BACKGROUND: Training-related improvements in motor function are associated with changes in movement representation of the primary motor cortex (M1). In healthy individuals, transcranial magnetic stimulation (TMS) of M1 delivered in a strict temporal relationship (Hebbian-type stimulation) during execution of movements enhances these effects and is superior to random stimulation. OBJECTIVE: The authors tested whether training combined with Hebbian-type M1 stimulation enhances M1 reorganization in patients with stroke. METHODS: Six patients with chronic stroke participated in the study. Patients executed robot-assisted wrist extension movements at 0.2 Hz frequency while subthreshold repetitive TMS was applied over M1 in a strict temporal relationship to the training movements. TMS was applied to either the affected hemisphere (contralateral M1) or the nonaffected hemisphere (ipsilateral M1) at 0.1 Hz. Intervention-related changes in motor maps and intracortical excitability were measured using TMS. RESULTS: Training alone or combined Hebbian-type stimulation of either M1 resulted in differential effects on motor maps and intracortical inhibition. Shifts in motor maps were associated with increases in intracortical excitability. In contrast to previous results for healthy participants, the inhibitory effect of ipsilateral M1 Hebbian-type stimulation was not present, and the facilitatory effect of contralateral M1 stimulation was more subtle. CONCLUSIONS: Hebbian-type stimulation is feasible in patients poststroke and induces map reorganization and associated decreases in GABAergic inhibition. However, because TMS protocols have a different effect on motor reorganization in the injured brain and may depend on location of the lesion, protocols need to be tailored to the patient's pathology.
BACKGROUND: Training-related improvements in motor function are associated with changes in movement representation of the primary motor cortex (M1). In healthy individuals, transcranial magnetic stimulation (TMS) of M1 delivered in a strict temporal relationship (Hebbian-type stimulation) during execution of movements enhances these effects and is superior to random stimulation. OBJECTIVE: The authors tested whether training combined with Hebbian-type M1 stimulation enhances M1 reorganization in patients with stroke. METHODS: Six patients with chronic stroke participated in the study. Patients executed robot-assisted wrist extension movements at 0.2 Hz frequency while subthreshold repetitive TMS was applied over M1 in a strict temporal relationship to the training movements. TMS was applied to either the affected hemisphere (contralateral M1) or the nonaffected hemisphere (ipsilateral M1) at 0.1 Hz. Intervention-related changes in motor maps and intracortical excitability were measured using TMS. RESULTS: Training alone or combined Hebbian-type stimulation of either M1 resulted in differential effects on motor maps and intracortical inhibition. Shifts in motor maps were associated with increases in intracortical excitability. In contrast to previous results for healthy participants, the inhibitory effect of ipsilateral M1 Hebbian-type stimulation was not present, and the facilitatory effect of contralateral M1 stimulation was more subtle. CONCLUSIONS: Hebbian-type stimulation is feasible in patients poststroke and induces map reorganization and associated decreases in GABAergic inhibition. However, because TMS protocols have a different effect on motor reorganization in the injured brain and may depend on location of the lesion, protocols need to be tailored to the patient's pathology.
Authors: Jessica Cooperrider; Havan Furmaga; Ela Plow; Hyun-Joo Park; Zhihong Chen; Grahame Kidd; Kenneth B Baker; John T Gale; Andre G Machado Journal: J Neurosci Date: 2014-07-02 Impact factor: 6.167
Authors: Kate Pirog Revill; Marc W Haut; Samir R Belagaje; Fadi Nahab; Daniel Drake; Cathrin M Buetefisch Journal: Neurorehabil Neural Repair Date: 2020-01-24 Impact factor: 3.919
Authors: C M Buetefisch; C Howard; C Korb; M W Haut; L Shuster; P Pergami; C Smith; G Hobbs Journal: Clin Neurophysiol Date: 2014-07-12 Impact factor: 3.708
Authors: Adrian G Guggisberg; Philipp J Koch; Friedhelm C Hummel; Cathrin M Buetefisch Journal: Clin Neurophysiol Date: 2019-04-15 Impact factor: 3.708
Authors: Penelope Talelli; Amanda Wallace; Michelle Dileone; Damon Hoad; Binith Cheeran; Rupert Oliver; Mehdi VandenBos; Ulrike Hammerbeck; Karen Barratt; Cecilia Gillini; Gabriella Musumeci; Marie-Hélène Boudrias; Geoffrey C Cloud; Joanna Ball; Jonathan F Marsden; Nicholas S Ward; Vincenzo Di Lazzaro; Richard G Greenwood; John C Rothwell Journal: Neurorehabil Neural Repair Date: 2012-03-12 Impact factor: 3.919