Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients

 So in 12 years did your doctors and stroke hospital solve this controversy?

Or did your doctors and stroke hospital do nothing with this? Do you prefer your incompetence NOT KNOWING? OR NOT DOING?

Their reasons for doing nothing?

Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?

The latest here.

 

Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients

2008, Brain Stimulation
 Friedhelm C. Hummel, MD a, 

Pablo Celnik, MD b, 

Alvero Pascual-Leone, MD c,

Felipe Fregni, MD, PhD c, 

Winston D. Byblow, MD d, 

Cathrin M. Buetefisch, MD e, 

John Rothwell, MD f, 

Leonardo G. Cohen, MD g, 

Christian Gerloff, MD a
a Brain Imaging and Neurostimulation Lab, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
b DepartmentofPhysicalMedicineandRehabilitation,DepartmentofNeurology,Johns HopkinsUniversity,Baltimore,Maryland
c Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachussets
d Movement Neuroscience Laboratory, Department of Sport & Exercise Science, University of Auckland, Auckland, New Zealand
e Neurological Therapeutic Center, Heinrich-Heine University Dusseldorf, Germany
 f  Department of Neurology, Department of Physiology, West Virginia University, Morgantown, West Virginia
g Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disordersand Stroke, National Institutes of Health, Bethesda, Maryland
 

Stroke is the leading cause of disability in the adult population of western industrialized countries.Despite significant improvements of acute stroke care, two thirds of stroke survivors have to cope with persisting neurologic deficits. Adjuvant brain stimulation is a novel approach to improving the treatment of residual deficits after stroke. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and epidural electrical stimulation have been used in first trials on small cohorts of stroke patients. Effect sizes in the order of 8% to 30% of functional improvement have been reported, but a publication bias toward presenting ‘‘promising’’ but not negative results is likely. Many questions regarding underlying mechanisms, optimal stimulation parameters, combination with other types of interventions, among others, are open. This review addresses six controversies related to the experimental application of brain stimulation techniques to stroke patients. Cortical stimulation after stroke will need to be individually tailored and a thorough patient stratification according to type and extent of clinical deficit, lesion location, lesion size, comorbidities, time in the recovery process, and perhaps also age and gender will be necessary. There is consensus that cortical stimulation in stroke patients is still experimental and should only be applied in the frame of scientific studies.
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 2008 Elsevier Inc. All rights reserved.
Keywords
 stroke; plasticity; recovery; rehabilitation
Correspondence: Christian Gerloff, MD, Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr, 52 20246 Hamburg,Germany.E-mail address: gerloff@uke.uni-hamburg.deSubmitted June 9, 2008; revised September 3, 2008. Accepted for publication September 5, 2008.
1935-861X/08/$ -see front matter
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 2008 Elsevier Inc. All rights reserved.doi:10.1016/j.brs.2008.09.003