachusetts General Hospital and Harvard Medical School, both in Boston, MA — set out to review these studies.

Dr. He and colleagues wanted to see if the technique improved motor skills for people who had stroke; to do so, the researchers examined the impact rTMS has on walking speed, balance, and other key factors for post-stroke rehabilitation.

The findings were published in the American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists.

rTMS ‘significantly improves walking speed’

Dr. He and team reviewed nine studies of rTMS — including five randomized controlled trials — which were published between 2012 and 2017.

The people who participated in these studies had either had an ischemic stroke — that is, a stroke caused by a blood clot in one of the brain’s arteries — or a hemorrhagic stroke — that is, one caused by bleeding within the brain.

Of the nine studies, six included data on the walking speed of 139 stroke survivors. The researchers carried out a pooled analysis of these studies, and the results revealed that rTMS “significantly improves walking speed.”

This improvement was greater among people who received stimulation on the same side of the brain that the stroke occurred. By contrast, those who received rTMS on the opposite side did not see any improvement.

Other key health outcomes for stroke survivors such as balance, motor function, or brain responsiveness did not show any improvement as a result of rTMS.

In the United States, it is estimated that almost 800,000 people annually have a stroke, which makes the condition a leading cause of long-term disability in the country. More than half of the seniors who survived a stroke have reduced mobility as a result.

Although the review shows that rTMS is a promising strategy for restoring independent walking, the authors say that more research is needed. Dr. He and colleagues conclude:

Future studies with larger sample sizes and an adequate follow-up period are required to further investigate the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques.”

via Stroke survivors may benefit from magnetic brain stimulation

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[Review] Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease – Full Text

Abstract

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is a therapeutic reality in post-stroke rehabilitation. It has a neuroprotective effect on the modulation of neuroplasticity, improving the brain’s capacity to retrain neural circuits and promoting restoration and acquisition of new compensatory skills.

Development

We conducted a literature search on PubMed and also gathered the latest books, clinical practice guidelines, and recommendations published by the most prominent scientific societies concerning the therapeutic use of rTMS in the rehabilitation of stroke patients. The criteria of the International Federation of Clinical Neurophysiology (2014) were followed regarding the inclusion of all evidence and recommendations.

Conclusions

Identifying stroke patients who are eligible for rTMS is essential to accelerate their recovery. rTMS has proven to be safe and effective for treating stroke complications. Functional brain activity can be optimised by applying excitatory or inhibitory electromagnetic pulses to the hemisphere ipsilateral or contralateral to the lesion, respectively, as well as at the level of the transcallosal pathway to regulate interhemispheric communication. Different studies of rTMS in these patients have resulted in improvements in motor disorders, aphasia, dysarthria, oropharyngeal dysphagia, depression, and perceptual-cognitive deficits. However, further well-designed randomised controlled clinical trials with larger sample size are needed to recommend with a higher level of evidence, proper implementation of rTMS use in stroke subjects on a widespread basis.

Introduction

Stroke patients should receive early neurorehabilitation after convalescence. For many years, researchers have aimed to identify new therapeutic targets to hasten recovery from stroke. However, we continue to lack a universally accepted, approved pharmacological therapy for these patients.1234 ;  5 After stroke, organisational changes in brain interneuronal activity in the affected area and the surrounding healthy tissue may on occasion promote functional recovery. Neurorehabilitation may help achieve this aim. Unfortunately, there are also occasions when neural reorganisation is suboptimal; in these cases, the problem persists and becomes chronic. In this context, transcranial magnetic stimulation (TMS) emerged as a tool for studying the brain and has been used since the mid-1980s to treat certain neuropsychiatric disorders. Neurorehabilitation is based on the idea that the brain is a dynamic entity able to adapt to internal and external homeostatic changes. This adaptive capacity, called neuroplasticity, is also present in patients with acquired brain injuries. The degree of recovery and the functional prognosis of these patients depend on the extent of neuroplastic changes.12345 ;  6 When performed by experienced physicians, TMS is a safe, non-invasive technique which enables the organisation of these neural changes (Fig. 1). The technique’s applications are expanding rapidly.12345678 ;  9

Modern TMS device.

Figure 1.

Modern TMS device.

We present the results of a literature review of the most relevant articles, manuals, and clinical practice guidelines addressing TMS (background information, diagnostic and therapeutic uses, and especially its usefulness for stroke neurorehabilitation) and published between 1985 (when the technique was first used) and 2015.

 

Development

The organisation of language in the brain

The left hemisphere of the brain is the anatomo-functional seat of language in 96% of right-handed and 70% of left-handed individuals. Language processing in the left hemisphere involves certain anatomical pathways for language comprehension, repetition, and production (Fig. 2). Positron emission tomography and functional magnetic resonance imaging (fMRI) studies conducted during multiple language tasks have shown brain activation not only in the main language centres (lesions to these areas may cause Broca aphasia, Wernicke aphasia, etc.) (Fig. 3) but also in many other locations, such as the thalamus (alertness), the basal ganglia (motor modulation), and the limbic system (affect and memory). Language is the perfect model for understanding how the central nervous system works as a whole.10 ;  11

Figure 2. The functional pathways involved in comprehension, repetition, and production of written, gesture, and spoken language, according to the Wernicke-Geschwind model. Within the left hemisphere, language organisation follows certain anatomical pathways for language comprehension, repetition, and production. Sounds are processed by the bilateral auditory cortex, in the superior temporal gyrus (primary auditory area), and decoded in the posterior area of the left temporal cortex (Wernicke area); the latter is connected to other cortical areas or networks which assign meaning to words. During reading, output from the primary visual area (bilaterally) travels to other parieto-occipital association areas for word and phrase recognition (especially the left fusiform gyrus, located in the inferior surface of the temporal lobe, where there is a key word recognition centre) and reaches the angular gyrus, which processes language-related visual and auditory information. In spontaneous language repetition and production, auditory information must travel through the arcuate fasciculus towards the left inferior frontal region (Broca area), which is responsible for language production; this area is also known to be involved in such other functions as action comprehension (mirror neurons). To produce written or spoken language, output from the Wernicke area, the Broca area, and nearby association areas must reach the primary motor cortex.10 ;  11
Adapted with permission from Bear et al.10

[…]

Continue —> Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation: Opening new doors to the treatment of cerebrovascular disease

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[PINTEREST Board] transcranial Direct Current Stimulation (tDCS), Transcranial Magnetic Stimulation (TMS)

 

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