Brain Stimul
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Randomized clinical trials (RCT) demonstrated that auricular acupuncture (AA) is effective in treatment of acute and chronic pain, although the mechanisms behind AA are not elucidated. ⋯ Considering the clinical data relating to the anatomy of neural pathways and experimental findings of the mechanisms of transcutaneous auricular vagal nerve stimulation, the analgesic effects of AA may be explained by stimulation of ABVN.
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Transcranial magnetic stimulation (TMS) is commonly used to measure the effects of stroke on corticomotor excitability, intracortical function, and interhemispheric interactions. The interhemispheric inhibition model posits that recovery of motor function after stroke is linked to rebalancing of asymmetric interhemispheric inhibition and corticomotor excitability. This model forms the rationale for using neuromodulation techniques to suppress unaffected motor cortex excitability, and facilitate affected motor cortex excitability. However, the evidence base for using neuromodulation techniques to promote post-stroke motor recovery is inconclusive. ⋯ The neurophysiological effects of stroke are primarily localised to the affected hemisphere, and there is no clear evidence for hyper-excitability of the unaffected hemisphere or imbalanced interhemispheric inhibition. This indicates that facilitating affected M1 excitability directly may be more beneficial than suppressing unaffected M1 excitability for promoting post-stroke recovery.
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Review Meta Analysis
Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis.
Non-invasive brain stimulation (NIBS) facilitates motor improvements post stroke. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are representative NIBS techniques frequently used in stroke motor rehabilitation. Our primary question is: Do these two techniques improve force production capability in paretic limbs? ⋯ Cumulative meta-analytic results revealed that tDCS and rTMS rehabilitation protocols successfully improved paretic limb force production capabilities.
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Review Meta Analysis
Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis.
Chronic pain is characterised by maladaptive neuroplasticity in many systems, including the motor system. There is evidence that patients with chronic pain demonstrate altered corticospinal and intracortical excitability; however, findings are inconsistent and existing literature in this area has not been systematically reviewed. ⋯ There is evidence of motor cortex disinhibition in chronic pain populations, suggestive of a disruption in GABA-mediated intracortical inhibition. Disinhibition was more pronounced in populations with neuropathic pain. These findings provide new insights into the relationship between chronic pain and motor cortex excitability, which may have meaningful implications for the future treatment of chronic pain conditions.