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Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke - PubMed

Michael A Dimyan  1 , Leonardo G Cohen

Review

Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke

Michael A Dimyan et al. Neurorehabil Neural Repair. 2010 Feb.

Abstract

Motor impairments are a major cause of morbidity and disability after stroke. This article reviews evidence obtained using transcranial magnetic stimulation (TMS) that provides new insight into mechanisms of impaired motor control and disability. They briefly discuss the use of TMS in the diagnosis, prognosis, and therapy of poststroke motor disability. Particular emphasis is placed on TMS as a tool to explore mechanisms of neuroplasticity during spontaneous and treatment-induced recovery of motor function to develop more rational and clinically useful interventions for stroke rehabilitation.

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Figures

Figure 1. Intra- and inter-hemispheric excitability within M1 in the healthy (A) and stroke affected (B) brain

This diagram depicts intracortical neuronal populations within the primary motor cortices that experience excitability changes after stroke. Black neurons reflect inhibitory influences and white neurons represent excitatory populations. A) Diagram of M1s interactions in the healthy brain that result in modulation of excitability in pyramidal tract (PT) neurons as tested by TMS. B) Changes in activity of these networks after stroke. Ipsilesional short interval intracortical inhibition (SICI) within M1 is decreased compared to the contralesional M1. At movement onset, interhemispheric inhibition at 10ms inter-stimulus intervals (IHI10) from contralesional to ipsilesional M1 is greater in the stroke brain than in the healthy brain. Whether this change in IHI10 is due to an increase in the transcallosal glutamatergic elements or ipsilesional inhibitory networks, and how IHI10 interacts with SICI in the stroke brain have yet to be elucidated.

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