Original ResearchEfficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation
Section snippets
Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) is a technique that uses a magnetic field, inducing an electrical current in the underlying brain tissue,6 which interacts with ongoing activity in the neural tissue. Trains of repetitive stimuli (rTMS), present the opportunity to interact even more effectively with cortical activity.7, 8, 9
Interference with cognitive processing when TMS is applied during performance of a task is called online TMS.10 In contrast, in the case of offline stimulation, TMS is
Online studies
Online TMS applied over cortical areas involved in verbal processing (perisylvian cortex of the dominant, usually left hemisphere) has been reported to facilitate picture naming and other language-related tasks in healthy subjects,22, 23, 24, 25, 26, 27, 28, 29 as well as in epileptic patients.15 Similar facilitatory effects of online rTMS were observed with picture naming after stimulation of prefrontal cortices (PFCs) in healthy volunteers15 and in patients with Alzheimer's disease (AD).30
Online studies
Enhancement of visual attention functions has been found in healthy subjects after stimulation of the parietal cortex.14, 56, 57 RTMS can be seen in this area as a interventional tool in sensory extinction58, 59 or unilateral neglect60, 61, 62 patients. Unilateral neglect can be defined as a defective ability to orient, detect, and report novel stimuli presented in the hemispace contralateral to the brain lesion, in which cannot be attributed to sensory-motor impairment functions (ie,
Transcranial direct current stimulation
At the end of the last century, another stimulation technique received renewed attention from the scientific community,72, 73 although knowledge of its existence and documentation of its clinical applications date back, at least, at the beginning of the 19th century.74 This method relies on application of direct currents (DC) and is known as transcranial DC stimulation (tDCS).73, 75, 76 Electrical currents are applied constantly at low intensities (1-2 mA) over a long period, usually in minutes
General discussion
The effects induced by rTMS or tDCS stimulation on cortical function are complex. The observed behavioral modifications reflect changes in cortical activity, which are dependent on a number of variables, such as the frequency of stimulation, its polarity, duration, intensity, and the site of stimulation. Moreover, we should bear in mind that the brain does not react passively to cortical stimulation, but that the response depends on its state of activation. It has been shown that offline rTMS
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