Post-Stroke Recovery

Stroke, or cerebral infarction, is one of the leading causes of mortality in the world after heart disease and cancer, and is the leading cause of adult disability. A stroke is caused by a loss of blood supply to the brain, due to an obstruction of a blood vessel. Oxygen deprivation can lead to irreversible damage to the brain – the severity of damage depends on the duration of deprivation. Cerebral infarction damages brain tissue, and leads to neurological deficits and functional impairments according to the brain area that was damaged. Cerebral infarction or stroke can lead to limb paralysis, speech impairment, visual acuity or field deficits, or sensory impairment.

Current treatments: The only FDA-approved therapy for stroke available today is treatment with tissue plasminogen activator (TPA), a substance that opens obstructed blood vessels. There is a time window of 3.5-4 hours after the onset of a stroke during which this treatment is effective. Transcranial magnetic stimulation (TMS) can non-invasively stimulate the release of neurotrophic factors (such as BDNF) from nerve terminals in the brain, which can strengthen synaptic connections in relevant brain areas and even stimulate cellular regeneration. A number of studies have established the safety of treating stroke patients with TMS, and have shown that this treatment improves post-stroke recovery. Also, it has been found that TMS therapy in conjunction with physical therapy significantly improves the rate and extent of rehabilitation. However, it should be noted that as standard TMS devices are limited to stimulation of superficial brain areas, studies have been limited to the hand-associated motor cortex; whereas the more important aspect of stroke rehabilitation is the recovery of locomotive capacity. Hence it is hoped that this and other aspects may potentially be improved by Deep TMS treatment.

Selected References

Naeser MA, Martin PI, Ho M, Treglia E, Kaplan E, Bashir S, Pascual-Leone A Transcranial magnetic stimulation and aphasia rehabilitation. Arch Phys Med Rehabil. 2012 Jan;93(1 Suppl):S26-34.
Hoyer EH, Celnik PA. Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation. Restor Neurol Neurosci. 2011;29(6):395-409. Review.
Emara TH, Moustafa RR, Elnahas NM, Elganzoury AM, Abdo TA, Mohamed SA, Eletribi MA. Repetitive transcranial magnetic stimulation at 1Hz and 5Hz produces sustained improvement in motor function and disability after ischaemic stroke. Eur J Neurol. 2010 Sep;17(9):1203-9.
Málly J, Dinya E. Recovery of motor disability and spasticity in post-stroke after repetitive transcranial magnetic stimulation (rTMS). Brain Res Bull. 2008 Jul 1;76(4):388-95.
Summers JJ, Kagerer FA, Garry MI, Hiraga CY, Loftus A, Cauraugh JH. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study. J Neurol Sci. 2007 Jan 15;252(1):76-82.

*At this time, TMS is not FDA-approved for the treatment of post-stroke recovery, which would be considered an off-label application.