Potential Locations for Noninvasive Brain Stimulation in Treating Poststroke Deficits: Exploration From Multimodal Neuroimaging

Noninvasive brain stimulation (NIBS) shows promise for poststroke deficits (PSDs), but efficacy may be limited by inconsistent stimulation sites.

By integrating neuroimaging meta-analysis, lesion-symptom mapping (LSM), and resting-state functional connectivity (FC) analysis, we employed three analytical pipelines to explore potential NIBS targets for alexia, aphasia, apraxia, ataxia, dysarthria, hemiplegia, paresthesia, and dysphagia. Pipeline 1 identified cortical regions directly associated with each PSD via coordinate-based meta-analysis using Neurosynth Compose. Pipeline 2 identified cortical regions exhibiting maximal functional connectivity with neurosynth-derived regions of interest (ROI). Pipeline 3 identified cortical regions functionally connected to ROIs from a prior large-scale LSM study. During Pipeline 2 and 3, ROIs were used for seed-to-voxel FC analysis using resting-state fMRI data from 100 healthy subjects. Identified cortical targets were mapped onto the scalp and referenced by the 10-20 system and continuous proportional coordinates.

Potential cortical targets and scalp locations were identified for all eight PSDs. For instance, for hemiplegia, validated targets included primary motor and somatosensory cortices and supplementary motor area; novel targets included angular gyrus, superior frontal gyrus, inferior parietal lobule, medial prefrontal cortex, and precuneus.

This multimodal approach systematically identified precise NIBS targets, confirming established sites and revealing novel regions to broaden neuromodulation strategies for poststroke recovery.