title: Stroke subtype and motor impairment influence contralesional excitability.
abstract: OBJECTIVE
  The nonlesioned motor cortex (M1NL) is thought to be hyperexcitable in patients with subacute or chronic stroke and offers a promising therapeutic target. However, whether M1NL excitability behaves the same for subcortical and cortical strokes is unknown. The aim of the present study was to determine whether cortical, or purely subcortical, strokes have a different effect on M1NL excitability.
  
  
  METHODS
  We looked for correlations between the Fugl-Meyer (FM) score and M1NL resting motor threshold (RMTNL) in 34 stroke survivors classified according to lesion location (cortico-subcortical or purely subcortical). In addition to the FM, the Wolf Motor Score and motor power were measured.
  
  
  RESULTS
  FM correlated with RMTNL for subcortical (r = 0.82; p = 0.001) but not for cortical strokes (r = 0.11; p = 0.62). Likewise, Wolf Motor Score (r = -0.62; p = 0.03) and motor power (r = 0.64; p = 0.023) were correlated with RMTNL for the subcortical group, but not for the cortical group.
  
  
  CONCLUSIONS
  We show that the impact on M1NL depends on lesion location and conclude that protocols aimed at reducing M1NL cortical excitability may be worth exploring for subcortical but not for cortical stroke.
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Thickbroom
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Mar
authors.initials: M
authors.lastname: Cortes
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Avrielle
authors.initials: A
authors.lastname: Rykman
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Volpe
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: H Igo
authors.initials: HI
authors.lastname: Krebs
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
authors.affiliation: From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. dje2002@med.cornell.edu.
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Edwards
mesh_terms: D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000473:pathology*; D009069:Movement Disorders / Q000209:etiology*; D059906:Neuroimaging; D012720:Severity of Illness Index; D013223:Statistics as Topic; D020521:Stroke / Q000145:classification / Q000150:complications / Q000473:pathology; D034941:Upper Extremity / Q000503:physiopathology