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Cerebral Cortex Advance Access published online on October 5, 2009
Cerebral Cortex, doi:10.1093/cercor/bhp216
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Motor Cortex Plasticity Predicts Recovery in Acute Stroke

Vincenzo Di Lazzaro1, P. Profice1, F. Pilato1, F. Capone1, F. Ranieri1, P. Pasqualetti2,3, C. Colosimo4, E. Pravatà4, A. Cianfoni5 and M. Dileone1

1 Istituto di Neurologia, Università Cattolica, 00168 Rome, Italy, 2 Servizio di Statistica Medica & Information Technology-Medical Statistics and Information Technology, Associazione Fatebenefratelli per la Ricerca-Fatebenefratelli Association for Research, Fatebenefratelli Hospital at Isola Tiberina, 00186 Rome, Italy, 3 Casa di Cura San Raffaele, Cassino and Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, 00163 Rome, Italy, 4 Institute of Radiology, Università Cattolica, 00168 Rome, Italy, 5 Medical University of South Carolina, WV 25301 Charleston, SC

Address correspondence to Vincenzo Di Lazzaro. Istituto di Neurologia, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy. Email: vdilazzaro{at}rm.unicatt.it

Repetitive transcranial magnetic stimulation of the brain given as intermittent theta burst stimulation (iTBS) can induce long-term potentiation (LTP)–like changes in the stimulated hemisphere and long-term depression (LTD)–like changes in the opposite hemisphere. We evaluated whether LTP- and LTD-like changes produced by iTBS in acute stroke correlate with outcome at 6 months. We evaluated the excitability of affected hemisphere (AH) and unaffected hemisphere (UH) by measuring motor threshold and motor-evoked potential (MEP) amplitude under baseline conditions and after iTBS of AH in 17 patients with acute ischemic stroke. Baseline amplitude of MEPs elicited from AH was significantly smaller than that of MEPs elicited from UH, and baseline motor threshold was higher for the AH. Higher baseline MEP values in UH correlated with poor prognosis. iTBS produced a significant increase in MEP amplitude for AH that was significantly correlated with recovery. A nonsignificant decrease in MEP amplitude was observed for the UH. When the decrease in the amplitude of UH MEPs was added to the regression model, the correlation was even higher. Functional recovery is directly correlated with LTP-like changes in AH and LTD-like changes in UH and inversely correlated with the baseline excitability of UH.

Key Words: LTD • LTP • transcranial magnetic stimulation


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