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Interhemispheric Competition After Stroke: Brain Stimulation to Enhance Recovery of Function of the Affected Hand

Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, Hospital for Neurosurgery and Neurology, Kipfenberg, Germany, dennis.nowak{at}neurologie-kipfenberg.de, Department of Neurology, University Hospital, University of Cologne, Cologne, Germany

Christian Grefkes, MD

Department of Neurology, University Hospital, University of Cologne, Cologne, Germany, Neuromodulation and Neurorehabilitation Group, Max Planck Institute for Neurological Research, Cologne Germany

Mitra Ameli, MD

Department of Neurology, University Hospital, University of Cologne, Cologne, Germany

Gereon R. Fink, MD, PhD

Department of Neurology, University Hospital, University of Cologne, Cologne, Germany

Background and purpose. Within the concept of interhemispheric competition, technical modulation of the excitability of motor areas in the contralesional and ipsilesional hemisphere has been applied in an attempt to enhance recovery of hand function following stroke. This review critically summarizes the data supporting the use of novel electrophysiological concepts in the rehabilitation of hand function after stroke. Summary of review. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are powerful tools to inhibit or facilitate cortical excitability. Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke. No significant adverse effects have been noted when applying brain stimulation in stroke patients. To date, however, the clinical effects are small to moderate and short lived. Future work should elucidate whether repetitive administration of rTMS or tDCS over several days and the combination of these techniques with behavioral training (ie, physiotherapy) could result in an enhanced effectiveness. Conclusion. Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.

Key Words: Stroke rehabilitation • Repetitive transcranial magnetic stimulation • Transcranial direct current stimulation • Interhemispheric competition

This version was published on September 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 7, 641-656 (2009)
DOI: 10.1177/1545968309336661


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