Ann Rehabil Med.  2018 Aug;42(4):495-501. 10.5535/arm.2018.42.4.495.

Changes in Intracortical Excitability of Affected and Unaffected Hemispheres After Stroke Evaluated by Paired-Pulse Transcranial Magnetic Stimulation

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea. mhko@jbnu.ac.kr
  • 2Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

Abstract


OBJECTIVE
To assess the altered pattern of intracortical excitability of the affected and unaffected hemispheres in stroke patients using paired-pulse transcranial magnetic stimulation (TMS).
METHODS
We evaluated intracortical inhibition (ICI) and intracortical facilitation (ICF) in both hemispheres at acute and subacute stages of 103 stroke patients using paired-pulse TMS. The patients were divided into two groups: mild-to-moderate patients whose motor evoked potential (MEP) was recorded in the affected hemisphere; and severe patients whose MEP was not recorded in the affected hemisphere.
RESULTS
In mild-to-moderate patients, the value of ICI in the affected hemisphere was increased from 70.3% to 77.9% and the value of ICI in the unaffected hemisphere was decreased from 74.8% to 70.3% with eventual progression in acute to subacute stages of stroke. In severe patients, the value of ICI in the unaffected hemisphere was increased from 65.4% to 75.6%. The changes in ICF were not significantly different in this study.
CONCLUSION
We conclude that the unaffected hemisphere was more disinhibited than the affected hemisphere in acute phase of mild-to-moderate stroke, and the affected hemisphere was more disinhibited in the subacute stage. The unaffected hemisphere was inhibited in severe cases in acute-to-subacute phases of stroke. This finding facilitates appropriate neuromodulation of acute-to-subacute phases in mild-to-severe stroke patients.

Keyword

Transcranial magnetic stimulation; Cortical excitability; Stroke

MeSH Terms

Evoked Potentials, Motor
Humans
Stroke*
Transcranial Magnetic Stimulation*

Figure

  • Fig. 1. Comparison of the changes in intracortical excitability of cerebral hemisphere. AH, affected hemisphere; UH, unaffected hemisphere; T1, 1st assessment session; T2, 2nd assessment session. *p<0.05.


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