NeuroImage. Clinical · 2026
Neuroimaging biomarkers of non-invasive brain stimulation in post-stroke recovery: EEG and fMRI perspectives.
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Kim Seoyeon, Lee Sang Wook, Lee Minji
Аннотация
BACKGROUND: Non-invasive brain stimulation (NIBS) has emerged as a promising approach to enhance neuroplasticity and functional recovery after stroke. However, substantial inter-individual variability in treatment response limits its clinical translation. The lack of objective neuroimaging biomarkers that capture stimulation-induced brain reorganization remains a critical barrier to personalized neuromodulation.
OBJECTIVE: To synthesize current evidence on electroencephalography (EEG)- and functional magnetic resonance imaging (fMRI)-based biomarkers of NIBS-induced neuroplasticity in post-stroke populations and to present a unified neuroimaging framework for predicting treatment response and guiding individualized stimulation strategies.
METHODS: This review provides a comprehensive and integrative synthesis of studies investigating neuroimaging correlates of NIBS, focusing on EEG and fMRI modalities. Evidence is organized within a unified neuroimaging framework spanning multiple levels of neural organization, including cortical excitability, oscillatory dynamics, and large-scale functional connectivity. Multimodal and computational approaches, such as EEG-fMRI integration and electric field modeling, are also considered to highlight emerging analytical frameworks.
RESULTS: Converging evidence indicates that NIBS induces measurable changes across multiple neural scales. EEG-based metrics, including oscillatory activity, TMS-evoked potentials, and interhemispheric balance indices, reflect modulation of cortical excitability and network dynamics. fMRI findings demonstrate alterations in regional activation and functional connectivity, particularly within motor and association networks. Multimodal approaches further improve the characterization of stimulation-induced reorganization and enhance the prediction of functional recovery.
CONCLUSIONS: Neuroimaging biomarkers derived from EEG and fMRI provide critical insight into the mechanisms and variability of NIBS-induced neuroplasticity. Integrating these biomarkers into a unified framework enables stratification of patients and supports the development of precision neuromodulation strategies in stroke rehabilitation. Future research should prioritize large-scale validation and the implementation of biomarker-driven, adaptive stimulation paradigms.
OBJECTIVE: To synthesize current evidence on electroencephalography (EEG)- and functional magnetic resonance imaging (fMRI)-based biomarkers of NIBS-induced neuroplasticity in post-stroke populations and to present a unified neuroimaging framework for predicting treatment response and guiding individualized stimulation strategies.
METHODS: This review provides a comprehensive and integrative synthesis of studies investigating neuroimaging correlates of NIBS, focusing on EEG and fMRI modalities. Evidence is organized within a unified neuroimaging framework spanning multiple levels of neural organization, including cortical excitability, oscillatory dynamics, and large-scale functional connectivity. Multimodal and computational approaches, such as EEG-fMRI integration and electric field modeling, are also considered to highlight emerging analytical frameworks.
RESULTS: Converging evidence indicates that NIBS induces measurable changes across multiple neural scales. EEG-based metrics, including oscillatory activity, TMS-evoked potentials, and interhemispheric balance indices, reflect modulation of cortical excitability and network dynamics. fMRI findings demonstrate alterations in regional activation and functional connectivity, particularly within motor and association networks. Multimodal approaches further improve the characterization of stimulation-induced reorganization and enhance the prediction of functional recovery.
CONCLUSIONS: Neuroimaging biomarkers derived from EEG and fMRI provide critical insight into the mechanisms and variability of NIBS-induced neuroplasticity. Integrating these biomarkers into a unified framework enables stratification of patients and supports the development of precision neuromodulation strategies in stroke rehabilitation. Future research should prioritize large-scale validation and the implementation of biomarker-driven, adaptive stimulation paradigms.