Bibliometric Analysis of Non-Invasive Brain Stimulation Therapy for Post-Stroke Unilateral Neglect.

Unilateral neglect (UN) is a common debilitating consequence of stroke. This review focused on the effect of noninvasive brain stimulation (NIBS) techniques in the recovery of UN in poststroke patients. Relevant databases were comprehensively searched, including Cochrane Central Register of Controlled Trials, Medline, Embase, the Web of Knowledge, and relevant websites. All randomized controlled trials were identified which used NIBS for poststroke UN. The methodological quality and risk of bias were systematically evaluated. Twelve studies were included, and 11 randomized controlled trials were made further meta-analysis. Participants who were randomized to active transcranial direct current stimulation (effect size [ES], -0.51; 95% confidence interval [CI], -1.02 to -0.01; P = 0.04) and repetitive transcranial magnetic stimulation (ES, -1.76; 95% CI, -2.40 to -1.12; P < 0.00001) decreased UN severity after intervention compared with the control group. Nonsignificant pooled effect size presented for continuous theta burst stimulation results (ES, -0.77; 95% CI, -1.90 to 0.37; P = 0.18). No participants experienced serious adverse events. This review found evidence for the efficacy of repetitive transcranial magnetic stimulation in the remediation of poststroke UN, but the efficacy of transcranial direct current stimulation and continuous theta burst stimulation was uncertain. Large-sample randomized controlled clinical trials are needed to understand effects of NIBS on poststroke UN.

The brain has the innate ability to undergo neuronal plasticity, which refers to changes in its structure and functions in response to continued changes in the environment. Although these concepts are well established in animal slice preparation models, their application to a large number of human subjects could only be achieved using noninvasive brain stimulation (NIBS) techniques. In this review, we discuss the mechanisms of plasticity induction using NIBS techniques including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), random noise stimulation (RNS), transcranial ultrasound stimulation (TUS), vagus nerve stimulation (VNS), and galvanic vestibular stimulation (GVS). We briefly introduce these techniques, explain the stimulation parameters and potential clinical implications. Although their mechanisms are different, all these NIBS techniques can be used to induce plasticity at the systems level, to examine the neurophysiology of brain circuits and have potential therapeutic use in psychiatric and neurological disorders. TMS is the most established technique for the treatment of brain disorders, and repetitive TMS is an approved treatment for medication-resistant depression. Although the data on the clinical utility of the other modes of stimulation are more limited, the electrical stimulation techniques (tDCS, tACS, RNS, VNS, GVS) have the advantage of lower cost, portability, applicability at home, and can readily be combined with training or rehabilitation. Further research is needed to expand the clinical utility of NIBS and test the combination of different modes of NIBS to optimize neuromodulation induced clinical benefits.

International Conference on Transcranial Magnetic and Direct Current Stimulation

P113 Modulation of food and body weight implicit attitudes with non-invasive brain stimulation techniques

Non-invasive brain stimulation (NIBS), including transcranial magnetic and electrical stimulations, has recently been used to modulate sleep and treat sleep disorders. Herein, we reviewed studies that used NIBS to modulate sleep in healthy populations or patients with sleep disorders. Repetitive transcranial magnetic stimulation enhanced sleep slow oscillations and consistently improved subjective symptoms in patients with insomnia and restless legs syndrome. Transcranial electrical stimulation also increased slow-wave sleep in healthy populations and improved subjective sleep symptoms in patients with insomnia. Individualized NIBS and other NIBS techniques may be promising for treating sleep disorders, and future studies are warranted to determine optimal stimulation parameters and evaluate their long-term safety.

Chapter 56 - Transcranial stimulation and cognition

Since the introduction of transcranial magnetic stimulation (TMS) almost four decades ago, non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to study brain-behaviour relationships in healthy and impaired states with unprecedented precision. Various NIBS techniques, including TMS, transcranial direct current stimulation (tDCS), and emerging methods such as transcranial alternating current stimulation (tACS) and transcranial random noise stimulation (tRNS) are employed in both research and clinical settings. TMS has gained regulatory approval for treating conditions like major depressive disorder and migraine, while tDCS is showing efficacy in enhancing cognitive functions in various populations. This collection of articles examines key studies, including the modulation of cognitive-motor functions, optimization of light stimulation for Alzheimer’s therapy, and effects on risk-taking behaviour in violent offenders. Notably, the findings suggest that NIBS can effectively influence executive functions and decision-making processes. They highlight the integration of NIBS with neuroimaging techniques, the importance of personalized targeting, and the potential for combined therapeutic approaches. Future directions include addressing methodological challenges and leveraging artificial intelligence to refine treatment protocols. Collectively, these advancements position NIBS as a transformative tool in both neuroscience research and clinical practice, offering new avenues for understanding and treating complex neuropsychiatric conditions.

Major depressive disorder (MDD) and cardiovascular diseases are intimately associated. Depression is an independent risk factor for mortality in cardiovascular samples. Neuroendocrine dysfunctions in MDD are related to an overactive hypothalamus-pituitary-adrenal (HPA) axis and increased sympathetic activity. Novel intervention strategies for MDD include the non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). In fact, although these techniques have being increasingly used as a treatment for MDD, their cardiovascular effects were not sufficiently investigated, which would be important considering the dyad MDD/cardiovascular disorders. We investigated this issue through a systematic review for published articles from the first date available to May 2012 in MEDLINE and other databases, looking for main risk factors and surrogate markers for cardiovascular disease such as: cortisol, heart rate variability (HRV), alcohol, smoking, obesity, hypertension, glucose. We identified 37 articles (981 subjects) according to our eligibility criteria. Our main findings were that NIBS techniques might be effective strategies for down-regulating HPA activity and regulating food, alcohol, and cigarette consumption. NIBS’s effects on HRV and blood pressure presented mixed findings, with studies suggesting that HRV values can decrease or remain unchanged after NIBS, while one study found that rTMS increased blood pressure levels. Also, a single study showed that glucose levels decrease after tDCS. However, most studies tested the acute effects after one single session of rTMS/tDCS; therefore further studies are necessary to investigate whether NIBS modifies cardiovascular risk factors in the long-term. In fact, considering the burden of cardiac disease, further trials in cardiovascular, depressed, and non-depressed samples using NIBS should be performed.

Several noninvasive brain stimulation techniques have gained significant attention in neurocognitive science and clinical research due to their potential efficacy in addressing neurological, psychiatric, and cognitive impairments. This study explores global trends and research hotspots in brain stimulation research for cognitive impairment and related disorders. Using a data set from 1989 to 2024 sourced from the Web of Science Core Collection, 4156 records were analyzed through bibliometric methods, including publication trends, country or region, and institutional analysis, and document co-citation analysis (DCA). Results revealed a steady increase in research, with a significant increase in publications during the period from 2019 to 2023. The USA led in citation counts (1117), centrality (0.37), while China topped the burst value (72.31). The University of London led in citation counts (235), whereas Capital Medical University topped the sigma value (1.77). Transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS) dominated the top positions in DCA analysis. Emerging trends were identified through burst keywords, including "transcranial Doppler," "subthalamic nucleus stimulation," "cerebral blood flow," "vascular dementia," and "cardiopulmonary bypass." These emerging research hotspots underscore the growing focus on vascular aspects of cognitive impairment and advanced brain stimulation methods. Additionally, newer noninvasive techniques like fast gamma magnetic stimulation, paired-associative stimulation with TMS (PAS-TMS), and theta-burst stimulation are identified as promising avenues for future research, offering significant potential for therapeutic advancements. This study provides a comprehensive overview of the global landscape, trends, and future directions in brain stimulation research for cognitive impairment.

Working memory improvement with non-invasive brain stimulation of the dorsolateral prefrontal cortex: A systematic review and meta-analysis

Introduction: Cognitive impairments occur frequently in stoke survivors, yet current conventional post-stroke care focuses mainly on motor function. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are noninvasive brain stimulation techniques (NIBS) that are used in neurological rehabilitation. Its efficacy is well-established in motor recovery post-stroke, but research on its effects on the associated cognitive decline after stroke is fairly new. The aim of this review is to evaluate recent studies and provide a summary on the effects of NIBS on post-stroke cognitive decline.&#13;\n&#13;\nMethods: PubMed and CINAHL were searched using the keywords: “cerebrovascular accident”, “stroke”, “NIBS” or “noninvasive brain stimulation”, “tDCS” or “transcranial direct current stimulation”, and “TMS” or “transcranial magnetic stimulation”. PEDro system was used to assess the quality of the studies that passed the inclusion and exclusion criteria.&#13;\n&#13;\nResults: The initial search returned 1081 citations, among which 12 were included in this review. The mean PEDro score of the studies was 7.5 out of 10. The trials had a total of 176 participants with stroke. Lesion site was heterogeneous. Six trials investigated tDCS, and the other 6 investigated rTMS. The main outcome measures were grouped into 3 domains: memory, visuospatial, and attention. Both tDCS and rTMS resulted in significant changes in the visuospatial domain in terms of improving spatial neglect. The results on memory and attention are mixed, but tDCS shows more consistent results.&#13;\n&#13;\nConclusion: NIBS is a safe and low-cost treatment that can improve cognitive decline post-stroke. However, the evidence is still lacking due to the small number of trials and sample sizes. More studies need to be conducted in order to establish a proper guideline for usage. Long term effects also need to be investigated.

In a recent review article by Levasseur-Moreau et al. (2013), the authors discussed the effects of non-invasive brain stimulation (NIBS) on cognitive functions and proposed a potential application of NIBS in security or military personnel. We believe that this research endeavor is questionable since it might disclose several scientific as well as ethical concerns. In the following, we highlight our reservations about the potential use of NIBS in army and/or security services. Over the past decades, non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic (TMS) or transcranial direct current stimulation (tDCS) have been extensively used to investigate brain function and brain plasticity in the living human brain. Early studies provided evidence that NIBS is capable of evoking short-lasting modulatory effects on brain functions. Based on this finding, subsequent proof-of-principle studies quickly progressed to also affect motor and cognitive functions. Originally, NIBS techniques were primarily used in basic research to unravel physiological brain processes and/or to establish brain-behavior relationships. The underlying motivation for many researchers is to extend the boundaries of knowledge and to translate findings of basic research into clinical science, that is, to develop new adjuvant therapeutic tools. In fact, NIBS might be a promising tool for the treatment of neurological and psychiatric diseases (Floel, 2013). For example, Hummel and colleagues showed a beneficial effect of a short period of tDCS in chronic stroke patients on paretic hand function (Hummel et al., 2005). Based on this finding, the authors and other subsequent studies (Lindenberg et al., 2010) suggested that such interventional strategies in combination with customary rehabilitative treatments may play an adjuvant role in neurorehabilitation. Nevertheless, clinical trials on larger patient samples are still needed to confirm the promising results that have been achieved so far by smaller clinical studies. Apart from a translation to the clinical settings, it has been suggested to use these techniques for “neuroenhancement” in cognitive abilities or sports, fueling a vivid discussion concerning ethical issues of the use of NIBS in healthy human subjects (Hamilton et al., 2011; Brukamp and Gross, 2012; Cohen Kadosh et al., 2012; Banissy and Muggleton, 2013). However, to our mind, the use of these techniques in military or security personnel goes even a step further and accentuates concerns as compared to the use in “civilians.” First, the use of NIBS in military or security services is problematic with respect to the autonomy of individuals receiving NIBS: In the military context, the risk of coercion is much more pronounced and autonomous decisions cannot always be warranted (Tennison and Moreno, 2012). Second, safety issues might be aggravated in this context and might not only apply to the person receiving NIBS but also to third persons. Both safety and autonomy represent principles that may help to identify ethical problems and guide related decisions (Beauchamp and Childress, 1994; Walker, 2009; Brukamp and Gross, 2012).

Transcranial static magnetic field stimulation (tSMS) can induce functional recovery in patients with subacute stroke

Introduction: Stroke is a leading cause of adult-onset disability. Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous vagus nerve stimulation (tVNS) are promising adjuncts to upper limb rehabilitation. The use of functional neuroimaging through task functional MRI (fMRI) or functional near-infrared spectroscopy (fNIRS) allows the visualisation of cortical activation patterns associated with stroke-related impairment and recovery. The present study comprehensively reviews the evidence base for the effects of NIBS on clinical and functional neuroimaging outcomes after stroke. Methods: Systematic searches were carried out in MEDLINE and EMBASE via Ovid. Inclusion criteria were clinical trials of adults with stroke and arm weakness undergoing NIBS, with clinical measures of arm function and neuroimaging outcome measures that included either task fMRI or task fNIRS. Two authors independently carried out study screening, risk of bias assessments, and data collection for clinical and neuroimaging outcomes pre- and post-intervention. Results: A total of 17 studies (12 rTMS, 5 tDCS), including 495 participants, met the inclusion criteria. Fifteen studies used task fMRI and four used task fNIRS. Improvements in arm-related motor activity were observed following both rTMS and tDCS. Most studies reported increased activation in ipsilesional sensorimotor areas alongside reductions in contralesional activation. Discussion: rTMS and tDCS may improve upper limb recovery in people with stroke. The increase in the laterality index towards activation of the ipsilesional hemisphere suggests that these NIBS techniques may facilitate neural reorganisation and restoration of motor networks in the affected hemisphere.

Background and Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting the upper and lower motor neurons, with a bleak prognosis and few treatment options. Non-invasive brain stimulation (NIBS) techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), represent emerging approaches aimed at modulating cortical hyperexcitability, a relevant pathogenetic mechanism in ALS. Materials and Methods: A systematic review of the literature was conducted following the PRISMA guidelines, exploring the Scopus and PubMed databases from April to June 2025 with terms related to ALS and NIBS. A total of 18 relevant studies were selected from the initial 708 articles, analysing stimulation protocols, clinical and neurophysiological outcomes, and associated biomarkers; their validity was assessed using the revised Cochrane risk-of-bias (RoB2) tool. Results: The selected studies were extremely heterogeneous, with NIBS techniques, including magnetic (rTMS, cTBS, tSMS) and electrical (tDCS) stimulation, showing variable effects. Low-frequency protocols (1 Hz rTMS) and cTBS showed a slight slowing of clinical progression, while prolonged home stimulation with tDCS and tSMS showed more significant improvements in terms of efficacy, tolerability, and adherence. The main limitations concern the heterogeneity of patients and protocols and the lack of standardised biomarkers, which is why the analysis remained at a descriptive level. The use of telemonitoring and caregiver training are essential to ensure safety and accessibility. Conclusions: NIBS represents a promising therapeutic approach for ALS, but further multicentre, standardised studies with prolonged follow-up are needed. Future strategies should include customisation of stimulation, combination with other therapies, and extension of application to pre-symptomatic phases.