title: Probing modifications of cortical excitability during stroke recovery with navigated transcranial magnetic stimulation.
abstract: OBJECTIVE
  To follow cortical excitability changes during recovery from stroke with navigated transcranial magnetic stimulation (nTMS), in particular, to characterize changes of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), to correlate them with recovery of upper extremity function, and to detect possible shifts of cortical hand representations.
  
  
  METHODS
  Single and paired pulse nTMS were delivered to the hemisphere with infarction and to the hemisphere without infarction in 14 first-ever stroke patients at 1 (T1) and 3 months (T2) after stroke. Electromyographic responses to nTMS stimulation were recorded from the first dorsal interosseus muscles. nTMS was used to ensure an accurate coil repositioning in repeated measurements. Hand function recovery was clinically evaluated using the Action Research Arm Test (ARAT) and 9-hole peg test (9-HPT).
  
  
  RESULTS
  SICI and ICF were modulated in both hemispheres during recovery. Inhibition in the hemisphere without infarction correlated significantly with the affected hand performance at T2; stronger disinhibition (poor inhibition) was associated with worse hand performance. Location of hand muscle representations was shifted in 3 well-recovered patients out of 14 patients at T2.
  
  
  CONCLUSIONS
  In line with earlier studies, disinhibition in the hemisphere without infarction may be related to poor recovery of the affected hand. Usage of the affected hand during stroke recovery seems to influence these cortical excitability changes. nTMS is a valuable tool for tracking muscle cortical representation changes during brain reorganization.
authors.affiliation: Hospital District of Helsinki and Uusimaa, Helsinki, Finland.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Lioumis
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Rozaliya
authors.initials: R
authors.lastname: Bikmullina
authors.forename: Anne-Mari
authors.initials: AM
authors.lastname: Vitikainen
authors.forename: Dubravko
authors.initials: D
authors.lastname: Kičić
authors.forename: Oili
authors.initials: O
authors.lastname: Salonen
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Nina
authors.initials: N
authors.lastname: Forss
authors.forename: Jyrki P
authors.initials: JP
authors.lastname: Mäkelä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000502:physiology*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006225:Hand / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009433:Neural Inhibition / Q000502:physiology; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*