Purpose of Review

Stroke remains a leading disabling condition, and many survivors have permanent disability despite acute stroke treatment and subsequent standard-of-care rehabilitation therapies. Adjunctive neuromodulation is an emerging frontier in the field of stroke recovery. In this narrative review, we aim to highlight and summarize various neuromodulation techniques currently being investigated to enhance recovery and reduce impairment in patients with stroke.

Recent Findings

For motor recovery, repetitive transcranial magnetic simulation (rTMS) and direct current stimulation (tDCS) have shown promising results in many smaller-scale trials. Still, their efficacy has yet to be proven in large-scale pivotal trials. A promising large-scale study investigating higher dose tDCS combined with constraint movement therapy to enhance motor recovery is currently underway. MRI-guided tDCS studies in subacute and chronic post-stroke aphasia showed promising benefits for picture-naming recovery. rTMS, particularly inhibitory stimulation over the contralesional homolog, could represent a pathway forward in post-stroke motor recovery in the setting of a well-designed and adequately powered clinical trial. Recently evidenced-based guideline actually supported Level A (definite efficacy) for the use of low-frequency rTMS of the primary motor cortex for hand motor recovery in the post-acute stage of stroke based on the meta-analysis result. Adjunctive vagal nerve stimulation has recently received FDA approval to enhance upper limb motor recovery in chronic ischemic stroke with moderate impairment, and progress has been made to implement it in real-world practice. Despite a few small and large-scale studies in epidural stimulation (EDS), further research on the utilization of EDS in post-stroke recovery is needed. Deep brain stimulation or stent-based neuromodulation has yet to be further tested regarding safety and efficacy.

Summary

Adjunctive neuromodulation to rehabilitation therapy is a promising avenue for promoting post-stroke recovery and decreasing the overall burden of disability. The pipeline for neuromodulation technology remains strong as they span from the preclinical stage to the post-market stage. We are optimistic to see that more neuromodulation tools will be available to stroke survivors in the not-to-distant future.

中文翻译：

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中风后运动恢复的神经调节：侵入性和非侵入性工具的叙述回顾

审查目的

中风仍然是一种主要的致残疾病，尽管急性中风治疗和随后的标准护理康复治疗，许多幸存者仍患有永久性残疾。辅助神经调节是中风恢复领域的一个新兴前沿。在这篇叙述性综述中，我们的目的是强调和总结目前正在研究的各种神经调节技术，以促进中风患者的康复并减少损伤。

最近的发现

对于运动恢复，重复经颅磁模拟（rTMS）和直流电刺激（tDCS）在许多小规模试验中显示出有希望的结果。尽管如此，它们的功效尚未在大规模关键试验中得到证实。目前正在进行一项有希望的大规模研究，调查较高剂量的经颅直流电刺激 (tDCS) 与约束运动疗法相结合，以增强运动恢复。MRI 引导的 tDCS 对亚急性和慢性中风后失语症的研究显示出对图片命名恢复的良好益处。rTMS，特别是对对侧同系物的抑制性刺激，可以在精心设计和充分动力的临床试验中代表中风后运动恢复的前进途径。根据荟萃分析结果，最近基于证据的指南实际上支持在中风后急性阶段使用初级运动皮层低频 rTMS 来恢复手部运动的 A 级（确定疗效）。辅助迷走神经刺激最近已获得 FDA 批准，用于增强中度损伤的慢性缺血性卒中的上肢运动恢复，并且在现实世界实践中的实施已取得进展。尽管在硬膜外刺激 (EDS) 方面进行了一些小型和大规​​模的研究，但仍需要进一步研究 EDS 在中风后恢复中的应用。深部脑刺激或基于支架的神经调节的安全性和有效性仍有待进一步测试。

概括

康复治疗的辅助神经调节是促进中风后恢复和减轻残疾总体负担的一个有前途的途径。从临床前阶段到上市后阶段，神经调节技术的管道仍然强劲。我们乐观地看到，在不远的将来，中风幸存者将可以使用更多的神经调节工具。