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

doi:10.1212/WNL.0000000000001828

Stroke subtype and motor impairment influence contralesional excitability

Neurology. 2015 Aug 11;85(6):517-20. doi: 10.1212/WNL.0000000000001828. Epub 2015 Jul 17.

Authors

Gary W Thickbroom¹, Mar Cortes¹, Avrielle Rykman¹, Bruce T Volpe¹, Felipe Fregni¹, H Igo Krebs¹, Alvaro Pascual-Leone¹, Dylan J Edwards²

Affiliations

¹ 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.
² 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. dje2002@med.cornell.edu.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Female
Functional Laterality / physiology*
Humans
Male
Motor Cortex / pathology*
Movement Disorders / etiology*
Neuroimaging
Severity of Illness Index
Statistics as Topic
Stroke* / classification
Stroke* / complications
Stroke* / pathology
Upper Extremity / physiopathology

Abstract

Publication types

MeSH terms

Grants and funding