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August 11, 2015; 85 (6) Article

Stroke subtype and motor impairment influence contralesional excitability

Gary W. Thickbroom, Mar Cortes, Avrielle Rykman, Bruce T. Volpe, Felipe Fregni, H. Igo Krebs, Alvaro Pascual-Leone, Dylan J. Edwards
First published July 17, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001828
Gary W. Thickbroom
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.
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Mar Cortes
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.
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Avrielle Rykman
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.
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Bruce T. Volpe
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.
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Felipe Fregni
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.
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H. Igo Krebs
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.
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Alvaro Pascual-Leone
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.
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Dylan J. Edwards
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.
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Citation
Stroke subtype and motor impairment influence contralesional excitability
Gary W. Thickbroom, Mar Cortes, Avrielle Rykman, Bruce T. Volpe, Felipe Fregni, H. Igo Krebs, Alvaro Pascual-Leone, Dylan J. Edwards
Neurology Aug 2015, 85 (6) 517-520; DOI: 10.1212/WNL.0000000000001828

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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.

Conclusion: 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.

GLOSSARY

Cx=
cortico-subcortical;
FM=
Fugl-Meyer;
M1L=
lesioned motor cortex;
M1NL=
nonlesioned primary motor cortex;
MEPNL=
nonlesioned motor evoked potential;
MP=
motor power;
MSO=
maximum stimulator output;
RMTL=
lesioned hemisphere resting motor threshold;
RMTNL=
nonlesioned hemisphere resting motor threshold;
SC=
subcortical;
TCI=
transcallosal inhibition;
TOAST=
Trial of Org 10172 in Acute Stroke Treatment;
WMS=
Wolf Motor Score

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received December 1, 2014.
  • Accepted in final form April 10, 2015.
  • © 2015 American Academy of Neurology
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