http://nnr.sagepub.com/content/30/3/244?etoc
- William Huynh, PhD1,2⇑
- Steve Vucic, PhD3
- Arun V. Krishnan, PhD2
- Cindy S-Y. Lin, PhD4
- Matthew C. Kiernan, DSc1
- 1Brain and Mind Research Institute, University of Sydney, New South Wales, Australia
- 2Prince of Wales Clinical School, University of New South Wales, New South Wales, Australia
- 3Western Clinical School, University of Sydney, New South Wales, Australia
- 4University of New South Wales, New South Wales, Australia
- William Huynh, PhD, Institute of Neurological Sciences, Prince of Wales Hospital, NSW 2031, Australia. Email: w.huynh@neura.edu.au
Abstract
Background. Evolution of changes in intracortical excitability following stroke, particularly in the contralesional hemisphere, is being
increasingly recognized in relation to maximizing the potential for functional recovery.
Objective.
The present study utilized a prospective longitudinal design over a
12-month period from stroke onset, to investigate the
evolution of intracortical excitability involving
both motor cortices and their relationship to recovery, and whether such
changes were influenced by baseline stroke
characteristics.
Methods. Thirty-one patients with acute
unilateral ischemic stroke were recruited from a tertiary hospital
stroke unit. Comprehensive
clinical assessments and cortical excitability were
undertaken at stroke onset using a novel threshold-tracking
paired-pulse
transcranial magnetic stimulation technique, and
repeated at 3-, 6-, and 12-month follow-up in 17 patients who completed
the
longitudinal assessment.
Results. Shortly
following stroke, short-interval intracortical inhibition (SICI) was
significantly reduced in both lesioned and
contralesional hemispheres that correlated with
degree of recovery over the subsequent 3 months. Over the follow-up
period,
ipsilesional SICI remained reduced in all patient
groups, while SICI over the contralesional hemisphere remained reduced
only
in the groups with cortical stroke or more baseline
functional impairment.
Conclusions. The current study has
demonstrated that evolution of intracortical excitability, particularly
over the contralesional hemisphere,
may vary between patients with differing baseline
stroke and clinical characteristics, suggesting that ongoing
contralesional
network recruitment may be necessary for those
patients who have significant disruptions to the integrity of
ipsilesional
motor pathways. Results from the present series
have implications for the development of neuromodulatory brain
stimulation
protocols to harness and thereby facilitate stroke
recovery.(What the hell is this?)
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