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Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke.
Ann Neurol. 2009 Sep; 66(3):298-309.AN

Abstract

OBJECTIVE

Facilitation of cortical excitability of the ipsilesional primary motor cortex (M1) may improve dexterity of the affected hand after stroke. The effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over ipsilesional M1 on movement kinematics and neural activity were examined in patients with subcortical or cortical stroke.

METHODS

Twenty-nine patients with impaired dexterity after stroke (16 subcortical middle cerebral artery [MCA] strokes, 13 MCA strokes involving subcortical tissue and primary or secondary cortical sensorimotor areas) received 1 session of 10 Hz rTMS (5-second stimulation, 25-second break, 1,000 pulses, 80% of the resting motor threshold) applied over: 1) ipsilesional M1 and 2) vertex (control stimulation). For behavioral testing, 29 patients performed index finger and hand tapping movements with the affected and unaffected hand prior to and following each rTMS application. For functional magnetic resonance imaging, 18 patients performed index finger tapping movements with the affected and unaffected hand before and after each rTMS application.

RESULTS

Ten-Hz rTMS over ipsilesional M1, but not over vertex, improved movement kinematics in 14 of 16 patients with subcortical stroke, but not in patients with additional cortical stroke. Ten-Hz rTMS slightly deteriorated dexterity of the affected hand in 7 of 13 cortical stroke patients. At a neural level, rTMS over ipsilesional M1 reduced neural activity of the contralesional M1 in 11 patients with subcortical stroke, but caused a widespread bilateral recruitment of primary and secondary motor areas in 7 patients with cortical stroke. Activity in ipsilesional M1 at baseline correlated with improvement of index finger tapping frequency induced by rTMS.

INTERPRETATION

The beneficial effects of 10 Hz rTMS over ipsilesional M1 on motor function of the affected hand depend on the extension of MCA stroke. Neural activity in ipsilesional M1 may serve as a surrogate marker for the effectiveness of facilitatory rTMS.

Authors+Show Affiliations

Department of Neurology, University Hospital Cologne, Cologne, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19798637

Citation

Ameli, Mitra, et al. "Differential Effects of High-frequency Repetitive Transcranial Magnetic Stimulation Over Ipsilesional Primary Motor Cortex in Cortical and Subcortical Middle Cerebral Artery Stroke." Annals of Neurology, vol. 66, no. 3, 2009, pp. 298-309.
Ameli M, Grefkes C, Kemper F, et al. Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke. Ann Neurol. 2009;66(3):298-309.
Ameli, M., Grefkes, C., Kemper, F., Riegg, F. P., Rehme, A. K., Karbe, H., Fink, G. R., & Nowak, D. A. (2009). Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke. Annals of Neurology, 66(3), 298-309. https://doi.org/10.1002/ana.21725
Ameli M, et al. Differential Effects of High-frequency Repetitive Transcranial Magnetic Stimulation Over Ipsilesional Primary Motor Cortex in Cortical and Subcortical Middle Cerebral Artery Stroke. Ann Neurol. 2009;66(3):298-309. PubMed PMID: 19798637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential effects of high-frequency repetitive transcranial magnetic stimulation over ipsilesional primary motor cortex in cortical and subcortical middle cerebral artery stroke. AU - Ameli,Mitra, AU - Grefkes,Christian, AU - Kemper,Friederike, AU - Riegg,Florian P, AU - Rehme,Anne K, AU - Karbe,Hans, AU - Fink,Gereon R, AU - Nowak,Dennis A, PY - 2009/10/3/entrez PY - 2009/10/3/pubmed PY - 2009/10/30/medline SP - 298 EP - 309 JF - Annals of neurology JO - Ann Neurol VL - 66 IS - 3 N2 - OBJECTIVE: Facilitation of cortical excitability of the ipsilesional primary motor cortex (M1) may improve dexterity of the affected hand after stroke. The effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over ipsilesional M1 on movement kinematics and neural activity were examined in patients with subcortical or cortical stroke. METHODS: Twenty-nine patients with impaired dexterity after stroke (16 subcortical middle cerebral artery [MCA] strokes, 13 MCA strokes involving subcortical tissue and primary or secondary cortical sensorimotor areas) received 1 session of 10 Hz rTMS (5-second stimulation, 25-second break, 1,000 pulses, 80% of the resting motor threshold) applied over: 1) ipsilesional M1 and 2) vertex (control stimulation). For behavioral testing, 29 patients performed index finger and hand tapping movements with the affected and unaffected hand prior to and following each rTMS application. For functional magnetic resonance imaging, 18 patients performed index finger tapping movements with the affected and unaffected hand before and after each rTMS application. RESULTS: Ten-Hz rTMS over ipsilesional M1, but not over vertex, improved movement kinematics in 14 of 16 patients with subcortical stroke, but not in patients with additional cortical stroke. Ten-Hz rTMS slightly deteriorated dexterity of the affected hand in 7 of 13 cortical stroke patients. At a neural level, rTMS over ipsilesional M1 reduced neural activity of the contralesional M1 in 11 patients with subcortical stroke, but caused a widespread bilateral recruitment of primary and secondary motor areas in 7 patients with cortical stroke. Activity in ipsilesional M1 at baseline correlated with improvement of index finger tapping frequency induced by rTMS. INTERPRETATION: The beneficial effects of 10 Hz rTMS over ipsilesional M1 on motor function of the affected hand depend on the extension of MCA stroke. Neural activity in ipsilesional M1 may serve as a surrogate marker for the effectiveness of facilitatory rTMS. SN - 1531-8249 UR - https://www.unboundmedicine.com/medline/citation/19798637/Differential_effects_of_high_frequency_repetitive_transcranial_magnetic_stimulation_over_ipsilesional_primary_motor_cortex_in_cortical_and_subcortical_middle_cerebral_artery_stroke_ L2 - https://doi.org/10.1002/ana.21725 DB - PRIME DP - Unbound Medicine ER -