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Related Experiment Video

Updated: Aug 9, 2025

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy
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Effective Intracerebral Connectivity in Acute Stroke: A TMS-EEG Study.

Franca Tecchio1, Federica Giambattistelli2, Camillo Porcaro1,3,4

  • 1Laboratory of Electrophysiology for Translational Neuroscience (LET'S), Institute for Cognitive Sciences and Technologies (ISTC), National Research Council of Italy (CNR), 00185 Rome, Italy.

Brain Sciences
|February 25, 2023
PubMed
Summary

Early stroke recovery hinges on understanding brain excitability. This study reveals overexcitable motor cortex in the lesioned hemisphere, crucial for targeted rehabilitation strategies in stroke patients.

Keywords:
TMS–EEGacute phasecenter-on surround-offcentral peripheral excitabilityelectromyography EMGstroke

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Area of Science:

  • Neuroscience
  • Rehabilitation Medicine
  • Clinical Neurology

Background:

  • Stroke significantly impairs motor and cognitive functions, with critical recovery occurring within the first 8-12 weeks post-event.
  • Understanding early neurophysiological changes is vital for optimizing rehabilitation strategies in the acute phase of stroke recovery.
  • Intracortical excitability dynamics in the acute phase following stroke remain incompletely understood.

Purpose of the Study:

  • To investigate intracortical excitability in the primary motor cortex (M1) of both hemispheres in acute stroke patients.
  • To compare excitability measures between lesioned and contralesional hemispheres, healthy controls, and within stroke patients.
  • To elucidate the role of altered excitatory/inhibitory networks in early stroke recovery.

Main Methods:

  • Utilized transcranial magnetic stimulation (TMS) combined with electroencephalography (TMS-EEG) to measure TMS-evoked potentials (TEPs).
  • Recorded motor-evoked potentials (MEPs) from the first dorsal interosseous muscle to assess motor pathway integrity.
  • Studied 17 acute stroke patients (within 10 days of onset) and 9 age-matched healthy volunteers, performing bilateral M1 stimulation.

Main Results:

  • Stroke patients exhibited reduced MEPs in the paretic hand compared to the non-paretic hand and healthy controls.
  • TEPs indicated an overexcitable lesioned (left) hemisphere compared to the contralesional (right) hemisphere and healthy controls.
  • Significant alterations in the relationship between lesioned and contralesional hemispheric excitability were observed.

Conclusions:

  • Acute stroke leads to significant changes in intracortical excitability, particularly an overexcitable lesioned motor cortex.
  • These findings suggest impairment of intracortical inhibitory networks and altered excitatory/inhibitory balance following stroke.
  • Understanding these early neurophysiological changes is critical for developing effective, targeted stroke rehabilitation interventions.