New hope for ameliorating stroke-induced deficits?

This scientific commentary refers to ‘Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia’ by Meinzer et al. (doi:10.1093/brain/aww002).The overall decline in stroke mortality observed over the past decades is due to both a reduction in stroke incidence, primarily resulting from cardiovascular risk factor interventions, and substantial progress in the acute treatment of stroke (e.g. recanalization due to thrombolysis and thrombectomy, decompressive therapy) as well as patient care (stroke units) (Mozaffarian et al., 2016). These improvements (in particular among people older than 65 years) are mirrored, however, by an increasing number of stroke survivors, who are left with persistent neurological deficits. Despite intensive rehabilitation, at least in countries with well developed healthcare systems, many stroke survivors are left with motor, language, spatial or other neuropsychological sequelae, all of which result in reduced functional independence. Consequently, stroke is the leading cause of acquired long-term disability and globally produces immense health, social and economic burdens (Mozaffarian et al., 2016). While physiotherapy, language therapy and occupational therapy are widely accepted elements of rehabilitation medicine that aim to restore functioning and quality of life in those with physical disabilities or cognitive impairments, novel approaches to rehabilitation are urgently needed. Such therapies may comprise behavioural, pharmacological or technical approaches, the latter including the use of robotic devices as well as non-invasive neuromodulatory techniques [i.e. transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)]. In this issue of Brain, Meinzer and colleagues raise new hope for the treatment of post-stroke aphasia by showing that electrical stimulation of the motor cortex [sic!] enhances treatment outcomes (Meinzer et al., 2016)