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Neurorehabilitation and Neural Repair
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1545968307302438v1
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Article

Dynamic Course of Intracortical TMS Paired-Pulse Responses During Recovery of Motor Function After Stroke

George F. Wittenberg, MD, PhD1*, Eric P. Bastings, MD2, Allison M. Fowlkes, MS3, Timothy M. Morgan, PhD4, David C. Good, MD5, Timothy P. Pons, PhD6

1 Departments of Neurology and Physiology and Pharmacology and the Neuroscience Program, Wake Forest University Health Sciences, Winston-Salem, NC
2 Department of Neurology, Wake Forest University Health Sciences,Winston-Salem, NC
3 Department of Neurology, Wake Forest University Health Sciences, Winston-Salem, NC
4 Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC
5 Departments of Neurology, Wake Forest University Health Sciences, Winston-Salem, NC
6 Departments of Neurosurgery and Physiology and Pharmacology and the Neuroscience Program, Wake Forest University Health Sciences, Winston-Salem, NC

* To whom correspondence should be addressed. E-mail: GWittenb{at}GRECC.UMaryland.edu.


  Abstract
Background. Recovery of motor function after stroke may be associated with changes in inhibitory and facilitatory circuits within the motor cortex. Objective. We explored such changes longitudinally after stroke, using transcranial magnetic stimulation (TMS). Methods. Subjects (N =27) with a single cerebral infarction affecting movement of either hand were studied at <10 days poststroke, 1 month, and 6 months. Age-matched control subjects (N =9) were studied at 2 times. Results. In contrast to previous studies, paired-pulse inhibition was increased in patients with a subcortical stroke compared to control subjects. After a cortical stroke, paired-pulse facilitation was also increased. Stroke location affected the time course of inhibition. Subcortical stroke resulted in increased inhibition initially that decreased over time, whereas cortical stroke had no significant effect on inhibition and a more immediate and lasting effect on facilitation. Conclusions.The time course of a decline in inhibition based on TMS after subcortical stroke followed the gain in motor recovery. Increased facilitation in cortical stroke patients is more likely to represent the effect of early cortical circuit disruption and may not play a role in subacute changes in motor function.

First published on May 23, 2007, doi:10.1177/1545968307302438

Neurorehabilitation and Neural Repair 2007;21:568.

A more recent version of this article appeared on December 1, 2007

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