Fregni F, Pascual-Leone ATechnology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol 3:383-393

Harvard Medical School and the Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Nature Clinical Practice Neurology (Impact Factor: 7.64). 08/2007; 3(7):383-93. DOI: 10.1038/ncpneuro0530
Source: PubMed


In neurology, as in all branches of medicine, symptoms of disease and the resulting burden of illness and disability are not simply the consequence of the injury, inflammation or dysfunction of a given organ; they also reflect the consequences of the nervous system's attempt to adapt to the insult. This plastic response includes compensatory changes that prove adaptive for the individual, as well as changes that contribute to functional disability and are, therefore, maladaptive. In this context, brain stimulation techniques tailored to modulate individual plastic changes associated with neurological diseases might enhance clinical benefits and minimize adverse effects. In this Review, we discuss the use of two noninvasive brain stimulation techniques--repetitive transcranial magnetic stimulation and transcranial direct current stimulation--to modulate activity in the targeted cortex or in a dysfunctional network, to restore an adaptive equilibrium in a disrupted network for best behavioral outcome, and to suppress plastic changes for functional advantage. We review randomized controlled studies, in focal epilepsy, Parkinson's disease, recovery from stroke, and chronic pain, to illustrate these principles, and we present evidence for the clinical effects of these two techniques.

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    • "After stroke, high frequency (4 5 Hz) or low frequency ( r1 Hz) rTMS may be used to increase ipsilesional or decrease contralesional excitability respectively. Given recent evidence of functional S1–S1 connections mediated by the CC in the human brain (Brodie et al., 2014), theoretically either of these rTMS approaches could be used to reestablish the balance of interhemispheric excitability after stroke (Fregni and Pascual-Leone, 2007; Nowak et al., 2009). The majority of previous rTMS studies have focused on modulation of M1 excitability. "
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    ABSTRACT: Emerging evidence indicates impairments in somatosensory function may be a major contributor to motor dysfunction associated with neurologic injury or disorders. However, the neuroanatomical substrates underlying the connection between aberrant sensory input and ineffective motor output are still under investigation. The primary somatosensory cortex (S1) plays a critical role in processing afferent somatosensory input and contributes to the integration of sensory and motor signals necessary for skilled movement. Neuroimaging and neurostimulation approaches provide unique opportunities to non-invasively study S1 structure and function including connectivity with other cortical regions. These research techniques have begun to illuminate casual contributions of abnormal S1 activity and connectivity to motor dysfunction and poorer recovery of motor function in neurologic patient populations. This review synthesizes recent evidence illustrating the role of S1 in motor control, motor learning and functional recovery with an emphasis on how information from these investigations may be exploited to inform stroke rehabilitation to reduce motor dysfunction and improve therapeutic outcomes. Copyright © 2015. Published by Elsevier Ltd.
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    • "TMS is a neuromodulatory technique introduced in the 1980s by Barker et al., who showed that single electromagnetic pulses over the motor cortex elicited painless muscular contractions in the contralateral hand. Later on, other studies showed that repetitive pulses of TMS (rTMS) induce neuroplastic effects according to the parameters of polarization: high-frequency rTMS (usually ≥10Hz) induced an increase in cortical excitability, while slow or lowfrequency rTMS – (usually ≤1Hz) induced opposite effects [129]. "
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    • "Such efforts have led to development of the repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy for pharmacoresistant epileptic patients (Kimiskidis, 2010). rTMS is a noninvasive brain stimulation method (Barker et al., 1985), where the coils put over the top of cortical and subcortical regions, resulting in long term changes in their neural activity and overall excitability (Fregni and Pascual- Leone, 2007; Mally and Stone, 2007; Post and Keck, 2001; Ridding and Rothwell, 2007; Walsh and Cowey, 2000). Previous studies on human showed that application of lowfrequency rTMS led to decrement in neuronal excitability and had anticonvulsant effect (Bae et al., 2007; Chen et al., 1997; Fregni et al., 2005; Hsu et al., 2011; Joo et al., 2007; Sun et al., 2011, 2012; Tergau et al., 1999). "
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    ABSTRACT: In this study, the effect of repetitive transcranial magnetic stimulation (rTMS) on the kindling induced changes in electrophysiological firing properties of hippocampal CA1 pyramidal neurons was investigated. Male Wistar rats were kindled by daily electrical stimulation of the basolateral amygdala in a semi-rapid manner (12 stimulations/day) until they achieved stage-5 seizure. One group (kindled+rTMS (KrTMS)) of animals received rTMS (240 pulses at 1Hz) at 5min after termination of daily kindling stimulations. Twenty four hours following the last kindling stimulation electrophysiological properties of hippocampal CA1 pyramidal neurons were investigated using whole-cell patch clamp technique, under current clamp condition. Amygdala kindling significantly decreased the adaptation index, post-afterhyperpolarization, rheobase current, utilization time, delay to the first rebound spike. It caused also an increase in the voltage sag, number of rebound spikes and number of evoked action potential. Results of the present study revealed that application of rTMS following kindling stimulations had antiepileptogenic effects. In addition, application of rTMS prevented hyperexcitability of CA1 pyramidal neurons induced by kindling and conserved the normal neuronal firing. Copyright © 2015. Published by Elsevier B.V.
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