http://nnr.sagepub.com/content/27/3/219.abstract?etoc
Abstract
Background. With the advent of novel brain
stimulation techniques aimed at improving functional outcome,
understanding poststroke plasticity
becomes critical for the appropriate selection of
patients and optimal timing to introduce neuromodulatory interventions.
Objective. To better define the temporal evolution of central and peripheral neuroplastic changes in the first 3 months after stroke
and their clinical implications. Methods. Transcranial magnetic stimulation, peripheral nerve excitability, and clinical assessments were undertaken longitudinally
in 31 acute stroke patients, comprising a total of 384 clinical studies. Results. During the hyperacute phase (<7 days), short-interval intracortical inhibition (SICI) was significantly reduced in lesioned
(4.3% ± 1.3%) and contralesional hemispheres (3.6% ± 1.9%) compared with controls (11.4% ± 1.3%, P = .001). There were also significant alterations in accommodative properties of motor axons in the affected limb. At follow-up,
SICI remained suppressed in both hemispheres in the context of significant clinical improvement. Conclusion.
Simultaneous assessment of central and peripheral motor pathways has
identified bilateral plastic changes that develop throughout
the neural axis in acute stroke patients. It is
proposed that these changes represent an adaptive response and that the
persistent
bihemispheric reduction in SICI may act to promote
stroke recovery through cortical reorganization.
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