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Related Experiment Videos

Remote changes in cortical excitability after stroke.

Cathrin M Bütefisch1, Johannes Netz, Marion Wessling

  • 1Neurological Therapeutic Center, Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany. cathrin.buetefisch@uni-duesseldorf.de

Brain : a Journal of Neurology
|January 23, 2003
PubMed
Summary
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Stroke recovery is linked to increased excitatory activity in the non-affected motor cortex. This study used transcranial magnetic stimulation (TMS) to show altered brain excitability in stroke patients with good hand function recovery, suggesting a shift towards excitation.

Area of Science:

  • Neuroscience
  • Neurology
  • Rehabilitation Medicine

Background:

  • Changes in cerebral metabolism and excitability in brain areas remote from a lesion are implicated in functional recovery after stroke.
  • Understanding these changes in the non-affected hemisphere is crucial for elucidating recovery mechanisms.

Purpose of the Study:

  • To investigate alterations in inhibitory and excitatory activity within the motor cortex of the non-affected hemisphere in stroke patients.
  • To determine if these neurophysiological changes correlate with the extent of functional recovery, specifically hand function.

Main Methods:

  • Utilized Transcranial Magnetic Stimulation (TMS) to assess motor cortex excitability in 13 stroke patients with good hand recovery and 13 healthy controls.
  • Employed paired-pulse TMS with varying conditioning stimulus (CS) intensities and interstimulus intervals (ISIs) to probe inhibitory and excitatory circuits.

Related Experiment Videos

  • Measured motor evoked potential (MEP) amplitudes and recruitment curves to quantify cortical excitability.

    • Main Results:

    • Motor threshold (MT), mean test MEP, and recruitment curves were comparable between stroke patients and healthy volunteers, indicating unchanged overall corticomotoneuronal excitability.
    • Patients with good recovery exhibited increased paired-pulse excitability at short ISIs (2-3 ms) compared to controls at longer ISIs (10-15 ms).
    • In good recovery patients, inhibitory activity at low CS intensities was similar to controls, but excitatory effects increased more steeply at higher CS intensities, suggesting a shift towards excitation.

    Conclusions:

    • Stroke patients with good functional recovery show a shift towards increased excitatory activity in the contralesional motor cortex, particularly at short ISIs.
    • This altered balance of excitation and inhibition may represent a crucial neurophysiological mechanism underlying functional reorganization and recovery post-stroke.
    • The absence of these excitability changes in patients with poor recovery underscores their relevance to successful functional outcomes.