Changes in Intracortical Excitability of Affected and Unaffected Hemispheres After Stroke Evaluated by Paired-Pulse Transcranial Magnetic Stimulation
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (23)
- Sanes JN, "Plasticity and primary motor cortex", Annu Rev Neurosci, 23, pp.393~415 (2000)[DOI]
- Hummel F, "Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke", Brain, 128, pp.490~499 (2005)[DOI]
- Khedr EM, "Long-term effect of repetitive transcranial magnetic stimulation on motor function recovery after acute ischemic stroke", Acta Neurol Scand, 121, pp.30~37 (2010)[DOI]
- 고명환, "뇌졸중 환자에서 경두개 직류전류 자극에 의한 손 기능 호전", Annals of Rehabilitation Medicine, 33(3), pp.259~264 (2009), 대한재활의학회
- Chang WH, "Long-term effects of rTMS on motor recovery in patients after subacute stroke", J Rehabil Med, 42, pp.758~764 (2010)[DOI]
- 김서영, "Factors Associated With Upper Extremity Functional Recovery Following Low-Frequency Repetitive Transcranial Magnetic Stimulation in Stroke Patients", Annals of Rehabilitation Medicine, 40(3), pp.373~382 (2016), 대한재활의학회
- Hickmott PW, "Local circuit properties underlying cortical reorganization", J Neurophysiol, 88, pp.1288~1301 (2002)[DOI]
- Kujirai T, "Corticocortical inhibition in human motor cortex", J Physiol, 471, pp.501~519 (1993)[DOI]
- Cicinelli P, "Interhemispheric asymmetries of motor cortex excitability in the postacute stroke stage: a paired-pulse transcranial magnetic stimulation study", Stroke, 34, pp.2653~2658 (2003)[DOI]
- Manganotti P, "Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke", Clin Neurophysiol, 113, pp.936~943 (2002)[DOI]
- Liepert J, "The glutamate antagonist riluzole suppresses intracortical facilitation", J Neural Transm (Vienna), 104, pp.1207~1214 (1997)[DOI]
- Shimizu T, "Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke", Brain, 125, pp.1896~1907 (2002)[DOI]
- Rossini PM, "Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee", Electroencephalogr Clin Neurophysiol, 91, pp.79~92 (1994)[DOI]
- Liepert J, "Motor cortex disinhibition of the unaffected hemisphere after acute stroke", Muscle Nerve, 23, pp.1761~1763 (2000)[DOI]
- Boroojerdi B, "Transcallosal inhibition in cortical and subcortical cerebral vascular lesions", J Neurol Sci, 144, pp.160~170 (1996)[DOI]
- Netz J, "Reorganization of motor output in the non-affected hemisphere after stroke", Brain, 120, pp.1579~1586 (1997)[DOI]
- Turton A, "Contralateral and ipsilateral EMG responses to transcranial magnetic stimulation during recovery of arm and hand function after stroke", Electroencephalogr Clin Neurophysiol, 101, pp.316~328 (1996)[DOI]
- Boddington LJ, "Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation", Brain Stimul, 10, pp.214~222 (2017)[DOI]
- Di Pino G, "Modulation of brain plasticity in stroke: a novel model for neurorehabilitation", Nat Rev Neurol, 10, pp.597~608 (2014)[DOI]
- Mittmann T, "Lesion-induced transient suppression of inhibitory function in rat neocortex in vitro", Neuroscience, 60, pp.891~906 (1994)[DOI]
- Honaga K, "State of intracortical inhibitory interneuron activity in patients with chronic stroke", Clin Neurophysiol, 124, pp.364~370 (2013)[DOI]
- Lefaucheur JP, "Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)", Clin Neurophysiol, 125, pp.2150~2206 (2014)[DOI]
- Cassidy JM, "Interhemispheric inhibition measurement reliability in stroke: a pilot study", Neuromodulation, 19, pp.838~847 (2016)[DOI]