There is that word again; 'efficacy' meaning it works. What the hell did your hospital do with that in the ensuing 14 years? I bet they just let stroke survivors stay disabled. Couldn't be bothered to lift a finger to help. Does your doctor and hospital even know what the word efficacy means?
Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients
2008, Brain Stimulation
Controversy: Noninvasive and invasive cortical stimulation show efficacy in treating stroke patients
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
MovementNeuroscienceLaboratory,DepartmentofSport&ExerciseScience,UniversityofAuckland,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 Disorders and 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(Meaning you need to create protocols.) 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.(Why? You don't list any negatives.)
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
MovementNeuroscienceLaboratory,DepartmentofSport&ExerciseScience,UniversityofAuckland,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 Disorders and 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(Meaning you need to create protocols.) 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.(Why? You don't list any negatives.)
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