Non-Invasive Brain Stimulation Technology for Stroke Patients: tDCS, rTMS, PBM = 뇌졸중 환자의 기능회복을 위한 비침습적 뇌 자극술: 경두개 직류 자극, 반복 경두개 자기 자극, 광생체조절

국문 초록 (Abstract)

서론 : 최근 뇌기능 조절을 위한 다양한 뇌 기능조절 기술들이 선보이고 있는 가운데, 뇌졸중 환자를 위한 비침습적 뇌 자극 방법들의 기전 및 임상적 효과 그리고 사용 시 고려사항에 대한 다양한 논문이 최근 다수 출판되었다. 특히, 비침습적 뇌 자극 방법 중 임상에서 사용되기 시작한 경두개 직류 자극, 반복적경두개 자기 자극, 광생체조절을 중심으로 최근 출판된 논문을 리뷰하였다. 본론 : 경두개 직류 자극, 반복적 경두개 자기 자극과 광생체조절은 미세 전류와 자기장 또는 근적외선을 이용하여 뇌 활성도를 조절(대뇌피질의 흥분도를 억제 또는 증가)하는 방법으로 뇌졸중 환자의 뇌 기능 향상에 긍정적인 영향을 미치며 이는 운동기능 및 인지기능 향상에 도움을 줄 수 있다고 보고되었다. 그럼에도 불구하고 이러한 비침습적 뇌 자극 방법에 대한 정확한 기전은 여전히 불명확하며 또한 임상 적용과 관련하여 중재 기간, 강도, 적용 영역 등 명확한 가이드라인이 부재한 실정이다. 결론 : 향후, 뇌졸중 재활을 위한 명확한 기전과 효율적인 임상 적용을 위한 다양한 동물 실험 및 추가적인 임상 연구를 통해 보다 명확한 근거와 구체적인 임상 가이드라인이 연구될 것이라 기대된다.

다국어 초록 (Multilingual Abstract)

Introduction : The purpose of this study was to review the mechanisms, clinical effects, and considerations for the use of non-invasive brain stimulation methods for stroke patients. This study reviewed recently published papers focusing on tDCS, rTMS, and PBM, which are mainly used in clinical practice among non-invasive brain stimulation methods. Discussion : tDCS, rTMS, and PBM control brain activity (inhibit or increase cortical excitability) by stimulating the brain using micro-currents (1~2mA), magnetic field change, and near infrared radiation. As a result, it has a positive effect on the improvement of brain function in stroke patients, and was found to be effective in improving motor and cognitive functions. Nevertheless, the exact mechanism of this non-invasive brain stimulation method is still unclear, and clear guidelines such as the intervention period, intensity, and application area in relation to clinical application have not yet been fully developed. Conclusion : In the future, it is expected that clearer evidence and specific clinical guidelines will be studied through various animal experiments and additional clinical studies for a clear mechanism for stroke rehabilitation and efficient clinical application.

목차 (Table of Contents)

• Ⅰ. Introduction Ⅱ. Discussion Ⅲ. Conclusion

참고문헌 (Reference)

1 김덕용, "만성 뇌졸중 후 편마비 환자에서 2주간 경두개 전기 자극 후 상지 운동기능 향상" 대한재활의학회 33 (33): 5-11, 2009

2 원경아, "뇌졸중 환자의 상지기능에 대한 경두개 직류자극술 효과 : 체계적 고찰 및 메타분석" 대한신경계작업치료학회 9 (9): 7-23, 2020

3 Koch, G, "θ-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect" 78 (78): 24-30, 2012

4 Williams, J. A, "Updates on the use of non-invasive brain stimulation in physical and rehabilitation medicine" 41 (41): 305-311, 2009

5 Hoyer, E. H, "Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation" 29 (29): 395-409, 2011

6 Dionisio, A, "Transcranial magnetic stimulation as an intervention tool to recover from language, swallowing and attentional deficits after stroke: A systematic review" 46 (46): 176-183, 2018

7 Huisa, B. N, "Transcranial laser therapy for acute ischemic stroke : A pooled analysis of NEST-1 and NEST-2" 8 (8): 315-320, 2013

8 Marchina, S, "Transcranial direct current stimulation for post-stroke dysphagia : A systematic review and meta-analysis of randomized controlled trials" 268 (268): 293-304, 2021

9 Khedr, E. M, "Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction" 81 (81): 495-499, 2010

10 Hara, T, "The effect of non-invasive brain stimulation(NIBS)on attention and memory function in stroke rehabilitation patients : A systematic review and metaanalysis" 11 (11): 1-17, 2021

11 Park, J. W, "The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia : A randomized controlled study" 25 (25): 324-, 2013

12 지상구, "The Effects of Repetitive Transcranial Magnetic Stimulation on the Gait of Acute Stroke Patients" 한국자기학회 20 (20): 129-132, 2015

13 Nitsche, M. A, "Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans" 57 (57): 1899-1901, 2001

14 Lee, D. Y, "Short-term effect of kinesio taping of lower-leg proprioceptive neuromuscular facilitation pattern on gait parameter and dynamic balance in chronic stroke with foot drop" 9 (9): 1-9, 2021

15 Rossi, S, "Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research" 120 (120): 2008-2039, 2009

16 Nikolin, S, "Safety of repeated sessions of transcranial direct current stimulation : A systematic review" 11 (11): 278-288, 2018

17 Kim, Y. H, "Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke" 37 (37): 1471-1476, 2006

18 Lim, J. Y, "Repetitive transcranial magnetic stimulation to hemispatial neglect in patients after stroke : An open-label pilot study" 42 (42): 447-452, 2010

19 Corti, M, "Repetitive transcranial magnetic stimulation of motor cortex after stroke : A focused review" 91 (91): 254-270, 2012

20 Tung, Y. C, "Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke : A systematic review and meta-analysis of randomized controlled trials" 33 (33): 1102-1112, 2019

21 Takeuchi, N, "Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke" 36 (36): 2681-2686, 2005

22 Du, J, "Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia : A randomized, double-blind clinical trial" 127 (127): 1907-1913, 2016

23 Emara, T. H, "Repetitive transcranial magnetic stimulation at 1Hz and 5Hz produces sustained improvement in motor function and disability after ischaemic stroke" 17 (17): 1203-1209, 2010

24 Priori, A, "Polarization of the human motor cortex through the scalp" 9 (9): 2257-2260, 1998

25 Barker, A. T, "Non-invasive magnetic stimulation of human motor cortex" 325 (325): 1106-1107, 1985

26 Hummel, F. C, "Non-invasive brain stimulation: A new strategy to improve neurorehabilitation after stroke?" 5 (5): 708-712, 2006

27 Cheng, I. K. Y, "Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia : A randomized controlled study" 49 (49): 475-481, 2017

28 Zivin, J. A, "NeuroThera®Efficacy and Safety Trial-3(NEST-3) : A double-blind, randomized, sham-controlled, parallel group, multicenter, pivotal study to assess the safety and efficacy of transcranial laser therapy with the NeuroThera® Laser System for the treatment of acute ischemic stroke within 24 h of stroke onset" 9 (9): 950-955, 2014

29 Trompetto, C, "Motor recovery following stroke : A transcranial magnetic stimulation study" 111 (111): 1860-1867, 2000

30 Song, W, "Low-frequency transcranial magnetic stimulation for visual spatial neglect : A pilot study" 41 (41): 162-165, 2009

31 Antal, A, "Low intensity transcranial electric stimulation : Safety, ethical, legal regulatory and application guidelines" 128 (128): 1774-1809, 2017

32 Chang, W. H, "Long-term effects of rTMS on motor recovery in patients after subacute stroke" 42 (42): 758-764, 2010

33 Ridding, M. C, "Is there a future for therapeutic use of transcranial magnetic stimulation?" 7 : 559-567, 2007

34 Maeda, F, "Interindividual variability of the modulatory effects of repetitive transcranial magnetic stimulation on cortical excitability" 133 (133): 425-430, 2000

35 Lampl, Y, "Infrared laser therapy for ischemic stroke : A new treatment strategy : Results of the NeuroThera Effectiveness and Safety Trial-1(NEST-1)" 38 (38): 1843-1849, 2007

36 Lefebvre, S, "Increased functional connectivity one week after motor learning and tDCS in stroke patients" 340 (340): 424-435, 2017

37 Sasaki, N, "High-frequency rTMS on leg motor area in the early phase of stroke" 117 (117): 189-194, 2017

38 Winstein, C. J, "Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American heart association/American stroke association" 47 (47): e98-e169, 2016

39 Lennon, S, "Gait outcome following outpatient physiotherapy based on the bobath concept in people post stroke" 28 (28): 873-881, 2006

40 Lefaucheur, J. P, "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation(rTMS) : An update(2014-2018)" 131 (131): 474-528, 2020

41 Chang, M. C, "Enhancement of cortical excitability and lower limb motor function in patients with stroke by transcranial direct current stimulation" 8 (8): 561-566, 2015

42 Hummel, F, "Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke" 128 (128): 490-499, 2005

43 Yan, R. B, "Effect of transcranial direct-current stimulation on cognitive function in stroke patients : A systematic review and meta-analysis" 15 (15): 1-14, 2020

44 Kim, D. Y, "Effect of transcranial direct current stimulation on motor recovery in patients with subacute stroke" 89 (89): 879-886, 2010

45 Klomjai, W, "Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients : A randomized shamcontrolled crossover study" 61 (61): 286-291, 2018

46 Bai, X, "Different therapeutic effects of transcranial direct current stimulation on upper and lower limb recovery of stroke patients with motor dysfunction : A meta-analysis" 2019 : 1-13, 2019

47 Reis, J, "Contribution of transcranial magnetic stimulation to the understanding of cortical mechanisms involved in motor control" 586 (586): 325-351, 2008

48 Dos Anjos, S. M, "Constraint-induced movement therapy for improving motor function of the paretic lower extremity after stroke" 99 (99): 75-78, 2020

49 Rektorova, I, "Cognitive functioning after repetitive transcranial magnetic stimulation in patients with cerebrovascular disease without dementia : A pilot study of seven patients" 229 : 157-161, 2005

50 Lewis, P. M, "Brain neuromodulation techniques : A review" 22 (22): 406-421, 2016

51 Roque, C, "Astrocytes contribute to the neuronal recovery promoted by high‐frequency repetitive magnetic stimulation in in vitro models of ischemia" 99 (99): 1414-1432, 2021

52 Fregni, F, "Asham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients" 37 (37): 2115-2122, 2006

53 Brunoni, A. R, "A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation" 14 (14): 1133-1145, 2011