Modulating cortical excitability in acute stroke: a repetitive TMS study.
OBJECTIVE
Changes in cerebral cortex excitability have been demonstrated after a stroke and are considered relevant for recovery. Repetitive transcranial magnetic stimulation (rTMS) of the brain can modulate cerebral cortex excitability and, when rTMS is given as theta burst stimulation (TBS), LTP- or LTD-like changes can be induced. The aim of present study was to evaluate the effects of TBS on cortical excitability in acute stroke.


METHODS
In 12 acute stroke patients, we explored the effects of facilitatory TBS of the affected hemisphere and of inhibitory TBS of the unaffected hemisphere on cortical excitability to single-pulse transcranial magnetic stimulation (TMS) on both sides. The effects produced by TBS in patients were compared with those observed in a control group of age-matched healthy individuals.


RESULTS
In patients, both the facilitatory TBS of the affected motor cortex and the inhibitory TBS of the unaffected motor cortex produced a significant increase of the amplitude of MEPs evoked by stimulation of the affected hemisphere. The effects observed in patients were comparable to those observed in controls.


CONCLUSIONS
Facilitatory TBS over the stroke hemisphere and inhibitory TBS over the intact hemisphere in acute phase enhance the excitability of the lesioned motor cortex.


CONCLUSIONS
TBS might be useful to promote cortical plasticity in stroke patients.
Di Lazzaro
V
V
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy; Fondazione Don C Gnocchi, Rome, Italy. Electronic address: vdilazzaro@rm.unicatt.it.
Pilato
F
F
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Dileone
M
M
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Profice
P
P
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Capone
F
F
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Ranieri
F
F
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Musumeci
G
G
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Cianfoni
A
A
Institute of Radiology, Università Cattolica, L.go A. Gemelli 8, 00168 Rome, Italy.
Pasqualetti
P
P
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Tonali
P A
PA
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy; Fondazione Don C Gnocchi, Rome, Italy.
D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D018592:Cross-Over Studies; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009433:Neural Inhibition / Q000502:physiology / Q000528:radiation effects; D011930:Reaction Time / Q000502:physiology / Q000528:radiation effects; D020521:Stroke / Q000473:pathology / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation