title: Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand.
abstract: OBJECTIVE
  Within the concept of interhemispheric competition, technical modulation of the excitability of motor areas in the contralesional and ipsilesional hemisphere has been applied in an attempt to enhance recovery of hand function following stroke. This review critically summarizes the data supporting the use of novel electrophysiological concepts in the rehabilitation of hand function after stroke.
  
  
  RESULTS
  Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are powerful tools to inhibit or facilitate cortical excitability. Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke. No significant adverse effects have been noted when applying brain stimulation in stroke patients. To date, however, the clinical effects are small to moderate and short lived. Future work should elucidate whether repetitive administration of rTMS or tDCS over several days and the combination of these techniques with behavioral training (ie, physiotherapy) could result in an enhanced effectiveness.
  
  
  CONCLUSIONS
  Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.
authors.affiliation: Department of Neurology, University Hospital, University of Cologne, Cologne, Germany. dennis.nowak@neurologie-kipfenberg.de
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Nowak
authors.forename: Christian
authors.initials: C
authors.lastname: Grefkes
authors.forename: Mitra
authors.initials: M
authors.lastname: Ameli
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
mesh_terms: D004599:Electric Stimulation Therapy; D007839:Functional Laterality; D006225:Hand; D006801:Humans; D009043:Motor Activity / Q000502:physiology; D009044:Motor Cortex / Q000503:physiopathology*; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation