title: Induction of cortical plastic changes in wrist muscles by paired associative stimulation in the recovery phase of stroke patients.
abstract: BACKGROUND
  Paired associative stimulation (PAS) combining peripheral nerve and transcranial magnetic stimulation (TMS) have been proposed to induce long-term changes in excitability of the cerebral cortex and potentially optimize motor recovery in stroke patients.
  
  
  OBJECTIVE
  This pilot study examined whether short-lasting changes in cortical excitability could be induced by a single session of PAS within the first months after stroke.
  
  
  METHODS
  Six hemiparetic patients with a subcortical stroke were included. The single session PAS protocol was applied at 1, 5, and 12 months after stroke. During the follow-up, the clinical recovery of wrist function was assessed in parallel to the PAS study by the Fugl-Meyer motor scale and dynamometry of wrist extension.
  
  
  RESULTS
  The PAS protocol induced a significant extensor carpi radialis motor evoked potential facilitation (mean +78.5%) on the paretic side 5 months after stroke. The facilitation was still present 12 months after stroke but on average smaller (+30 %).
  
  
  CONCLUSIONS
  These electrophysiological findings suggest that patients with subcortical infarcts may respond to PAS in an earlier than later period after stroke. If the clinical efficacy of interventions such as PAS is confirmed, it could be proposed early as add-on therapy to optimize training-induced plasticity processes.
authors.affiliation: Universités de Toulouse, IFR 96, Pôle Santé, Société, Réadaptation, Hôpitaux de Toulouse, INSERM U 825, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Castel-Lacanal
authors.forename: Philippe
authors.initials: P
authors.lastname: Marque
authors.forename: Jean
authors.initials: J
authors.lastname: Tardy
authors.forename: Xavier
authors.initials: X
authors.lastname: de Boissezon
authors.forename: Vincent
authors.initials: V
authors.lastname: Guiraud
authors.forename: François
authors.initials: F
authors.lastname: Chollet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Loubinoux
authors.forename: Marion Simonetta
authors.initials: MS
authors.lastname: Moreau
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D019054:Evoked Potentials, Motor / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology*; D017063:Outcome Assessment, Health Care / Q000379:methods; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D010865:Pilot Projects; D011712:Pyramidal Tracts / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014953:Wrist / Q000294:innervation / Q000503:physiopathology