Cognitive and neurophysiological effects of non-invasive brain stimulation in stroke patients after motor rehabilitation

Federico D’Agata, Elena Peila, Alessandro Cicerale, Marcella M. Caglio, Paola Caroppo, Sergio Vighetti, Alessandro Piedimonte, Alice Minuto, Marcello Campagnoli, Adriana Salatino, Maria T. Molo, Paolo Mortara, Lorenzo Pinessi, Giuseppe Massazza

Research output: Contribution to journalArticlepeer-review


The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results.

Original languageEnglish
Article number135
JournalFrontiers in Behavioral Neuroscience
Issue numberJun
Publication statusPublished - Jun 24 2016


  • Mirror-box therapy
  • Non-invasive brain stimulation
  • Stroke rehabilitation
  • Transcranial direct current stimulation
  • Transcranial magnetic stimulation

ASJC Scopus subject areas

  • Behavioral Neuroscience
  • Cognitive Neuroscience
  • Neuropsychology and Physiological Psychology


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