title: Shaping Early Reorganization of Neural Networks Promotes Motor Function after Stroke.
abstract: Neural plasticity is a major factor driving cortical reorganization after stroke. We here tested whether repetitively enhancing motor cortex plasticity by means of intermittent theta-burst stimulation (iTBS) prior to physiotherapy might promote recovery of function early after stroke. Functional magnetic resonance imaging (fMRI) was used to elucidate underlying neural mechanisms. Twenty-six hospitalized, first-ever stroke patients (time since stroke: 1-16 days) with hand motor deficits were enrolled in a sham-controlled design and pseudo-randomized into 2 groups. iTBS was administered prior to physiotherapy on 5 consecutive days either over ipsilesional primary motor cortex (M1-stimulation group) or parieto-occipital vertex (control-stimulation group). Hand motor function, cortical excitability, and resting-state fMRI were assessed 1 day prior to the first stimulation and 1 day after the last stimulation. Recovery of grip strength was significantly stronger in the M1-stimulation compared to the control-stimulation group. Higher levels of motor network connectivity were associated with better motor outcome. Consistently, control-stimulated patients featured a decrease in intra- and interhemispheric connectivity of the motor network, which was absent in the M1-stimulation group. Hence, adding iTBS to prime physiotherapy in recovering stroke patients seems to interfere with motor network degradation, possibly reflecting alleviation of post-stroke diaschisis.
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany.|Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA.|Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: L J
authors.initials: LJ
authors.lastname: Volz
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany.|Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: A K
authors.initials: AK
authors.lastname: Rehme
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany.|Max Planck Institute for Neurological Research, Cologne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Michely
authors.affiliation: Max Planck Institute for Neurological Research, Cologne, Germany.|Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Nettekoven
authors.affiliation: Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany.|Institute for Clinical Neuroscience, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: S B
authors.initials: SB
authors.lastname: Eickhoff
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany.|Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany.
authors.forename: G R
authors.initials: GR
authors.lastname: Fink
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany.|Max Planck Institute for Neurological Research, Cologne, Germany.|Institute of Neurosciences and Medicine (INM-1, INM-3), Juelich Research Centre, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Grefkes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007297:Inpatients; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009069:Movement Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology*; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology; D012146:Rest; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: diaschisis; fMRI; motor network connectivity; motor recovery; rTMS; stroke