Efeitos Cognitivos da estimulação magnética transcraniana sobre o córtex motor primário de pacientes pós acidente vascular cerebral: Revisão sistemática e metanálise
- 19 de jun. de 2025
- 11 min de leitura
Atualizado: 21 de jun. de 2025
Fernanda Vieira MoraesUniversidade Federal de Goiás https://orcid.org/0009-0004-5949-7290
Sandra de Fátima Barboza FerreiraUniversidade Federal de Goiás https://orcid.org/0000-0002-3035-5131
Marco Túlio Antônio Garcia- ZapataUniversidade Federal de Goiás https://orcid.org/0000-0002-6754-7161
Denise Sisterolli DinizUniversidade Federal de Goiás
DOI:
Palavras-chave:
cognição, Disfunção Cognitiva, Reabilitação
Resumo
Introdução: O objetivo desse estudo é fazer uma revisão sistemática do efeito da Estimulação Magnética Transcrania repetitiva (EMTr) na cognição de pacientes pós Acidente Vascular Cerebral (AVC) estimulados no córtex motor primário (M1), muito utilizado para recuperação motora e pouco investigado acerca do desfecho cognitivo. Método: Dois revisores independentes selecionaram e avaliaram a qualidade dos estudos; dez estudos foram selecionados para leitura, porém apenas três artigos e uma tese estavam adequados aos critérios de inclusão. Resultados: Todos os estudos objetivaram verificar melhora motora pós AVC e avaliaram a repercussão na cognição através de testes, entre eles o Miniexame do Estado Mental. Dois deles verificaram relação da melhora motora com repercussão positiva na cognição, sugerindo a inibição em M1 como uma forma de restabelecer o equilíbrio hemisférico ou influenciar a conexão de outras áreas distantes do cérebro e os outros dois não verificaram efeito significativo na cognição, mas também não observaram interferência negativa. Conclusão: Há indícios que a estimulação em M1 altera positivamente a cognição de pacientes após AVC. Este resultado fortalece a visão sistêmica das interconexões cerebrais e do córtex motor primário ser um ponto de acesso para estimular e impactar funções de natureza complexa.
Referências
A?k?n, A., Tosun, A., & Demirdal, Ü. S. (2017). Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial. Somatosensory and Motor Research, 34(2), 102–107. https://doi.org/10.1080/08990220.2017.1316254
Bhattacharjee, S., Kashyap, R., Abualait, T., Annabel Chen, S. H., Yoo, W. K., & Bashir, S. (2021). The Role of Primary Motor Cortex: More Than Movement Execution. Em Journal of Motor Behavior (Vol. 53, Número 2, p. 258–274). Routledge. https://doi.org/10.1080/00222895.2020.1738992
Bonnard, M., Camus, M., de Graaf, J., & Pailhous, J. (2003). Direct evidence for a binding between cognitive and motor functions in humans: a TMS study. Journal of cognitive neuroscience, 15(8), 1207–1216. https://doi.org/10.1162/089892903322598157
Cramer, S. C., Wolf, S. L., Adams, H. P., Chen, D., Dromerick, A. W., Dunning, K., Ellerbe, C., Grande, A., Janis, S., Lansberg, M. G., Lazar, R. M., Palesch, Y. Y., Richards, L., Roth, E., Savitz, S. I., Wechsler, L. R., Wintermark, M., & Broderick, J. P. (2017). Stroke Recovery and Rehabilitation Research: Issues, Opportunities, and the National Institutes of Health StrokeNet. Stroke, 48(3), 813–819. https://doi.org/10.1161/STROKEAHA.116.015501
D’Agata, F., Peila, E., Cicerale, A., Caglio, M. M., Caroppo, P., Vighetti, S., Piedimonte, A., Minuto, A., Campagnoli, M., Salatino, A., Molo, M. T., Mortara, P., Pinessi, L., & Massazza, G. (2016a). Cognitive and neurophysiological effects of non-invasive brain stimulation in stroke patients after motor rehabilitation. Frontiers in Behavioral Neuroscience, 10(Jun). https://doi.org/10.3389/fnbeh.2016.00135
Fan, J., Li, X., Yu, X., Liu, Z., Jiang, Y., Fang, Y., Zong, M., Suo, C., Man, Q., & Xiong, L. (2023). Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030. Neurology, 101(2), E137–E150. https://doi.org/10.1212/WNL.0000000000207387
Feigin, V. L., Norrving, B., & Mensah, G. A. (2017). Global Burden of Stroke. Circulation Research, 120(3), 439–448. https://doi.org/10.1161/CIRCRESAHA.116.308413
Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., Abbasifard, M., Abbasi-Kangevari, M., Abd-Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M., Abushouk, A. I., Adebayo, O. M., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., … Murray, C. J. L. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
Fisicaro, F., Lanza, G., Grasso, A. A., Pennisi, G., Bella, R., Paulus, W., & Pennisi, M. (2019). Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Em Therapeutic Advances in Neurological Disorders (Vol. 12). SAGE Publications Ltd. https://doi.org/10.1177/1756286419878317
Fregni, F., Boggio, P. S., Valle, A. C., Rocha, R. R., Duarte, J., Ferreira, M. J. L., Wagner, T., Fecteau, S., Rigonatti, S. P., Riberto, M., Freedman, S. D., & Pascual-Leone, A. (2006b). A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke, 37(8), 2115–2122. https://doi.org/10.1161/01.STR.0000231390.58967.6b
Frey, J., Najib, U., Lilly, C., & Adcock, A. (2020). Novel TMS for Stroke and Depression (NoTSAD): Accelerated Repetitive Transcranial Magnetic Stimulation as a Safe and Effective Treatment for Post-stroke Depression. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.00788
Gong, C., Hu, H., Peng, X. M., Li, H., Xiao, L., Liu, Z., Zhong, Y. B., Wang, M. Y., & Luo, Y. (2023). Therapeutic effects of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: a systematic review and meta-analysis. Em Frontiers in Human Neuroscience (Vol. 17). Frontiers Media S.A. https://doi.org/10.3389/fnhum.2023.1177594
Hara, T., Shanmugalingam, A., McIntyre, A., & Burhan, A. M. (2021). The effect of non-invasive brain stimulation (Nibs) on attention and memory function in stroke rehabilitation patients: A systematic review and meta-analysis. Em Diagnostics (Vol. 11, Número 2). MDPI. https://doi.org/10.3390/diagnostics11020227
Harvey, M., & Kerkhoff, G. (2015). Effects of non-invasive brain stimulation on attention: Current debates, cognitive studies and novel clinical applications. Neuropsychologia, 74, 1–6. https://doi.org/10.1016/j.neuropsychologia.2015.06.020
Hummel, F. C., & Cohen, L. G. (2006). Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurology, 5(8), 708–712. https://doi.org/10.1016/S1474-4422(06)70525-7
Kuan, Y. C., Lin, L. F., Wang, C. Y., Hu, C. C., Liang, P. J., & Lee, S. C. (2022). Association Between Turning Mobility and Cognitive Function in Chronic Poststroke. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.772377
Lefaucheur, J. P., Aleman, A., Baeken, C., Benninger, D. H., Brunelin, J., Di Lazzaro, V., Filipovi?, S. R., Grefkes, C., Hasan, A., Hummel, F. C., Jääskeläinen, S. K., Langguth, B., Leocani, L., Londero, A., Nardone, R., Nguyen, J. P., Nyffeler, T., Oliveira-Maia, A. J., Oliviero, A., … Ziemann, U. (2020). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Em Clinical Neurophysiology (Vol. 131, Número 2, p. 474–528). Elsevier Ireland Ltd. https://doi.org/10.1016/j.clinph.2019.11.002
Li, K. P., Sun, J., Wu, C. Q., An, X. fei, Wu, J. J., Zheng, M. X., Hua, X. Y., & Xu, J. G. (2023). Effects of repetitive transcranial magnetic stimulation on post-stroke patients with cognitive impairment: A systematic review and meta-analysis. Em Behavioural Brain Research (Vol. 439). Elsevier B.V. https://doi.org/10.1016/j.bbr.2022.114229
Liew, S. L., Santarnecchi, E., Buch, E. R., & Cohen, L. G. (2014). Non-invasive brain stimulation in neurorehabilitation: Local and distant effects for motor recovery. Em Frontiers in Human Neuroscience (Vol. 8, Número JUNE). Frontiers Media S. A. https://doi.org/10.3389/fnhum.2014.00378
Liu, M., Bao, G., Bai, L., & Yu, E. (2021). The role of repetitive transcranial magnetic stimulation in the treatment of cognitive impairment in stroke patients: A systematic review and meta-analysis. Science Progress, 104(2). https://doi.org/10.1177/00368504211004266
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Em The BMJ (Vol. 372). BMJ Publishing Group. https://doi.org/10.1136/bmj.n71
Pinto, C. B. (2018). Efeito da terapia combinada da EMTr com fluoxetina na reabilitação da função motora de pacientes pós AVE isquêmico- tese de doutorado.
Sandrini, M., & Cohen, L. G. (2013). Noninvasive brain stimulation in neurorehabilitation. Em Handbook of Clinical Neurology (Vol. 116, p. 499–524). Elsevier B.V. https://doi.org/10.1016/B978-0-444-53497-2.00040-1
Somaa, F. A., de Graaf, T. A., & Sack, A. T. (2022). Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Em Frontiers in Neurology (Vol. 13). Frontiers Media S.A. https://doi.org/10.3389/fneur.2022.793253
Tomeh, A., Yusof Khan, A. H. K., Inche Mat, L. N., Basri, H., & Wan Sulaiman, W. A. (2022). Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence. Em Brain Sciences (Vol. 12, Número 6). MDPI. https://doi.org/10.3390/brainsci12060761
Tomeh, A., Yusof Khan, A. H. K., & Wan Sulaiman, W. A. (2022). Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review. Em Frontiers in Aging Neuroscience (Vol. 14). Frontiers Media S.A. https://doi.org/10.3389/fnagi.2022.897837
Tsai, P. Y., Lin, W. S., Tsai, K. T., Kuo, C. Y., & Lin, P. H. (2020). High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans. Journal of Psychiatry and Neuroscience, 45(4), 262–270. https://doi.org/10.1503/jpn.190060
van Lieshout, E. C. C., van Hooijdonk, R. F., Dijkhuizen, R. M., Visser-Meily, J. M. A., & Nijboer, T. C. W. (2019). The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review. Neurorehabilitation and Neural Repair, 33(5), 355–374. https://doi.org/10.1177/1545968319834900
Wessel, M. J., Zimerman, M., & Hummel, F. C. (2015). Non-invasive brain stimulation: An interventional tool for enhancing behavioral training after stroke. Em Frontiers in Human Neuroscience (Vol. 9, Número MAY). Frontiers Media S. A. https://doi.org/10.3389/fnhum.2015.00265
Wissel, J., Olver, J., & Sunnerhagen, K. S. (2013). Navigating the poststroke continuum of care. Em Journal of Stroke and Cerebrovascular Diseases (Vol. 22, Número 1, p. 1–8). https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.05.021
Xu, B., Lin, C., Guo, C., & Wang, H. (2023). Comparing conventional treatment, single-target rTMS, or dual-target rTMS for the treatment of post-stroke cognitive impairment — clinical effects and neuroscientific insights: study protocol for a randomized controlled trial. Trials, 24(1), 478. https://doi.org/10.1186/s13063-023-07491-x
Yin, M., Liu, Y., Zhang, L., Zheng, H., Peng, L., Ai, Y., Luo, J., & Hu, X. (2020). Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial. Frontiers in Neural Circuits, 14. https://doi.org/10.3389/fncir.2020.563777
Yu, K., Sun, J., Jiao Tong University, S., Rajan Kashyap, C., Xu, N., Wang, Y., Wang, R., & Zai, W. (2022). Systematic review and network meta-analysis of effects of noninvasive brain stimulation on post-stroke cognitive impairment. https://www.crd.york.ac.uk/prospero/,
A?k?n, A., Tosun, A., & Demirdal, Ü. S. (2017). Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial. Somatosensory and Motor Research, 34(2), 102–107. https://doi.org/10.1080/08990220.2017.1316254
Bhattacharjee, S., Kashyap, R., Abualait, T., Annabel Chen, S. H., Yoo, W. K., & Bashir, S. (2021). The Role of Primary Motor Cortex: More Than Movement Execution. Em Journal of Motor Behavior (Vol. 53, Número 2, p. 258–274). Routledge. https://doi.org/10.1080/00222895.2020.1738992
Bonnard, M., Camus, M., de Graaf, J., & Pailhous, J. (2003). Direct evidence for a binding between cognitive and motor functions in humans: a TMS study. Journal of cognitive neuroscience, 15(8), 1207–1216. https://doi.org/10.1162/089892903322598157
Cramer, S. C., Wolf, S. L., Adams, H. P., Chen, D., Dromerick, A. W., Dunning, K., Ellerbe, C., Grande, A., Janis, S., Lansberg, M. G., Lazar, R. M., Palesch, Y. Y., Richards, L., Roth, E., Savitz, S. I., Wechsler, L. R., Wintermark, M., & Broderick, J. P. (2017). Stroke Recovery and Rehabilitation Research: Issues, Opportunities, and the National Institutes of Health StrokeNet. Stroke, 48(3), 813–819. https://doi.org/10.1161/STROKEAHA.116.015501
D’Agata, F., Peila, E., Cicerale, A., Caglio, M. M., Caroppo, P., Vighetti, S., Piedimonte, A., Minuto, A., Campagnoli, M., Salatino, A., Molo, M. T., Mortara, P., Pinessi, L., & Massazza, G. (2016a). Cognitive and neurophysiological effects of non-invasive brain stimulation in stroke patients after motor rehabilitation. Frontiers in Behavioral Neuroscience, 10(Jun). https://doi.org/10.3389/fnbeh.2016.00135
Fan, J., Li, X., Yu, X., Liu, Z., Jiang, Y., Fang, Y., Zong, M., Suo, C., Man, Q., & Xiong, L. (2023). Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030. Neurology, 101(2), E137–E150. https://doi.org/10.1212/WNL.0000000000207387
Feigin, V. L., Norrving, B., & Mensah, G. A. (2017). Global Burden of Stroke. Circulation Research, 120(3), 439–448. https://doi.org/10.1161/CIRCRESAHA.116.308413
Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., Abbasifard, M., Abbasi-Kangevari, M., Abd-Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M., Abushouk, A. I., Adebayo, O. M., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., … Murray, C. J. L. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
Fisicaro, F., Lanza, G., Grasso, A. A., Pennisi, G., Bella, R., Paulus, W., & Pennisi, M. (2019). Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Em Therapeutic Advances in Neurological Disorders (Vol. 12). SAGE Publications Ltd. https://doi.org/10.1177/1756286419878317
Fregni, F., Boggio, P. S., Valle, A. C., Rocha, R. R., Duarte, J., Ferreira, M. J. L., Wagner, T., Fecteau, S., Rigonatti, S. P., Riberto, M., Freedman, S. D., & Pascual-Leone, A. (2006b). A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke, 37(8), 2115–2122. https://doi.org/10.1161/01.STR.0000231390.58967.6b
Frey, J., Najib, U., Lilly, C., & Adcock, A. (2020). Novel TMS for Stroke and Depression (NoTSAD): Accelerated Repetitive Transcranial Magnetic Stimulation as a Safe and Effective Treatment for Post-stroke Depression. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.00788
Gong, C., Hu, H., Peng, X. M., Li, H., Xiao, L., Liu, Z., Zhong, Y. B., Wang, M. Y., & Luo, Y. (2023). Therapeutic effects of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: a systematic review and meta-analysis. Em Frontiers in Human Neuroscience (Vol. 17). Frontiers Media S.A. https://doi.org/10.3389/fnhum.2023.1177594
Hara, T., Shanmugalingam, A., McIntyre, A., & Burhan, A. M. (2021). The effect of non-invasive brain stimulation (Nibs) on attention and memory function in stroke rehabilitation patients: A systematic review and meta-analysis. Em Diagnostics (Vol. 11, Número 2). MDPI. https://doi.org/10.3390/diagnostics11020227
Harvey, M., & Kerkhoff, G. (2015). Effects of non-invasive brain stimulation on attention: Current debates, cognitive studies and novel clinical applications. Neuropsychologia, 74, 1–6. https://doi.org/10.1016/j.neuropsychologia.2015.06.020
Hummel, F. C., & Cohen, L. G. (2006). Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurology, 5(8), 708–712. https://doi.org/10.1016/S1474-4422(06)70525-7
Kuan, Y. C., Lin, L. F., Wang, C. Y., Hu, C. C., Liang, P. J., & Lee, S. C. (2022). Association Between Turning Mobility and Cognitive Function in Chronic Poststroke. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.772377
Lefaucheur, J. P., Aleman, A., Baeken, C., Benninger, D. H., Brunelin, J., Di Lazzaro, V., Filipovi?, S. R., Grefkes, C., Hasan, A., Hummel, F. C., Jääskeläinen, S. K., Langguth, B., Leocani, L., Londero, A., Nardone, R., Nguyen, J. P., Nyffeler, T., Oliveira-Maia, A. J., Oliviero, A., … Ziemann, U. (2020). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Em Clinical Neurophysiology (Vol. 131, Número 2, p. 474–528). Elsevier Ireland Ltd. https://doi.org/10.1016/j.clinph.2019.11.002
Li, K. P., Sun, J., Wu, C. Q., An, X. fei, Wu, J. J., Zheng, M. X., Hua, X. Y., & Xu, J. G. (2023). Effects of repetitive transcranial magnetic stimulation on post-stroke patients with cognitive impairment: A systematic review and meta-analysis. Em Behavioural Brain Research (Vol. 439). Elsevier B.V. https://doi.org/10.1016/j.bbr.2022.114229
Liew, S. L., Santarnecchi, E., Buch, E. R., & Cohen, L. G. (2014). Non-invasive brain stimulation in neurorehabilitation: Local and distant effects for motor recovery. Em Frontiers in Human Neuroscience (Vol. 8, Número JUNE). Frontiers Media S. A. https://doi.org/10.3389/fnhum.2014.00378
Liu, M., Bao, G., Bai, L., & Yu, E. (2021). The role of repetitive transcranial magnetic stimulation in the treatment of cognitive impairment in stroke patients: A systematic review
and meta-analysis. Science Progress, 104(2). https://doi.org/10.1177/00368504211004266
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Em The BMJ (Vol. 372). BMJ Publishing Group. https://doi.org/10.1136/bmj.n71
Pinto, C. B. (2018). Efeito da terapia combinada da EMTr com fluoxetina na reabilitação da função motora de pacientes pós AVE isquêmico- tese de doutorado.
Sandrini, M., & Cohen, L. G. (2013). Noninvasive brain stimulation in neurorehabilitation. Em Handbook of Clinical Neurology (Vol. 116, p. 499–524). Elsevier B.V. https://doi.org/10.1016/B978-0-444-53497-2.00040-1
Somaa, F. A., de Graaf, T. A., & Sack, A. T. (2022). Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. Em Frontiers in Neurology (Vol. 13). Frontiers Media S.A. https://doi.org/10.3389/fneur.2022.793253
Tomeh, A., Yusof Khan, A. H. K., Inche Mat, L. N., Basri, H., & Wan Sulaiman, W. A. (2022). Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence. Em Brain Sciences (Vol. 12, Número 6). MDPI. https://doi.org/10.3390/brainsci12060761
Tomeh, A., Yusof Khan, A. H. K., & Wan Sulaiman, W. A. (2022). Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review. Em Frontiers in Aging Neuroscience (Vol. 14). Frontiers Media S.A. https://doi.org/10.3389/fnagi.2022.897837
Tsai, P. Y., Lin, W. S., Tsai, K. T., Kuo, C. Y., & Lin, P. H. (2020). High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans. Journal of Psychiatry and Neuroscience, 45(4), 262–270. https://doi.org/10.1503/jpn.190060
van Lieshout, E. C. C., van Hooijdonk, R. F., Dijkhuizen, R. M., Visser-Meily, J. M. A., & Nijboer, T. C. W. (2019). The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review. Neurorehabilitation and Neural Repair, 33(5), 355–374. https://doi.org/10.1177/1545968319834900
Wessel, M. J., Zimerman, M., & Hummel, F. C. (2015). Non-invasive brain stimulation: An interventional tool for enhancing behavioral training after stroke. Em Frontiers in Human Neuroscience (Vol. 9, Número MAY). Frontiers Media S. A. https://doi.org/10.3389/fnhum.2015.00265
Wissel, J., Olver, J., & Sunnerhagen, K. S. (2013). Navigating the poststroke continuum of care. Em Journal of Stroke and Cerebrovascular Diseases (Vol. 22, Número 1, p. 1–8). https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.05.021
Xu, B., Lin, C., Guo, C., & Wang, H. (2023). Comparing conventional treatment, single-target rTMS, or dual-target rTMS for the treatment of post-stroke cognitive impairment — clinical effects and neuroscientific insights: study protocol for a randomized controlled trial. Trials, 24(1), 478. https://doi.org/10.1186/s13063-023-07491-x
Yin, M., Liu, Y., Zhang, L., Zheng, H., Peng, L., Ai, Y., Luo, J., & Hu, X. (2020). Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial. Frontiers in Neural Circuits, 14. https://doi.org/10.3389/fncir.2020.563777
Yu, K., Sun, J., Jiao Tong University, S., Rajan Kashyap, C., Xu, N., Wang, Y., Wang, R., & Zai, W. (2022). Systematic review and network meta-analysis of effects of noninvasive brain stimulation on post-stroke cognitive impairment. https://www.crd.york.ac.uk/prospero/,
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