Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation

Department of Biomedical Sciences and Biotechnology, National Institute of Neuroscience-Italy, University of Brescia and Cognitive Neuroscience Section, IRCCS San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Brain Stimulation (Impact Factor: 4.4). 10/2008; 1(4):326-36. DOI: 10.1016/j.brs.2008.07.002
Source: PubMed


Cognitive deficits are a common consequence of neurologic disease, in particular, of traumatic brain injury, stroke, and neurodegenerative disorders, and there is evidence that specific cognitive training may be effective in cognitive rehabilitation. Several investigations emphasize the fact that interacting with cortical activity, by means of cortical stimulation, can positively affect the short-term cognitive performance and improve the rehabilitation potential of neurologic patients. In this respect, preliminary evidence suggests that cortical stimulation may play a role in treating aphasia, unilateral neglect, and other cognitive disorders. Several possible mechanisms can account for the effects of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) on cognitive performance. They all reflect the potential of these methods to improve the subject's ability to relearn or to acquire new strategies for carrying out behavioral tasks. The responsible mechanisms remain unclear but they are most likely related to the activation of impeded pathways or inhibition of maladaptive responses. Modifications of the brain activity may assist relearning by facilitating local activity or by suppressing interfering activity from other brain areas. Notwithstanding the promise of these preliminary findings, to date no systematic application of these methods to neurorehabilitation research has been reported. Considering the potential benefit of these interventions, further studies taking into consideration large patient populations, long treatment periods, or the combination of different rehabilitation strategies are needed. Brain stimulation is indeed an exciting opportunity in the field of cognitive neurorehabilitation, which is clearly in need of further research.

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Available from: Michael A Nitsche
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    • "Finally, neuromodulation approaches, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS) and deep brain stimulation can potentially enhance cognition by modulating neuronal excitability [162] [163]. Thus far, evidences for possible cognitive effects of neuromodulatory strategies for MDD remain largely unknown. "
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    • "The effects are determined by the stimulation polarity: anodal stimulation increases excitability and cathodal stimulation decreases it (Liebetanz, Nitsche, Tergau, & Paulus, 2002; Nitsche & Paulus, 2000). tDCS has principally been used to study motor, visual (for a recent review, see Antal, Paulus, & Nitsche, 2011), and cognitive functions (for a recent review, see Jacobson, Koslowsky, & Lavidor, 2012) and to evaluate its potential in therapeutic applications for different neurological diseases (Miniussi et al., 2008; Sparing & Mottaghy, 2008). tDCS has been applied over frontoparietal and temporoparietal areas to promote a linguistic improvement, and different results have been obtained (Monti et al., 2013; Schlaug, Marchina, & Wan, 2011). "
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