Harnessing theta waves: tACS as a breakthrough in alleviating post-stroke chronic pain

 Will your competent? doctor do anything with this?

Here's how long your doctor has been incompetent in not having protocols to prevent this problem. Which means your board of directors is incompetent in not having correct goals for the stroke medical 'professionals'!

39% to 55% post stroke pain (3 posts to October 2022)

The latest here:

Harnessing theta waves: tACS as a breakthrough in alleviating post-stroke chronic pain

Ningjing Song^1,2,3,4Ling Long^1,2,3,4Nianquan Liu^1,2,3,4Yujun Luo^1,2,3,4Meng Wei^1,2,3,4Hai Huang^1,2,3,4*Wan Liu^1,2,3,4*

• ¹Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China
• ²Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
• ³Hubei Sizhen Laboratory, Wuhan, China
• ⁴First Clinical Medical College, Hubei University of Chinese Medicine, Wuhan, China

Neural oscillations play a critical role in the regulation of brain functions, with theta waves (4–8 Hz) in the sensorimotor cortex significantly influencing pain perception and modulation. These oscillations can modulate pain signal transmission, emotional cognition, and neuroplasticity. Post-stroke chronic pain is a common and complex symptom that imposes significant physiological and psychological burdens on patients. Transcranial alternating current stimulation (tACS), a non-invasive brain stimulation technique, can synchronize specific frequency neural activities, reorganize brain networks, and modulate neuroplasticity by adjusting specific frequency neural oscillations. In recent years, tACS has been widely applied in the research and treatment of various neurological and psychiatric disorders. This study aims to systematically summarize the current research progress on the regulation of θ oscillations in sensorimotor cortex by tACS. By reviewing relevant experimental and clinical studies, we explore the specific mechanisms of θ oscillations in pain perception and modulation and analyze the mechanisms and effects of tACS modulation of θ oscillations. Additionally, we examine the central and peripheral neural mechanisms of post-stroke chronic pain, emphasizing the critical role of the sensorimotor cortex in pain processing. In conclusion, tACS shows potential for modulating sensorimotor cortex θ oscillations and alleviating post-stroke chronic pain. This research provides new insights into the neural modulation mechanisms related to pain and offers potential new directions for developing novel therapies. Future clinical studies and technological optimizations are necessary to ensure the effectiveness and feasibility of tACS in clinical practice.

1 Introduction

Chronic post-stroke pain (PSCP) is a prevalent complication, affecting approximately 12% of individuals who have experienced a stroke (Zhan et al., 2019). The pathogenesis of PSCP is intricate, involving the reorganization and dysfunction of both the central and peripheral nervous systems (Larson et al., 2019). Patients frequently endure severe neuropathic pain, sensory abnormalities, and heightened pain sensitivity. Current therapeutic interventions, including pharmacological treatments, physiotherapy, and cognitive behavioral therapy, often demonstrate limited efficacy, with many patients struggling to achieve sustained pain relief (Haslam et al., 2021). Central nervous system pathological alterations are central to the challenging nature of PSCP, particularly the dysfunction of the sensorimotor cortex, which is closely linked to pain perception. Consequently, the modulation of sensorimotor cortex activity to alleviate pain has emerged as an urgent research priority. Recent advancements in neuroscience have highlighted the significant role of neural electrical activity in pain stimulation and perception (Yin and Zhao, 2024). Consequently, the modulation of sensorimotor cortex activity to alleviate pain has emerged as an urgent research priority.

Recent advancements in neuroscience have highlighted the significant role of neural electrical activity in pain stimulation and perception, emphasizing the importance of neural oscillation energy regulation and phase properties in the onset and modulation of pain. Neural oscillations are integral not only to pain processing but also to a wide range of cognitive and sensory functions. The sensorimotor cortex, a critical region for processing sensory input and motor output (Kong et al., 2024), is particularly influenced by θ-wave (4–8 Hz) neural oscillations (θ oscillations), which are pivotal in sensorimotor integration, attention regulation, and pain modulation. Research indicates that synchronized θ wave activity may enhance the integration of sensory information and the formulation of motor plans by modulating the functional connectivity within the sensorimotor network. Furthermore, θ waves play a distinctive role in pain modulation, particularly in chronic pain conditions, where abnormalities in θ wave patterns may be linked to central sensitization phenomena. Such abnormalities in neural oscillation patterns are posited to be central mechanisms in the development of chronic pain.

Transcranial alternating current stimulation (tACS) is an emerging neuromodulation technique that non-invasively applies specific frequency alternating currents to the scalp to modulate neural oscillations in the brain (Feurra et al., 2011; Wischnewski et al., 2023). Transcranial alternating current stimulation (tACS) presents a promising avenue for the treatment of persistent sensorimotor cortex pain (PSCP) through the modulation of θ oscillations. Although the application of tACS in pain research remains in its nascent stages, ongoing investigations continue to explore its analgesic effects and underlying mechanisms, with a current paucity of direct evidence to definitively elucidate the analgesic mechanism of tACS (Angelakis et al., 2013; May et al., 2021). This study aims to systematically synthesize the existing research on the modulation of θ oscillations in the sensorimotor cortex via tACS, to investigate the specific role of these oscillations in pain perception and modulation, and to analyze the effects and mechanisms of their modulation by tACS. Furthermore, this paper will delve into the mechanisms of tACS intervention in PSCP, with a particular focus on the central and peripheral neural mechanisms involved, highlighting the critical role of the sensorimotor cortex in pain processing. Additionally, the paper will propose future research directions and discuss the clinical application prospects of tACS, with the objective of providing a theoretical foundation and practical references for the treatment of chronic pain using this modality.

More at link.

Alzheimer's Progression May Be Slowed by Targeted Magnetic Pulses, Study Suggests

 Is your competent? doctor closely following this because of your extra risk of dementia post stroke?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018

Do you prefer your doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

If they were competent at all they would have done something from this research in 2019. But they incompetently didn't do anything, did they?

Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls September 2019

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? What did you do with the 2019 research? 

The latest here: 

Alzheimer's Progression May Be Slowed by Targeted Magnetic Pulses, Study Suggests

Investigational transcranial magnetic stimulation that targeted a brain network involved in memory slowed progression in mild-to-moderate Alzheimer's disease, data from a small phase II study suggested.

At 1 year, noninvasive personalized stimulation of the default mode network (DMN) led to an estimated mean change of 1.3 points on the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB), compared with 2.4 points for sham treatment (P=0.038), reported Giacomo Koch, MD, PhD, of the University of Ferrara in Italy at the Clinical Trials on Alzheimer's Disease annual meeting in Madrid.

CDR-SB scores -- the primary outcome in this single-center study -- range from 0 to 18, with higher scores indicating greater impairment.

Repetitive stimulation also led to significantly better scores on a key secondary measure of activities of daily living compared with sham (P<0.001) at 1 year.

The findings confirm the potential of transcranial magnetic stimulation to enhance neuroplasticity, gamma activity, and network connectivity in the DMN, Koch said. "Personalized noninvasive brain stimulation of the DMN could represent a novel therapeutic approach in Alzheimer's disease patients," he stated.

The results add to prior 6-month evidence supporting neuromodulation to slow cognitive impairment and preserve activities of daily living, he added.

"I'm encouraged by consistency of the efficacy signals across endpoints in this 1-year monocentric placebo-controlled study," noted Jeffrey Cummings, MD, ScD, of University of Nevada in Las Vegas. "Given its lack of serious side effects, this precision medicine neuromodulation approach represents a promising new direction for treatment research in the field of Alzheimer's."

The DMN is responsible for memory and has preferential accumulation of amyloid-beta and tau versus other regions, Koch noted. The precuneus is a key DMN hub.

"We are targeting synaptic dysfunction in Alzheimer's disease," Koch said. "The synaptic dysfunction is the consequence of complex interactions between amyloid deposition, tau, and neuroinflammation that occurs during several years. And at some point, it progressively affects the communication with neurons and disrupts synaptic activity at different levels."

The study randomized 48 people with mild-to-moderate Alzheimer's disease to treatment or sham for 52 weeks. It included 31 patients from the previous 6-month randomized trial who extended therapy to 12 months; 17 new participants also received the identical protocol for 12 months. A number of people were lost to follow-up during the COVID-19 pandemic, and a total of 32 participants ultimately completed the 12-month study.

Personalization was established using single-pulse transcranial magnetic stimulation concurrently with electroencephalography (EEG) and MRI data to define the best spot to engage connectivity. The therapy consisted of 20 Hz pulses and was delivered daily for 10 sessions during an induction phase, then in weekly 20-minute sessions for the next 50 weeks.

EEGs showed that transcranial magnetic stimulation increased functional connectivity within the DMN, which correlated with clinical outcomes, Koch said. The procedure was safe and well tolerated, he noted; adverse events included headache, scalp or skin discomfort, and neck pain or stiffness.

Study limitations include a small sample size and mixed enrollment methods. In an upcoming trial, treatment will be calibrated quarterly using transcranial magnetic stimulation and EEG concurrently in combination with MRI-guided navigation.

Disclosures

Koch is a co-founder of Sinaptica Therapeutics, which developed the SinaptiStim system tested in this trial. He also reported relationships with Epitech, Roche, Novo Nordisk, and PIAM Farmaceutici, and filed for patents about targeted non-invasive brain stimulation and combination drugs for neurodegenerative diseases. He has received funding from Alzheimer Drug Discovery Foundation, European Commission Horizon 2020, Italian Ministry Of Health, Italian Ministry of Education, and Brightfocus Foundation.

Cummings disclosed numerous relationships with pharmaceutical companies and others.

Primary Source

Clinical Trials on Alzheimer's Disease

Source Reference: Koch G "Results of a 52-week phase II trial of repetitive TMS of the default mode network in mild to moderate Alzheimer's disease" CTAD 2024.

Rapid Cognitive Improvement With Noninvasive Brain Stimulation

Ask your doctor how much of your lost 5 cognitive years from your stroke  this will recover.

Rapid Cognitive Improvement With Noninvasive Brain Stimulation

Transcranial alternating current stimulation (tACS) provides moderate cognitive benefits in healthy older adults(So your doctor needs to initiate research on this in stroke patients) as well as those with neuropsychiatric disorders, results of the largest and most comprehensive meta-analysis of tACS to date show.

"tACS has shown great promise at enhancing mental function, but whether this technology can truly fulfill its promise has been a topic of considerable debate in the field of brain stimulation," senior investigator Robert Reinhart, PhD, with the Cognitive & Clinical Neuroscience Laboratory, Boston University, told Medscape Medical News. 

Given conflicting evidence on tACS for boosting cognition, Reinhart and colleagues leveraged statistical meta-analytic techniques to quantify how consistent the evidence is across several studies.

The time was right to do this, Reinhart said, as the number of tACS studies has "more than doubled since the previous meta-analysis and tACS designs have rapidly evolved, becoming increasingly sophisticated."

The study was published online May 24 in Science Translational Medicine.

Significant, Immediate Improvement

The analysis included 102 studies of tACS in healthy individuals as well as those with neurological or psychiatric conditions published between 2006 and 2021.

Together, these studies involved 2893 participants (1290 men and 1603 women) with a mean age of 30 years; 333 participants were older (mean age 67 years).

A total of 177 participants had a clinical disorder such as major depressive disorder, attention deficit hyperactivity disorder (ADHD), epilepsy, Parkinson's disease, schizophrenia, and mild cognitive impairment.

When compiling over 300 measures of mental function across all the studies, there was evidence for significant, reliable, and immediate improvement in mental function with tACS, Reinhart told Medscape Medical News.

When examining specific mental functions separately — such as memory, attention, or intelligence — tACS produced the strongest improvement in executive control, or the ability to adapt behavior in the face of new, surprising, or conflicting information, he noted.

"We also found improvements in the ability to pay attention, the ability to memorize information for both short and long periods of time, as well as in measures of intelligence. Together, these results suggest that tACS has the ability to particularly improve specific kinds of mental function, at least in the short term," Reinhart said.

To establish the effect of tACS in people who might most need it, the researchers examined how tACS impacted mental function in two subpopulations which may be particularly vulnerable to brain changes: older adults and clinical populations.

"In both subpopulations, we found reliable evidence for improvements in mental function with tACS. Interestingly, we also found that in specialized tACS, which can target two brain regions at the same time, manipulating the relationship between the two regions can both enhance or reduce mental function," Reinhart told Medscape Medical News

This bidirectional regulation of mental function could be particularly useful in the clinic, he noted.

"For example, conditions like depression may involve reduced reward-processing capabilities while others like bipolar disorder may involve a highly active reward-processing system. With the capability to change mental function in either direction, we may be able to flexibly develop targeted designs to cater to specific clinical needs," Reinhart said.

The researchers caution that while the analyses suggest immediate enhancements in cognitive function with tACS, they do not speak to the sustainability of these improvements. The durability of cognitive changes is a key question for future studies.

"Great Potential" but Questions Remain

Commenting on this research for Medscape Medical News, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said tACS has shown "great potential" in modulating brain systems and circuits. "However, it is important to note that tACS is still in the early stages of development and requires further refinement."

"Before tACS can become widely applicable, several crucial aspects need to be addressed. Firstly, we need to determine the specific brain regions that should be targeted for optimal results. Additionally, we must identify which types of individuals would benefit the most from this technology," said Lakhan, who was not involved in the meta-analysis.

"Moreover, it is crucial to ascertain whether the benefits observed in controlled experiments truly translate into real-life scenarios such as driving a car, work performance, academic achievements, and improved social relationships. It is one thing to witness improvements on brain tests, but it is essential to understand the practical implications of these enhancements," Lakhan commented.

He said he envisions "a combination of drugs, devices, and applications will work together harmoniously within a closed system to modulate the brain, specifically targeting and alleviating conditions like depression, anxiety, and hyperactivity."

"However, this advancement raises profound questions about the boundaries between clinical use and neuro-enhancement, challenging our existing social constructs," said Lakhan.

"Our personalities, to a certain extent, are shaped by the intricate networks within our brains. Remarkably, our brain signatures can reveal aspects of our character, including agreeableness, openness, conscientiousness, neuroticism, and even our political affiliations," he added.

"As we venture into this exciting realm of brain unlocking and manipulation, it is imperative that we approach it with caution, ethical considerations, and a deep understanding of the potential consequences," Lakhan said.

"Only through responsible exploration and careful navigation can we fully harness the power of these technologies while respecting the complexities of our individual identities and the broader social implications they entail," he added.

This work was supported by grants from the National Institutes of Health and a gift from an individual philanthropist. Reinhart and Lakhan report no relevant financial relationships.

Sci Transl Med. Published online May 24, 2023. Abstract

 

Rapid Cognitive Improvement With Noninvasive Brain Stimulation

What does your doctor think of using this to combat your brain fog immediately post stroke?  

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Rapid Cognitive Improvement With Noninvasive Brain Stimulation

Transcranial alternating current stimulation (tACS) provides moderate cognitive benefits in healthy older adults as well as those with neuropsychiatric disorders, results of the largest and most comprehensive meta-analysis of tACS to date show.

"tACS has shown great promise at enhancing mental function, but whether this technology can truly fulfill its promise has been a topic of considerable debate in the field of brain stimulation," senior investigator Robert Reinhart, PhD, with the Cognitive & Clinical Neuroscience Laboratory, Boston University, told Medscape Medical News. 

Given conflicting evidence on tACS for boosting cognition, Reinhart and colleagues leveraged statistical meta-analytic techniques to quantify how consistent the evidence is across several studies.

The time was right to do this, Reinhart said, as the number of tACS studies has "more than doubled since the previous meta-analysis and tACS designs have rapidly evolved, becoming increasingly sophisticated."

The study was published online May 24 in Science Translational Medicine.

Significant, Immediate Improvement

The analysis included 102 studies of tACS in healthy individuals as well as those with neurological or psychiatric conditions published between 2006 and 2021.

Together, these studies involved 2893 participants (1290 men and 1603 women) with a mean age of 30 years; 333 participants were older (mean age 67 years).

A total of 177 participants had a clinical disorder such as major depressive disorder, attention deficit hyperactivity disorder (ADHD), epilepsy, Parkinson's disease, schizophrenia, and mild cognitive impairment.

When compiling over 300 measures of mental function across all the studies, there was evidence for significant, reliable, and immediate improvement in mental function with tACS, Reinhart told Medscape Medical News.

When examining specific mental functions separately — such as memory, attention, or intelligence — tACS produced the strongest improvement in executive control, or the ability to adapt behavior in the face of new, surprising, or conflicting information, he noted.

"We also found improvements in the ability to pay attention, the ability to memorize information for both short and long periods of time, as well as in measures of intelligence. Together, these results suggest that tACS has the ability to particularly improve specific kinds of mental function, at least in the short term," Reinhart said.

To establish the effect of tACS in people who might most need it, the researchers examined how tACS impacted mental function in two subpopulations which may be particularly vulnerable to brain changes: older adults and clinical populations.

"In both subpopulations, we found reliable evidence for improvements in mental function with tACS. Interestingly, we also found that in specialized tACS, which can target two brain regions at the same time, manipulating the relationship between the two regions can both enhance or reduce mental function," Reinhart told Medscape Medical News

This bidirectional regulation of mental function could be particularly useful in the clinic, he noted.

"For example, conditions like depression may involve reduced reward-processing capabilities while others like bipolar disorder may involve a highly active reward-processing system. With the capability to change mental function in either direction, we may be able to flexibly develop targeted designs to cater to specific clinical needs," Reinhart said.

The researchers caution that while the analyses suggest immediate enhancements in cognitive function with tACS, they do not speak to the sustainability of these improvements. The durability of cognitive changes is a key question for future studies.

"Great Potential" but Questions Remain

Commenting on this research for Medscape Medical News, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said tACS has shown "great potential" in modulating brain systems and circuits. "However, it is important to note that tACS is still in the early stages of development and requires further refinement."

"Before tACS can become widely applicable, several crucial aspects need to be addressed. Firstly, we need to determine the specific brain regions that should be targeted for optimal results. Additionally, we must identify which types of individuals would benefit the most from this technology," said Lakhan, who was not involved in the meta-analysis.

"Moreover, it is crucial to ascertain whether the benefits observed in controlled experiments truly translate into real-life scenarios such as driving a car, work performance, academic achievements, and improved social relationships. It is one thing to witness improvements on brain tests, but it is essential to understand the practical implications of these enhancements," Lakhan commented.

He said he envisions "a combination of drugs, devices, and applications will work together harmoniously within a closed system to modulate the brain, specifically targeting and alleviating conditions like depression, anxiety, and hyperactivity."

"However, this advancement raises profound questions about the boundaries between clinical use and neuro-enhancement, challenging our existing social constructs," said Lakhan.

"Our personalities, to a certain extent, are shaped by the intricate networks within our brains. Remarkably, our brain signatures can reveal aspects of our character, including agreeableness, openness, conscientiousness, neuroticism, and even our political affiliations," he added.

"As we venture into this exciting realm of brain unlocking and manipulation, it is imperative that we approach it with caution, ethical considerations, and a deep understanding of the potential consequences," Lakhan said.

"Only through responsible exploration and careful navigation can we fully harness the power of these technologies while respecting the complexities of our individual identities and the broader social implications they entail," he added.

This work was supported by grants from the National Institutes of Health and a gift from an individual philanthropist. Reinhart and Lakhan report no relevant financial relationships.

Sci Transl Med. Published online May 24, 2023. Abstract

 

Multi-modal investigation of transcranial ultrasound-induced neuroplasticity of the human motor cortex

 Oh hell, testing in healthy subjects. With NO stroke leadership we'll never get any useful testing in stroke survivors.

Multi-modal investigation of transcranial ultrasound-induced neuroplasticity of the human motor cortex

• Nardin Samuel ¹
• Ke Zeng ¹
• Irene E. Harmsen ¹
• 
  
• Nathan C. Rowland
• Robert Chen ²
• Andres M. Lozano ²
• Show all authors
• Show footnotes

Open AccessPublished:October 10, 2022DOI:https://doi.org/10.1016/j.brs.2022.10.001

Highlights

• •
  tbTUS impacts motor cortex excitability and intracortical circuits.
• •
  Repetitive tbTUS induces durable alterations in the human motor cortex.
• •
  tbTUS affects connectivity at the whole brain level and at distinct motor centers.
• •
  Understanding the mechanisms of tbTUS can inform novel neuromodulation protocols.

Abstract

Introduction

There is currently a gap in accessibility to neuromodulation tools that can approximate the efficacy and spatial resolution of invasive methods. Low intensity transcranial focused ultrasound stimulation (TUS) is an emerging technology for non-invasive brain stimulation (NIBS) that can penetrate cortical and deep brain structures with more focal stimulation compared to existing NIBS modalities. Theta burst TUS (tbTUS, TUS delivered in a theta burst pattern) is a novel repetitive TUS protocol that can induce durable changes in motor cortex excitability, thereby holding promise as a novel neuromodulation tool with durable effects.

Objective

The aim of the present study was to elucidate the neurophysiologic effects of tbTUS motor cortical excitability, as well on local and global neural oscillations and network connectivity.

Methods

An 80-second train of active or sham tbTUS was delivered to the left motor cortex in 15 healthy subjects. Motor cortical excitability was investigated through transcranial magnetic stimulation (TMS)-elicited motor-evoked potentials (MEPs), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) using paired-pulse TMS. Magnetoencephalography (MEG) recordings during resting state and an index finger abduction-adduction task were used to assess oscillatory brain responses and network connectivity. The correlations between the changes in neural oscillations and motor cortical excitability were also evaluated.

Results

tbTUS to the motor cortex results in a sustained increase in MEP amplitude and decreased SICI, but no change in ICF. MEG spectral power analysis revealed TUS-mediated desynchronization in alpha and beta spectral power. Significant changes in alpha power were detected within the supplementary motor cortex (Right > Left) and changes in beta power within bilateral supplementary motor cortices, right basal ganglia and parietal regions. Coherence analysis revealed increased local connectivity in motor areas. MEP and SICI changes correlated with both local and inter-regional coherence.

Conclusion

The findings from this study provide novel insights into the neurophysiologic basis of TUS-mediated neuroplasticity and point to the involvement of regions within the motor network in mediating this sustained response. Future studies may further characterize the durability of TUS-mediated neuroplasticity and its clinical applications as a neuromodulation strategy for neurological and psychiatric disorders.

Transcranial electrostimulation with special waveforms enhances upper-limb motor function in patients with chronic stroke: a pilot randomized controlled trial

 If you're chronic, good luck getting your insurance to pay for this.

Transcranial electrostimulation with special waveforms enhances upper-limb motor function in patients with chronic stroke: a pilot randomized controlled trial

• Shih-Ching Chen,
• Ling-Yu Yang,
• Muhammad Adeel,
• Chien-Hung Lai &
• Chih-Wei Peng 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 106 (2021) Cite this article

Abstract

Background

Transcranial direct current stimulation (tDCS) and intermittent theta burst stimulation (iTBS) were both demonstrated to have therapeutic potentials to rapidly induce neuroplastic effects in various rehabilitation training regimens. Recently, we developed a novel transcranial electrostimulation device that can flexibly output an electrical current with combined tDCS and iTBS waveforms. However, limited studies have determined the therapeutic effects of this special waveform combination on clinical rehabilitation. Herein, we investigated brain stimulation effects of tDCS-iTBS on upper-limb motor function in chronic stroke patients.

Methods

Twenty-four subjects with a chronic stroke were randomly assigned to a real non-invasive brain stimulation (NIBS; who received the real tDCS + iTBS output) group or a sham NIBS (who received sham tDCS + iTBS output) group. All subjects underwent 18 treatment sessions of 1 h of a conventional rehabilitation program (3 days a week for 6 weeks), where a 20-min NIBS intervention was simultaneously applied during conventional rehabilitation. Outcome measures were assessed before and immediately after the intervention period: Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Jebsen-Taylor Hand Function Test (JTT), and Finger-to-Nose Test (FNT).

Results

Both groups showed improvements in FMA-UE, JTT, and FNT scores after the 6-week rehabilitation program. Notably, the real NIBS group had greater improvements in the JTT (p = 0. 016) and FNT (p = 0. 037) scores than the sham NIBS group, as determined by the Mann–Whitney rank-sum test.

Conclusions

Patients who underwent the combined ipsilesional tDCS-iTBS stimulation with conventional rehabilitation exhibited greater impacts than did patients who underwent sham stimulation-conventional rehabilitation in statistically significant clinical responses of the total JTT time and FNT after the stroke. Preliminary results of upper-limb functional recovery suggest that tDCS-iTBS combined with a conventional rehabilitation intervention may be a promising strategy to enhance therapeutic benefits in future clinical settings.

Trial registration: ClinicalTrials.gov Identifier: NCT04369235. Registered on 30 April 2020.

Introduction

Neuromodulation is an evolving therapy for rehabilitation after a stroke and is also used to improve motor function in the lesioned cortex. Recently, studies indicated that neuromodulation could enhance neuroplasticity, the ability of the brain to reorganize or relearn in response to a new stimulus, resulting in facilitation of motor sensory recovery in stroke patients [1,2,3]. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation (NIBS) technique, is contemporarily important as it can modulate neuroplasticity in advanced rehabilitation medicine, such as pain, depression and, addictive diseases [4,5,6]. tDCS can selectively change the excitability of the regional cortex non-invasively and safely [7]. In addition, tDCS has been explored as a treatment option for stroke, particularly for upper/lower-limb motor function [8,9,10,11]. However, studies reported only 10% ~ 30% improvement in forearm motor function after stroke rehabilitation. Optimal stimulation strategies of tDCS to improve plasticity and enhance motor learning need to be determined.

Recovery as a result of traditional stroke rehabilitation often has poor outcomes and long rehabilitation times. Therefore, developing a more-effective therapeutic device is an important issue for stroke rehabilitation. To develop an optimal tDCS protocol to improve motor function, we designed and implemented a prototype of a novel transcranial electrostimulation device that can flexibly output an electrical current waveform by combining DC and theta burst waveforms [12]. Theta burst stimulation (TBS) was originally a novel waveform of repetitive transcranial magnetic stimulation (rTMS) that is more rapid and efficacious than rTMS [13]. Numerous studies determined that TBS has more advantages than other traditional waveforms of rTMS, such as long-lasting effects on motor-evoked potentials (MEPs) and neuronal excitability after a shorter stimulation duration [14,15,16], and it was associated with fewer adverse events [17]. It is well known that the most widely used TBS patterns are intermittent (i)TBS and continuous (c)TBS. iTBS consists of a 2-s train of TBS repeated every 10 s for a total of 190 s which produces long-term potentiation (LTP)-like effects, whereas cTBS consists of three-pulse bursts at 50 Hz repeated every 200 ms for 40 s, which induces long-term depression (LTD)-like cortical plasticity [14, 18,19,20].

Use of an rTMS protocol with iTBS in chronic stroke patients was shown to significantly increase ipsilesional M₁ excitability, enhanced MEP amplitudes, and improve upper-limb motor functions [15, 21,22,23]. One recent meta-analysis showed that the standardized mean difference (SMD) of iTBS was 0.60 (p = 0.018), whereas that for cTBS was 0.35 (p = 0.138) for the recovery of upper-limb motor outcomes in stroke patients, indicating that iTBS was more beneficial than cTBS in motor recovery after a stroke [24]. Therefore, modulation of cortical plasticity induced by iTBS may have therapeutic potential for patients with post-stroke motor disorders.

Both rTMS and tDCS can cause physiological effects and indirectly modulate deep-brain locations via neural circuits [25, 26]. In general, rTMS therapy is usually applied before undertaking occupational therapy for patients with motor function deficits, due to the bulky size of the rTMS device. On the contrary, the lightweight, portable tDCS device can be directly worn on a patient's head during active rehabilitation exercises, which was associated with augmentation of synaptic plasticity [27,28,29]. However, most traditional transcranial stimulators have only a DC waveform mode at present. Thus, our novel transcranial burst electrostimulator was designed to develop an effective and optimal therapeutic system for patients who need rehabilitation therapy. We previously demonstrated that compared to conventional anodal tDCS, the combined DC-iTBS electrostimulator induced LTP-like plasticity as evident from significantly enhanced MEP amplitudes for at least 30 min in animal experiments [12].

With the excellent efficacy of previously combined stimulation, we report a pilot randomized controlled study to examine the combined effects of DC-iTBS and conventional rehabilitation (CR) on upper-limb motor function as measured by the Fugl-Meyer Assessment upper extremity (FMA-UE), Finger-to-Nose test (FNT), and Jebsen-Taylor hand function test (JTT) in patients with chronic stroke compared to a sham intervention. To our knowledge, this is the first randomized controlled trial (RCT) to apply tDCS with iTBS to facilitate upper-limb motor function in chronic stroke patients. We also expected that the novel DC-iTBS stimulation combined with rehabilitation of the upper extremities would result in greater improvements and have potential to become a routine treatment strategy for stroke patients at hospitals and residential rehabilitation facilities.

More at link.

 

Transcranial Infrared Laser Stimulation Improves Cognition in Older Bipolar Patients: Proof of Concept Study

WHOM do we talk to to get this tested in stroke patients? With NO STROKE LEADERSHIP nothing will occur.  Augmenting prefrontal oxygenation sounds very likely to help stroke survivors.

Transcranial Infrared Laser Stimulation Improves Cognition in Older Bipolar Patients: Proof of Concept Study

 

Show all authors

Courtney M. O’Donnell, PhD, Douglas W. Barrett, PhD, Latham H. Fink, MD, PhD,

First Published February 2, 2021 Research Article 

https://doi.org/10.1177/0891988720988906

Article information

Abstract

This is the first study to examine if transcranial infrared laser stimulation (TILS) improves cognition in older euthymic bipolar patients, who exhibit greater cognitive decline than is expected for age-matched controls. TILS is a non-invasive novel form of photobiomodulation that augments prefrontal oxygenation and improves cognition in young adults by upregulating the mitochondrial respiratory enzyme cytochrome-c-oxidase. We used a crossover sham-controlled design to examine if TILS to bilateral prefrontal cortex produces beneficial effects on cognition in 5 euthymic bipolar patients (ages 60-85). We measured cognitive flexibility, verbal fluency, working memory, sustained attention and impulsivity with tasks that have been shown to differentiate between healthy older adults and older bipolar adults. We found TILS-induced improvements in cognitive performance on the tasks that measure cognitive flexibility and impulsivity, after 5 weekly sessions of TILS. We concluded that TILS appeared both safe and effective in helping alleviate the accelerated cognitive decline present in older bipolar patients.

Keywords bipolar disorder, cognitive decline, brain stimulation, photobiomodulation, prefrontal cortex

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Transcranial Electrical Stimulation Shows Promise for Treating Mild Traumatic Brain Injury

Would this help stroke survivors? We'll never know since we have NO stroke leadership to go to to ask these fuckingly simple questions and NO stroke strategy to address any of the problems in stroke.
I bet your doctor did NOTHING with this from April, 2016, fucking incompetence in public display once again.

Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

http://dgnews.docguide.com/transcranial-electrical-stimulation-shows-promise-treating-mild-traumatic-brain-injury?

SAN DIEGO -- September 29, 2017 -- Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers report significantly improved neural function in participants with mild traumatic brain injury (TBI).
Their findings are published online in the current issue of the journal Brain Injury.
In a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioural impairment.
Much about the pathology of mild TBI is not well understood, which has confounded efforts to develop optimal treatments, explained Roland Lee, MD, University of California at San Diego School of Medicine, San Diego, California. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial electrical stimulation (LIP-tES), has shown promise.
In their pilot study, which involved 6 participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The treatment effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex).
“Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild traumatic brain injury, with about 85% sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said Dr. Lee. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”
The researchers found that the brains of all 6 participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores.
“For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said Ming-Xiong Huang, PhD, University of California San Diego School of Medicine. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic brain injuries.”
Reference: http://dx.doi.org/10.1080/02699052.2017.1363409
SOURCE: University of California San Diego Health

Repetitive reaching training combined with transcranial Random Noise Stimulation in stroke survivors with chronic and severe arm paresis is feasible: a pilot, triple-blind, randomised case series

Never heard of this before so ask your doctor if this chronic therapy might help you. 

Repetitive reaching training combined with transcranial Random Noise Stimulation in stroke survivors with chronic and severe arm paresis is feasible: a pilot, triple-blind, randomised case series

• Kathryn S. Hayward,
• Sandra G. Brauer,
• Kathy L. RuddyEmail author,
• David Lloyd and
• Richard G. Carson

Journal of NeuroEngineering and Rehabilitation201714:46

DOI: 10.1186/s12984-017-0253-y

©  The Author(s). 2017

Received: 27 March 2017

Accepted: 15 May 2017

Published: 30 May 2017

Abstract

Background

Therapy that combines repetitive training with non-invasive brain stimulation is a potential avenue to enhance upper limb recovery after stroke. This study aimed to investigate the feasibility of transcranial Random Noise Stimulation (tRNS), timed to coincide with the generation of voluntary motor commands, during reaching training.

Methods

A triple-blind pilot RCT was completed. Four stroke survivors with chronic (6-months to 5-years) and severe arm paresis, not taking any medications that had the potential to alter cortical excitability, and no contraindications to tRNS or MRI were recruited. Participants were randomly allocated to 12 sessions of reaching training over 4-weeks with active or sham tRNS delivered over the lesioned hemisphere motor representation. tRNS was triggered to coincide with a voluntary movement attempt, ceasing after 5-s. At this point, peripheral nerve stimulation enabled full range reaching. To determine feasibility, we considered adverse events, training outcomes, clinical outcomes, corticospinal tract (CST) structural integrity, and reflections on training through in-depth interviews from each individual case.

Results

Two participants received active and two sham tRNS. There were no adverse events. All training sessions were completed, repetitive practice performed and clinically relevant improvements across motor outcomes demonstrated. The amount of improvement varied across individuals and appeared to be independent of group allocation and CST integrity.

Conclusion

Reaching training that includes tRNS timed to coincide with generation of voluntary motor commands is feasible. Clinical improvements were possible even in the most severely affected individuals as evidenced by CST integrity.

Trial registration

This study was registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) http://www.ANZCTR.org.au/ACTRN12614000952640.aspx. Registration date 4 September 2014, first participant date 9 September 2014.

Controversial Experiment for Brain-Dead Revival Dropped

I only posted this for the bolded statements which I had not heard about before. If your doctor is any good at all s/he will be able to tell you about them. 

Controversial Experiment for Brain-Dead Revival Dropped

A controversial experiment to revive brain-dead accident victims has been scrapped.
The Indian Council of Medical Research’s (ICMR) National Institute of Medical Statistics officially removed the “ReAnima” trial from India’s clinical trial registry on Nov. 11.
The experiment began in May when Himanshu Bansal, an orthopedic surgeon at Anupam Hospital in the north Indian state of Uttarakhand, announced plans to give approximately 20 brain-dead people a mix of interventions including injections of mesenchymal stem cells, peptides, transcranial laser stimulation and median nerve stimulation.
Transcranial laser stimulation is a process that involves shinning pulses of near-infrared light in the brain, while median nerve stimulation is the electrical stimulation of a major nerve that runs from the neck to the arm. Both techniques have been proven to improve cognition in patients with traumatic brain injury.
The ICMR identified several regulatory lapses in the trial that led to the decision, including a failure to seek permission to proceed from the Drug Controller General of India, a requirement for all clinical trials in India.
Bansal previously described his aim as bringing brain-dead individuals back to a minimally conscious state where patients show flickers of consciousness like moving their eyes to track objects.
While there is little evidence to show that brain-dead people can recover with function, Bansal has maintained that there is a significant number of cases of people who have recovered full consciousness from a minimally conscious state.
However, other researchers have doubted the project, claiming that situations where brain-dead individuals on life support who return to a fully functional state is hard to interpret and often lack evidence of brain death such as the apnea test, a measure of whether the person’s brain stem is making an effort to breathe.
Other concerns raised by scientists and physicians include whether the trial is ethically justified and that the mix of interventions has not been tested in animal models.
In a press statement, Bansal defended the proposal, saying there is no good animal models for human brain death.