Posts Tagged treatment

[ARTICLE] Impact of Transcranial Magnetic Stimulation on Functional Movement Disorders: Cortical Modulation or a Behavioral Effect? – Full Text

Introduction: Recent studies suggest that repeated transcranial magnetic stimulation (TMS) improves functional movement disorders (FMDs), but the underlying mechanisms are unclear. The objective was to determine whether the beneficial action of TMS in patients with FMDs is due to cortical neuromodulation or rather to a cognitive-behavioral effect.

Method: Consecutive patients with FMDs underwent repeated low-frequency (0.25 Hz) magnetic stimulation over the cortex contralateral to the symptoms or over the spinal roots [root magnetic stimulation (RMS)] homolateral to the symptoms. The patients were randomized into two groups: group 1 received RMS on day 1 and TMS on day 2, while group 2 received the same treatments in reverse order. We blindly assessed the severity of movement disorders before and after each stimulation session.

Results: We studied 33 patients with FMDs (dystonia, tremor, myoclonus, Parkinsonism, or stereotypies). The median symptom duration was 2.9 years. The magnetic stimulation sessions led to a significant improvement (>50%) in 22 patients (66%). We found no difference between TMS and RMS.

Conclusion: We suggest that the therapeutic benefit of TMS in patients with FMDs is due more to a cognitive-behavioral effect than to cortical neuromodulation.


Individuals with functional movement disorders (FMDs) account for 3–20% of all patients seen in movement-disorder clinics (13). There is no consensus treatment for FMDs (46). These movement disorders are not due to irreversible brain damage but their outcome is nonetheless poor: symptoms are persistent or worse after 1.5–7 years of follow-up in between 44 and 90% of patients (6, 7). FMDs generate major healthcare costs, as well as indirect costs due to unemployment and disability (8).

Recent studies suggest a beneficial effect of repeated supraliminal low-frequency transcranial magnetic stimulation (TMS) (i.e., TMS ≤ 1 Hz) on functional motor symptoms (914) [Ref. (15) for a review]. Among these studies, only one included a blinded assessment (11), and only one included a control group (sham treatment) (9). Focusing on FMDs more specifically, two studies showed a beneficial effect of supraliminal low-frequency TMS, with a mean improvement rate of 67% (11) and 97% (13). It is unclear whether the therapeutic benefit is due to cortical neuromodulation, i.e., to changes in cortical excitability and in connectivity between brain areas (15, 16). The alternative hypothesis is a cognitive-behavioral effect, a therapeutic effect that is linked to suggestion and/or motor relearning.

To address this issue, we blindly compared the therapeutic effect of repeated TMS and repeated root magnetic stimulation (RMS) in patients with FMDs. RMS was chosen as the control treatment to mimic TMS-induced movement without directly stimulating the cortex.

Continue —>  Frontiers | Impact of Transcranial Magnetic Stimulation on Functional Movement Disorders: Cortical Modulation or a Behavioral Effect? | Neurology


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[Abstract] The treatment of fatigue by non-invasive brain stimulation


The use of non-invasive brain neurostimulation (NIBS) techniques to treat neurological or psychiatric diseases is currently under development. Fatigue is a commonly observed symptom in the field of potentially treatable pathologies by NIBS, yet very little data has been published regarding its treatment. We conducted a review of the literature until the end of February 2017 to analyze all the studies that reported a clinical assessment of the effects of NIBS techniques on fatigue. We have limited our analysis to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). We found only 15 studies on this subject, including 8 tDCS studies and 7 rTMS studies. Of the tDCS studies, 6 concerned patients with multiple sclerosis while 6 rTMS studies concerned fibromyalgia or chronic fatigue syndrome. The remaining 3 studies included patients with post-polio syndrome, Parkinson’s disease and amyotrophic lateral sclerosis. Three cortical regions were targeted: the primary sensorimotor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex. In all cases, tDCS protocols were performed according to a bipolar montage with the anode over the cortical target. On the other hand, rTMS protocols consisted of either high-frequency phasic stimulation or low-frequency tonic stimulation. The results available to date are still too few, partial and heterogeneous as to the methods applied, the clinical profile of the patients and the variables studied (different fatigue scores) in order to draw any conclusion. However, the effects obtained, especially in multiple sclerosis and fibromyalgia, are really carriers of therapeutic hope.

Source: The treatment of fatigue by non-invasive brain stimulation

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[Abstract] Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness



  • A pilot study (n = 10) of motor cortex TMS as a treatment for functional (psychogenic) weakness is described.
  • Although there was a small improvement in self-reported symptom severity immediately after treatment this was not clinically significant or sustained.
  • Half of the participants reported late-onset adverse effects.
  • A single session of non-neuromodulatory TMS without additional therapy input was not an effective treatment for this cohort of stable chronic outpatients.



There has been a recent resurgence of interest in physical treatments for functional motor disorders (FMD) including Transcranial Magnetic Stimulation (TMS). This pilot study aimed to test the effectiveness of a single session of motor cortex TMS as a treatment for functional upper limb weakness.


Ten subjects with a diagnosis of functional upper limb weakness were randomised to immediate (n = 7) or delayed (3 months) (n = 3) TMS treatment. Median age was 35 (range 23–52) and median symptom duration was 2.3 years (range 5 months – 20 years). 46–70 single pulses were applied to the motor cortex at 120–150% motor threshold. We used a verbal protocol designed to standardized the effects of suggestion. Primary outcome measures were self-reported symptom severity, grip strength and tapping frequency immediately after treatment, and symptom severity and disability (SF-12 and Modified Rankin Scale (MRS)) after 3 months.


There was a small significant reduction in symptom severity immediately after treatment, but no improvement in grip strength or tapping frequency and no change in symptom severity, SF-12 or MRS 3 months after treatment. Small numbers precluded comparison of immediate treatment with delayed treatment. Four of eight subjects responding to three-month follow-up reported late-onset adverse effects.


This pilot study suggests limited benefits for TMS as a one-off non-neuromodulatory treatment for stable chronic outpatients. TMS may still have a role alongside more intensive multidisciplinary therapy input, or in patients with severe deficits where the possibility of normal movement can be hard to demonstrate.

Source: Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness

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[Abstract] Muscle strengthening for hemiparesis after stroke: A meta-analysis



Muscle weakness is a common consequence of stroke and can result in a decrease in physical activity. Changes in gait performance can be observed, especially a reduction in gait speed, and increased gait asymmetry, and energy cost is also reported.


The aim was to determine whether strengthening of the lower limbs can improve strength, balance and walking abilities in patients with chronic stroke.


Five databases (Pubmed, Cinhal, Cochrane, Web of Science, Embase) were searched to identify eligible studies. Randomized controlled trials were included and the risk of bias was evaluated for each study. Pooled standardized mean differences were calculated using a random effects model. The PRISMA statement was followed to increase clarity of reporting.


Ten studies, including 355 patients, reporting on the subject of progressive resistance training, specific task training, functional electrical stimulation and aerobic cycling at high-intensity were analysed. These interventions showed a statistically significant effect on strength and the Timed Up-and-Go test, and a non-significant effect on walking and the Berg Balance Scale.


Progressive resistance training seemed to be the most effective treatment to improve strength. When it is appropriately targeted, it significantly improves strength.

Source: Muscle strengthening for hemiparesis after stroke: A meta-analysis

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[BOOK] Improving Functional Outcomes in Physical Rehabilitation – Google Books

Front Cover

Improving Functional Outcomes in Physical Rehabilitation

By Susan B O’Sullivan, Thomas J Schmitz

Here is a practical, step-by-step guide to understanding the treatment process and selecting the most appropriate intervention for your patient. Superbly illustrated, in-depth coverage shows you how to identify functional deficits, determine what treatments are appropriate, and then to implement them to achieve the best functional outcome for your patients.


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[ARTICLE] New Directions in Research and Therapies in Traumatic Brain Injury – Full Text HTML/PDF


Traumatic brain injury (TBI) is a significant cause of disability and death and its incidence is rising in some specific populations. TBI can result in various disabilities, cognitive problems and psychiatric disorders, depending on the location of the injury and premorbid patient conditions.

Effective pharmacological and surgical treatments, however, are currently limited. Most randomised clinical trials for TBI treatments carried out to date have failed to show significant benefits. Initiatives such as the TRACK-TBI have highlighted the large variability in TBI treatment quality at different hospitals and widely differing death rates. This stimulated the establishment of the International Initiative for TBI Research (InTIBR), which aims to improve disease characterisation and patient management.

The development of effective treatments for TBI and their evaluation requires an understanding of the complex neuroregenerative processes that follow an injury. In the case of haematoma in TBI, decompressive craniectomy can be a life-saving intervention but must be performed rapidly. The neurotrophic agent, Cerebrolysin®, acts by mimicking neurotrophic factors (NTFs) and by stimulating the endogenous production of NTF in brain tissue. Experimental models show that this drug increases neurogenesis following TBI but these findings need to be converted into clinical practice. The potential of Cerebrolysin in TBI was demonstrated in a large retrospective cohort trial in Romania (n=7,769 adults). Cerebrolysin significantly improved Glasgow Outcome Scores (GOS) and respiratory distress (RDS) in patients with moderate or severe TBI at 10 and 30 days compared with controls.

This and other experimental treatments have potential in TBI but, in developing such therapies, the design of clinical trials should closely reflect the reality of biological processes underlying natural recovery from brain injury.

Full Text HTML —>  New Directions in Research and Therapies in Traumatic Brain Injury | Touch Neurology | Independent Insight for Medical Specialists.

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[REVIEW] Clinical neurorestorative progress in stroke – Full Text PDF


Stroke is the second most common single cause of death worldwide, with over five million deaths per year globally. So far, conventional therapy has failed to restore neurological function poststroke. Neurorestorative strategy has provided therapeutic benefit for the treatment of stroke. This review outlines the clinical advances, in which cell-based neurorestorative strategies offer the broadest range of potential treatments for stroke.

Stroke is identified by the sudden occurrence of a nonconvulsive, focal neurologic deficit.1 Among all the neurologic diseases of adult life, stroke ranks first in frequency and impact on disability. Stroke, after ischemic heart disease, is the second commonest single cause of death worldwide, with over five million deaths per year globally. The US Census Bureau has forecasted the distribution of incident stroke cases for the years 2010–2050. Over these 40 years, the number of incident strokes is expected to more than double, with the majority of the increase among the elderly (age .75 years) and minority groups (particularly Hispanics).2
Cerebral infarction basically comprises two pathophysiologic processes: 1) a loss in the supply of oxygen and glucose secondary to vascular occlusions and 2) an array of changes in cellular metabolism as a consequence of the collapse of energy-producing processes, with damage to cell membranes. Of potential therapeutic importance are the observations that some of the cellular processes leading to neuronal death are not irrevocable and may be reversed by early intervention, either restoration of blood flow or prevention of the influx of calcium into the cell. In the early stage, the most important therapy that can be taken into consideration is thrombolysis with tissue plasminogen activator, which is now a well-established treatment for acute ischemic stroke and is associated with significant improvements in outcomes.3 Unfortunately, the time window of 4.5 hours is its limitation. Other therapies for stroke are vascular revascularization and secondary prevention strategies. Vascular revascularization includes carotid endarterectomy and stenting. Secondary prevention strategies are mainly for hypertension, heart disease, atrial fibrillation, diabetes mellitus, cigarette smoking, hyperlipidemia, and antiplatelet, statin, and anticoagulant treatment. Together with the primary prevention concept for stroke, the main purpose of current therapies for stroke patients is to prevent stroke event other than to restore neurological impairment caused by the stroke.

However, when a stroke event really happens after all the possible treatments mentioned above, what can we do for the brain tissue lesion and how can we restore the functional impairment left by stroke? At first, neuroprotection is the important direction with a purpose to save the dying neuron with no encouraging results. Recently, a trend of switching from neuroprotectant toward neurorestorative approaches has been set on the fact that cerebral plasticity and neurological recovery can be stimulated in the post-acute ischemic brain. Neurorestorative processes include neurogenesis, angiogenesis, and synaptic plasticity, which have been shown to be beneficial for the functional improvement after stroke. In general, neurorestorative therapy includes pharmacological, cell-based, and neuromodulating therapy.4 In this review, we outline the clinical neurorestorative strategies with emphasis on cell-based therapy as a promising option for stroke.

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[REVIEW] Post-Stroke Depression | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF


Depression is a common complication post-stroke affecting approximately one-third of patients. The presence of post-stroke depression has been associated with decreases in functional recovery, social activity and cognition. In addition, the presence of mental health disorders following stroke may be associated with increased mortality. The present review discusses the prevalence, natural history and risk factors for post-stroke depression as well as issues around its assessment and impact on rehabilitation outcomes. Strategies for the prevention and management of post-stroke depression are reviewed. Recommendations for assessment and treatment are provided based on current guidelines. A discussion of post-stroke emotionalism, its impact and treatment is also included.

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via Post-Stroke Depression | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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What is Left Neglect?

The Transitional Learning Center's Blog

Left neglect, also known as unilateral neglect or hemispatial neglect, is one of the oddest symptoms of a brain injury.  It can also be one of the most troublesome symptoms.  Left neglect is a deficit that occurs following an injury to the right side of the brain.  Due to the injury, the brain has difficulty paying attention to items on the left side.  This is generally most apparent in difficulties noticing items visually on the left side.  For instance, a survivor with left neglect may bump into frames of doors on the his or her left or miss eating food on the left side of his or her plate.  It appears as if he or she is blind to items on the left but this is not a true vision issue.  It is an attention issue.  The brain is not attending to information on the left.  The survivor can have…

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[WEB SITE] What is a TBI? Traumatic Brain Injury Prognosis, Symptoms, Treatment, Research |

What is Traumatic Brain Injury?

Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.

Symptoms of TBI

Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.  A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.  A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Is there any treatment for TBI?

Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, the imaging test is a computed tomography (CT) scan. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.

What is the prognosis of someone diagnosed with a TBI?

Approximately half of severely head-injured patients will need surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue). Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in stupor, an unresponsive state, but one in which an individual can be aroused briefly by a strong stimulus, such as sharp pain; coma, a state in which an individual is totally unconscious, unresponsive, unaware, and unarousable; vegetative state, in which an individual is unconscious and unaware of his or her surroundings, but continues to have a sleep-wake cycle and periods of alertness; and a persistent vegetative state (PVS), in which an individual stays in a vegetative state for more than a month.

What research is being done to help people with brain injuries?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts TBI research in its laboratories at the National Institutes of Health (NIH) and also supports TBI research through grants to major medical institutions across the country. This research involves studies in the laboratory and in clinical settings to better understand TBI and the biological mechanisms underlying damage to the brain. This research will allow scientists to develop strategies and interventions to limit the primary and secondary brain damage that occurs within days of a head trauma, and to devise therapies to treat brain injury and improve long-term recovery of function.

via What is a TBI? Traumatic Brain Injury Prognosis, Symptoms, Treatment, Research |.

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