Mapping early changes of cortical motor output after subcortical stroke: a transcranial magnetic stimulation study.

Abstract:

:After acute stroke several changes in cortical excitability occur involving affected (AH) and unaffected hemisphere (UH) but whether they contribute to motor recovery is still controversial. We performed transcranial magnetic stimulation mapping of several upper limb muscles over the two hemispheres in thirteen patients at 4-12 days from subcortical stroke and after 1 month. The occurrence of mirror movements (MMs) on the healthy side during contraction of paretic muscles was measured. At baseline, cortical excitability parameters over the AH decreased in comparison with controls, while excitability over the UH increased correlating with severity of motor deficits of the affected arm at baseline as well as with poor recovery. At follow-up, map parameters of the UH became closer to those of controls independently from recovery, while for the AH the number of responsive sites increased significantly. Ipsilateral motor evoked responses (iMEPs) in the affected arm were never elicited. We observed an early impairment in dexterity of the ipsilesional hand that recovered over-time but persistently differed in comparison with controls. MMs occurrence increased at baseline correlating with reduced cortical excitability of the AH as well as with increased map density over the UH. The acute increased excitability of the UH after stroke has a negative prognostic value on recovery and negatively affects motor performance of the ipsilesional hand. Moreover, the absence of iMEPs and the normalization of motor cortical excitability at follow-up indicate that the UH primary motor area does not contribute to recovery.

journal_name

Brain Stimul

journal_title

Brain stimulation

authors

Chieffo R,Inuggi A,Straffi L,Coppi E,Gonzalez-Rosa J,Spagnolo F,Poggi A,Comi G,Comola M,Leocani L

doi

10.1016/j.brs.2012.06.003

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

322-9

issue

3

eissn

1935-861X

issn

1876-4754

pii

S1935-861X(12)00099-X

journal_volume

6

pub_type

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