Stroke is a leading cause of disability in many American Countries. Forty percent of stroke patients experience moderate functional impairments and 15% to 30% severe disability. Non-invasive brain stimulation (NIBS) techniques have been used as adjuvant treatments to physical therapy for motor recovery following stroke. High frequency rTMS and anodal tDCS can be delivered over the affected motor cortex in order to increase cortical excitability and induce brain plasticity with the motive to improve motor learning and attain functional goals in stroke patients. Low frequency rTMS and cathodal tDCS can be given to the unaffected motor cortex to reduce interhemispheric inhibition and hinder maladaptive plasticity. Combined therapy- NIBS plus pharmacotherapy- can lead to better results than one or the other alone. Many Novel studies show that NIBS techniques like as transcranial direct current stimulation (tDCS) and repetitive Transcranial magnetic stimulation (rTMS) can induce brain plasticity in post-stroke motor recovery. To understand the possible beneficial affects that pharmacotherapy might have in motor recovery when combined with NIBS as facilitators of plasticity, the biological model of SSRIs in motor recovery is taken as an example of this combined approach. Motor potentiating has been proved by pharmacological agents such as serotonin in both animals and humans. Its neuro-modulatory role influences directly and indirectly the brain motor activity, as observed in imaging studies. New approaches are being carried out and hopefully new strategies will come up in the next few years. There is still the need of evidence that a combined therapy could induce brain plasticity more than one or the other alone and that this approach could have a positive effect on motor recovery compared to the conventional treatments.

 Approach of Non-Invasive Brain Stimulation with Pharmacotherapy

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