Front. Psychiatry, 12 November 2012 | doi: 10.3389/fpsyt.2012.00088

Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke

  • 1Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
  • 2Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
  • 3Division of Neurology, Santa Casa de São Paulo Medical School, São Paulo, Brazil
  • 4Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
  • 5Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Introduction/Objectives: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation are two powerful non-invasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Moreover, recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Therefore, investigating and investing in innovative therapies that may improve neurorehabilitative stroke recovery are next steps in research and development. Participants/Materials and Methods: This article presents an up-to-date systematic review of the treatment effects of rTMS and tDCS on motor function. A literary search was conducted, utilizing search terms “stroke” and “transcranial stimulation.” Items were excluded if they failed to: (1) include stroke patients, (2) study motor outcomes, or (3) include rTMS/tDCS as treatments. Other exclusions included: (1) reviews, editorials, and letters, (2) animal or pediatric populations, (3) case reports or sample sizes ≤2 patients, and (4) primary outcomes of dysphagia, dysarthria, neglect, or swallowing. Results: Investigation of PubMed English Database prior to 01/01/2012 produced 695 applicable results. Studies were excluded based on the aforementioned criteria, resulting in 50 remaining studies. They included 1314 participants (1282 stroke patients and 32 healthy subjects) evaluated by motor function pre- and post-tDCS or rTMS. Heterogeneity among studies’ motor assessments was high and could not be accounted for by individual comparison. Pooled effect sizes for the impact of post-treatment improvement revealed consistently demonstrable improvements after tDCS and rTMS therapeutic stimulation. Most studies provided limited follow-up for long-term effects. Conclusion: It is apparent from the available studies that non-invasive stimulation may enhance motor recovery and may lead to clinically meaningful functional improvements in the stroke population. Only mild to no adverse events have been reported. Though results have been positive results, the large heterogeneity across articles precludes firm conclusions.

Keywords: transcranial direct current stimulation, repetitive transcranial magnetic stimulation, stroke, motor, transcranial magnetic stimulation, noninvasive brain stimulation

Citation: Adeyemo BO, Simis M, Macea DD and Fregni F (2012) Systematic review of parameters of stimulation, clinical trial design characteristics, and motor outcomes in non-invasive brain stimulation in stroke. Front. Psychiatry 3:88. doi: 10.3389/fpsyt.2012.00088

Received: 31 May 2012; Accepted: 22 September 2012;
Published online: 12 November 2012.

Edited by:

Andre R. Brunoni, Universidade de São Paulo, Brazil

Reviewed by:

Kátia K. Monte-Silva, Federal University of Pernambuco, Brazil
Pedro Shiozawa, Santa Casa de Misericórdia de São Paulo, Brazil

Copyright: © 2012 Adeyemo, Simis, Macea and Fregni. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.

*Correspondence: Felipe Fregni, Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, 125 Nashua Street #727, Boston, MA 02114, USA. e-mail:;

Marcel Simis and Debora Duarte Macea have contributed equally to this work.

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