TY - JOUR
T1 - Spasticity Management: The Current State of Transcranial Neuromodulation
AU - Leo, Antonino
AU - Naro, Antonino
AU - Molonia, Francesco
AU - Tomasello, Provvidenza
AU - Saccá, Ileana
AU - Bramanti, Alessia
AU - Russo, Margherita
AU - Bramanti, Placido
AU - Quartarone, Angelo
AU - Calabrò, Rocco Salvatore
N1 - Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - This narrative review aims to provide an objective view of the noninvasive neuromodulation (NINM) protocols available for treating spasticity, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). On the basis of the relevant randomized controlled trials, we infer that NINM is more effective in reducing spasticity when combined with the conventional therapies than used as a stand-alone treatment. However, the magnitude of NINM after-effects depends significantly on the applied hemisphere and the underlying pathology. Being in line with these arguments, low-frequency rTMS and cathodal-tDCS over the unaffected hemisphere are more effective in reducing spasticity than high-frequency rTMS and anodal-tDCS over the affected hemisphere in chronic poststroke. However, most of the studies are heterogeneous in the stimulation setup, patient selection, follow-up duration, and the availability of the sham operation. Therefore, the available data on the usefulness of NINM in reducing spasticity need to be confirmed by larger and multicentric randomized controlled trials to gather evidence on the efficiency of NINM regimens in reducing spasticity in various neurologic conditions.LEVEL OF EVIDENCE: V.
AB - This narrative review aims to provide an objective view of the noninvasive neuromodulation (NINM) protocols available for treating spasticity, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). On the basis of the relevant randomized controlled trials, we infer that NINM is more effective in reducing spasticity when combined with the conventional therapies than used as a stand-alone treatment. However, the magnitude of NINM after-effects depends significantly on the applied hemisphere and the underlying pathology. Being in line with these arguments, low-frequency rTMS and cathodal-tDCS over the unaffected hemisphere are more effective in reducing spasticity than high-frequency rTMS and anodal-tDCS over the affected hemisphere in chronic poststroke. However, most of the studies are heterogeneous in the stimulation setup, patient selection, follow-up duration, and the availability of the sham operation. Therefore, the available data on the usefulness of NINM in reducing spasticity need to be confirmed by larger and multicentric randomized controlled trials to gather evidence on the efficiency of NINM regimens in reducing spasticity in various neurologic conditions.LEVEL OF EVIDENCE: V.
KW - Journal Article
KW - Review
U2 - 10.1016/j.pmrj.2017.03.014
DO - 10.1016/j.pmrj.2017.03.014
M3 - Review article
C2 - 28433830
VL - 9
SP - 1020
EP - 1029
JO - PM and R
JF - PM and R
SN - 1934-1482
IS - 10
ER -