title: Increase in Short-Interval Intracortical Facilitation of the Motor Cortex after Low-Frequency Repetitive Magnetic Stimulation of the Unaffected Hemisphere in the Subacute Phase after Stroke.
abstract: Low-frequency repetitive transcranial magnetic stimulation of the unaffected hemisphere (UH-LF-rTMS) in patients with stroke can decrease interhemispheric inhibition from the unaffected to the affected hemisphere and improve hand dexterity and strength of the paretic hand. The objective of this proof-of-principle study was to explore, for the first time, effects of UH-LF-rTMS as add-on therapy to motor rehabilitation on short-term intracortical inhibition (SICI) and intracortical facilitation (ICF) of the motor cortex of the unaffected hemisphere (M1UH) in patients with ischemic stroke. Eighteen patients were randomized to receive, immediately before rehabilitation treatment, either active or sham UH-LF-rTMS, during two weeks. Resting motor threshold (rMT), SICI, and ICF were measured in M1UH before the first session and after the last session of treatment. There was a significant increase in ICF in the active group compared to the sham group after treatment, and there was no significant differences in changes in rMT or SICI. ICF is a measure of intracortical synaptic excitability, with a relative contribution of spinal mechanisms. ICF is typically upregulated by glutamatergic agonists and downregulated by gabaergic antagonists. The observed increase in ICF in the active group, in this hypothesis-generating study, may be related to M1UH reorganization induced by UH-LF-rTMS.
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Eduardo Arruda
authors.initials: EA
authors.lastname: Mello
authors.affiliation: Human Cortical Physiology and Stroke Rehabilitation Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 7D54, Bethesda, MD 20892, USA.
authors.forename: Leonardo G
authors.initials: LG
authors.lastname: Cohen
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Sarah
authors.initials: S
authors.lastname: Monteiro Dos Anjos
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Conti
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Karina Nocelo F
authors.initials: KN
authors.lastname: Andrade
authors.affiliation: Institute of Biomedical Sciences and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373, Prédio do CCS, Bloco M, Cidade Universitária, 21941-902 Rio de Janeiro, RJ, Brazil ; D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, 22281-032 Rio de Janeiro, RJ, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Tovar Moll
authors.affiliation: Institute of Biomedical Sciences and National Center for Structural Biology and Bioimaging (CENABIO), Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373, Prédio do CCS, Bloco M, Cidade Universitária, 21941-902 Rio de Janeiro, RJ, Brazil ; D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, 22281-032 Rio de Janeiro, RJ, Brazil.
authors.forename: Theo
authors.initials: T
authors.lastname: Marins
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Corina A
authors.initials: CA
authors.lastname: Fernandes
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil.
authors.forename: Waldyr
authors.initials: W
authors.lastname: Rodrigues
authors.affiliation: Neurology Clinical Division, Clinics Hospital/São Paulo University, Avenida Dr. Enéas C. Aguiar 255/5084, 05403-010 São Paulo, SP, Brazil ; Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, 05601-901 São Paulo, SP, Brazil.
authors.forename: Adriana Bastos
authors.initials: AB
authors.lastname: Conforto
mesh_terms: D018450:Disease Progression; D019054:Evoked Potentials, Motor; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome