Abstract
There has been considerable interest in trialing NBS in a range of neurological conditions, and in parallel the range of NBS techniques available continues to expand. Underpinning this is the idea that NBS modulates neuroplasticity and that plasticity is an important contributor to functional recovery after brain injury and to the pathophysiology of neurological disorders. However while the evidence for neuroplasticity and its varied mechanisms is strong, the relationship to functional outcome is less clear and the clinical indications remain to be determined. To be maximally effective, the application of NBS techniques will need to be refined to take into account the diversity of neurological symptoms, the fundamental differences between acute, longstanding and chronic progressive disease processes, and the differential part played by functional and dysfunctional plasticity in diseases of the brain and spinal cord.
Highlights
While there are a number of noninvasive brain stimulation (NBS) techniques that can alter indices of brain excitability, a lasting functional benefit from these interventions in clinical populations remains elusive
Driven by psychiatric applications, and modeled on the effectiveness of electro-convulsive therapy (ECT), there is increasing interest in how neuromodulation by noninvasive brain stimulation (NBS) might be extended to neurological disorders. Underpinning this is the idea that NBS modulates neuroplasticity and that plasticity is important in the pathophysiology of neurological disorders and plays an important role in functional recovery and adaptation to neurological deficits
Plasticity in neurology To be effective, NBS interventions must take into account the range of neurological disorders, their heterogeneity even within well-defined and characterized conditions, and the diverse time courses over which they act, from acute self-limiting injuries such as stroke, through chronic progressive disorders such as Parkinson's disease, to more established and persistent conditions such as dystonia
Summary
While there are a number of noninvasive brain stimulation (NBS) techniques that can alter indices of brain excitability, a lasting functional benefit from these interventions in clinical populations remains elusive. Plasticity in neurology To be effective, NBS interventions must take into account the range of neurological disorders, their heterogeneity even within well-defined and characterized conditions, and the diverse time courses over which they act, from acute self-limiting injuries such as stroke, through chronic progressive disorders such as Parkinson's disease, to more established and persistent conditions such as dystonia Stroke This model may present the most promise for the application of NBS if the intervention can facilitate a longer-lasting recovery in the absence of further brain damage. Experimental models suggest that these frequency-dependent stimulation protocols are probably up- or down-regulating the activity of excitatory glutamatergic synapses, and it follows that these interventions are most suited to clinical situations such as Parkinson's disease in which thalamocortical activation is impaired and modulation of excitatory synaptic transmission is indicated. Other newer NBS approaches continue to be developed and increase the range of potential applications in neurology [48]
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