Magnetic transcranial stimulation: clinical interest of the silent period in acute and chronic stages of stroke

Catano, Antonio; Houa, Myriam; Noël, Pierre

doi:10.1016/s0924-980x(97)00021-0

Cited by 45 publications

(22 citation statements)

References 32 publications

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“…Raised motor thresholds in the AH have been described in several reports (Heald et al 1993; Catano et al 1996, 1997a; Traversa et al 2000; Nardone and Tezzon 2002). Here, the resting thresholds in the AH had largely normalized by 1 month, although active thresholds were still raised at 3 months.…”

Section: Discussionmentioning

confidence: 79%

Stages of Motor Output Reorganization after Hemispheric Stroke Suggested by Longitudinal Studies of Cortical Physiology

et al. 2008

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Reorganization of motor circuits in the cerebral cortex is thought to contribute to recovery following stroke. These can be examined with transcranial magnetic stimulation (TMS) using measures of corticospinal tract integrity and intracortical excitability. However, little is known about how these changes develop during the important early period post-stroke and their influence on recovery. We used TMS to obtain multiple measures bilaterally in a group of 10 patients during the early days and weeks and up to 6 months post-stroke, in order to examine correlations with tests of hand function. Ten age-matched healthy subjects were also studied. After stroke, day-to-day variation in performance was unrelated to physiological measures in the first 3 weeks. Measures of corticospinal integrity averaged over the same period correlated well with hand function, but this relationship became weaker at 3 months. In contrast, most intracortical excitability measures did not correlate acutely but did so strongly at 3 months. Thus in the acute stage, patients’ performance is limited by damage to corticospinal output. Improved performance at 3 months may depend on reorganization in alternative cortical networks to maximize the efficiency of remaining corticospinal pathways—intracortical disinhibition may aid recovery by promoting access to these networks.

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Section: Discussionmentioning

confidence: 79%

Stages of Motor Output Reorganization after Hemispheric Stroke Suggested by Longitudinal Studies of Cortical Physiology

et al. 2008

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“…Our finding of a positive relationship between biceps cSP and motor ability (higher Fugl-Meyer scores), proximal arm motor performance (faster reaching response times) and spasticity (lower Modified Ashworth scores) appears to differ with these previously reported findings. However, in regards to the latter, even in patients with some recovery of hand movement there have been reports of a relationship between stronger intracortical inhibition in the affected hemisphere and lower Modified Ashworth scores (Uozumi et al , 1992, Catano et al , 1997, Catano et al , 1997{Cruz Martinez, 1998 #1445, Cruz Martinez et al , 1998). Interestingly, this association found with cSPs has been also reported when studying intracortical inhibition with paired-pulse TMS (a measure thought to reflect inhibition mediated by a different GABA subtype; (Liepert, 2006)).…”

Section: Discussionmentioning

confidence: 99%

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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“…Therefore, although this study was not designed to search for drug-induced changes, we believe that the reported findings on cortical motor excitability are unlikely to represent drug-related effects in our patient population. In a few studies, contraction force has been reported to affect SP duration (Catano et al, 1997), hence the use of a digital force gauge for continued monitoring would have been ideal for optimization of this factor. A very recent study suggests that SP durations evoked by an intensity of !130% RMT are more reliable (Damron et al, 2008), and Chistyakov and colleagues (2001) reported prolonged SP durations in mild-to-moderate TBI patients only with a TMS intensity of 130% RMT.…”

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confidence: 99%

Abnormal Corticospinal Excitability in Traumatic Diffuse Axonal Brain Injury

Bernabeu

Demirtaş-Tatlıdede

Opisso

et al. 2009

Journal of Neurotrauma

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This study aimed to investigate the cortical motor excitability characteristics in diffuse axonal injury (DAI) due to severe traumatic brain injury (TBI). A variety of excitatory and inhibitory transcranial magnetic stimulation (TMS) paradigms were applied to primary motor cortices of 17 patients and 11 healthy controls. The parameters of testing included resting motor threshold (MT), motor evoked potential (MEP) area under the curve, input-output curves, MEP variability, and silent period (SP) duration. The patient group overall revealed a higher MT, smaller MEP areas, and narrower recruitment curves compared to normal controls (p < 0.05). The alterations in excitability were more pronounced with an increase in DAI severity (p < 0.005) and the presence of motor impairment (p < 0.05), while co-existence of focal lesions did not affect the degree of MEP changes. MEP variability was significantly lower in the group with motor impairment only (p < 0.05). The intracortical inhibition, as revealed by SP duration, did not exhibit any significant differences in any of the patient groups. In conclusion, our findings expand the concept that impairment of the excitatory and inhibitory phenomena in the motor cortex does not proceed in parallel and demonstrate distinct patterns of aberrations in TBI. Furthermore, these data suggest that alterations in the corticospinal excitatory mechanisms are determined predominantly by the severity of DAI, and show a significant relationship with clinical motor dysfunction following severe trauma diffusely affecting the motor cortical connections. In severe TBI, motor and functional recovery might be linked to restitution of normal corticospinal mechanisms, indexed by normalization of the cortical excitability parameters.

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Magnetic transcranial stimulation: clinical interest of the silent period in acute and chronic stages of stroke

Cited by 45 publications

References 32 publications

Stages of Motor Output Reorganization after Hemispheric Stroke Suggested by Longitudinal Studies of Cortical Physiology

Stages of Motor Output Reorganization after Hemispheric Stroke Suggested by Longitudinal Studies of Cortical Physiology

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

Abnormal Corticospinal Excitability in Traumatic Diffuse Axonal Brain Injury

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