Low-Frequency Repetitive TMS Plus Anodal Transcranial DCS Prevents Transient Decline in Bimanual Movement Induced by Contralesional Inhibitory rTMS After Stroke

Takeuchi, Naoyuki; Tada, Takanori; Matsuo, Yohei; Ikoma, Katsunori

doi:10.1177/1545968311433295

Cited by 57 publications

(65 citation statements)

References 40 publications

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“…paretic hand) is stronger than that targeting the unaffected hemisphere (Nair et al , 2007, Butefisch et al , 2008, Kirton et al , 2010) and abnormally persistent during paretic finger movement preparation (Murase et al , 2004, Duque et al , 2005), particularly in those with poorer hand recovery. Ipsilateral silent period measurements have provided further support for the notion that interhemispheric inhibition targeting the paretic hand is stronger than that targeting the non-paretic hand (Takeuchi et al , 2012, Takechi et al , 2014) and than that measured in controls (Netz et al , 1997). …”

Section: Introductionmentioning

confidence: 79%

Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis

Harris-Love

Chan

Dromerick

et al. 2015

Neurorehabil Neural Repair

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In well-recovered stroke patients with preserved hand movement, motor dysfunction relates to interhemispheric and intracortical inhibition in affected hand muscles. In less fully recovered patients unable to move their hand, the neural substrates of recovered arm movements, crucial for performance of daily living tasks, are not well understood. Here, we evaluated interhemispheric and intracortical inhibition in paretic arm muscles of patients with no recovery of hand movement (n=16, upper extremity Fugl-Meyer Assessment = 27.0 ± 8.6). We recorded silent periods (contralateral and ipsilateral) induced by transcranial magnetic stimulation (TMS) during voluntary isometric contraction of the paretic biceps and triceps brachii muscles (correlates of intracortical and interhemispheric inhibition respectively), and investigated links between the silent periods and motor recovery, an issue that has not been previously explored. We report that interhemispheric inhibition, stronger in the paretic triceps than biceps brachii muscles, significantly correlated with the magnitude of residual impairment (lower Fugl-Meyer scores). In contrast, intracortical inhibition in the paretic biceps brachii, but not in the triceps, correlated positively with motor recovery (Fugl-Meyer scores) and negatively with spasticity (lower Modified Ashworth scores). Our results suggest that interhemispheric inhibition and intracortical inhibition of paretic upper arm muscles relate to motor recovery in different ways. While interhemispheric inhibition may contribute to poorer recovery, muscle-specific intracortical inhibition may relate to successful motor recovery and lesser spasticity.

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Section: Introductionmentioning

confidence: 79%

Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis

Harris-Love

Chan

Dromerick

et al. 2015

Neurorehabil Neural Repair

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“…A balanced ratio (~1) would indicate a balanced level of TCI exerted between both hemispheres, whereas an iSP ratio <1 indicates greater inhibition exerted from the ipsilesional upon contralesional hemisphere, and >1 indicates greater inhibition from the contralesional upon ipsilesional hemisphere. 35 …”

Section: Methodsmentioning

confidence: 99%

Assessment of Inter-Hemispheric Imbalance Using Imaging and Noninvasive Brain Stimulation in Patients With Chronic Stroke

Cunningham

Machado

Janini

et al. 2015

Archives of Physical Medicine and Rehabilitation

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OBJECTIVE To determine how inter-hemispheric balance in stroke, measured using transcranial magnetic stimulation (TMS), relates to balance defined using neuroimaging (functional magnetic resonance (fMRI) and diffusion tensor imaging (DTI)), and how these metrics of balance are associated with clinical measures of upper limb function and disability. DESIGN Cross-Sectional SETTING Clinical Research Laboratory PARTICIPANTS Ten chronic stroke patients (63±9 years) in a population based sample with unilateral upper-limb paresis. INTERVENTION Not applicable MAIN OUTCOME MEASURES Inter-hemispheric balance was measured with TMS, fMRI and DTI. TMS defined inter-hemispheric differences in recruitment of corticospinal output, the size of the corticomotor output maps and the degree of mutual transcallosal inhibition they exerted upon one another. fMRI studied whether cortical activation during the movement of the paretic hand was lateralized to the ipsilesional or to the contralesional primary motor (M1), premotor (PMC) and supplementary motor cortices (SMA). DTI was used to define inter-hemispheric differences in the integrity of the corticospinal tracts projecting from M1. Clinical outcomes tested function (upper-extremity Fugl-Meyer (UEFM) and the perceived disability in the use of the paretic hand [Motor Activity Log (MAL)]. RESULTS Inter-hemispheric balance assessed with TMS relates differently to fMRI and DTI. Patients with high fMRI lateralization to the ipsilesional hemisphere possessed stronger ipsilesional corticomotor output maps [M1 (r=.831, p=.006), PMC (r=.797, p=.01)], and better balance of mutual transcallosal inhibition (r=.810, p=.015). Conversely, we have found that patients with less integrity of the corticospinal tracts in the ipsilesional hemisphere show greater corticospinal output of homologous tracts in the contralesional hemisphere (r=.850, p=.004). However, neither an imbalance in their integrity nor an imbalance of their output relates to transcallosal inhibition. Clinically, while patients with less integrity of corticospinal tracts from the ipsilesional hemisphere showed worse impairments (UEFM) (r = −.768, p=.016), those with low fMRI lateralization to the ipsilesional hemisphere had greater perception of disability (MAL) [M1 (r=.883, p=.006), PMC (r=.817, p=.007) and SMA (r=.633, p=.062). CONCLUSIONS In patients with chronic motor deficits of the upper limb, fMRI may serve to mark perceived disability as well as transcallosal influence between hemispheres. DTI-based integrity of corticospinal tracts, however, may be useful in categorizing the range of functional impairments of the upper-limb. Further, in patients with extensive corticospinal damage, DTI may help infer the role of the contralesional hemisphere in recovery.

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“…Though these so-called state-dependent effects pose a challenge to the goal of a consistent and efficacious response, once identified, they can be exploited as well. To this end, NBS is increasingly combined with regimens of motor or cognitive training (e.g., Ditye et al, 2012; Reis et al, 2009), or other forms of NBS (Grüner et al, 2010; Loo et al, 2009; Takeuchi et al, 2012). …”

Section: Can Nbs Really Enhance Functions?mentioning

confidence: 99%

Is neuroenhancement by noninvasive brain stimulation a net zero-sum proposition?

et al. 2014

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In the past several years, the number of studies investigating enhancement of cognitive functions through non-invasive brain stimulation (NBS) has increased considerably. NBS techniques, such as transcranial magnetic stimulation and transcranial current stimulation, seem capable of enhancing cognitive functions in patients and in healthy humans, particularly when combined with other interventions, including pharmacologic, behavioral and cognitive therapies. The “net zero-sum model”, based on the assumption that brain resources are subjected to the physical principle of conservation of energy, is one of the theoretical frameworks proposed to account for such enhancement of function and its potential cost. We argue that to guide future neuroenhancement studies, the net-zero sum concept is helpful, but only if its limits are tightly defined.

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Low-Frequency Repetitive TMS Plus Anodal Transcranial DCS Prevents Transient Decline in Bimanual Movement Induced by Contralesional Inhibitory rTMS After Stroke

Cited by 57 publications

References 40 publications

Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis

Neural Substrates of Motor Recovery in Severely Impaired Stroke Patients With Hand Paralysis

Assessment of Inter-Hemispheric Imbalance Using Imaging and Noninvasive Brain Stimulation in Patients With Chronic Stroke

Is neuroenhancement by noninvasive brain stimulation a net zero-sum proposition?

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