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Cerebral Cortex Advance Access published online on May 4, 2005
Cerebral Cortex, doi:10.1093/cercor/bhi103
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© The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oupjournals.org

Article

Imagery-induced Cortical Excitability Changes in Stroke: A Transcranial Magnetic Stimulation Study

Paola Cicinelli 1*, Barbara Marconi 1, Marina Zaccagnini 1, Patrizio Pasqualetti 2, Maria Maddalena Filippi 3, and Paolo Maria Rossini 2

1 IRCCS Fondazione S. Lucia, Rehabilitation Hospital, Rome, Italy
2 AFaR Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy; Neurologia Clinica, Università Campus Biomedico, Rome, Italy
3 Neurologia Clinica, Università Campus Biomedico, Rome, Italy

* To whom correspondence should be addressed.
Paola Cicinelli, E-mail: p.cicinelli{at}hsantalucia.it


  Abstract

Focal transcranial magnetic stimulation (TMS) was employed in a population of hemiparetic stroke patients in a post-acute stage to map out the abductor digiti minimi (ADM) muscle cortical representation of the affected (AH) and unaffected (UH) hemisphere at rest, during motor imagery and during voluntary contraction. Imagery induced an enhancement of the ADM map area and volume in both hemispheres in a way which partly corrected the abnormal asymmetry between AH and UH motor output seen in rest condition. The voluntary contraction was the task provoking maximal facilitation in the UH, whereas a similar degree of facilitation was obtained during voluntary contraction and motor imagery in the AH. We argued that motor imagery could induce a pronounced motor output enhancement in the hemisphere affected by stroke. Further, we demonstrated that imagery-induced excitability changes were specific for the muscle ‘prime mover’ for the imagined movement, while no differences were observed with respect to the stroke lesion locations. Present findings demonstrated that motor imagery significantly enhanced the cortical excitability of the hemisphere affected by stroke in a post-acute stage. Further studies are needed to correlate these cortical excitability changes with short-term plasticity therefore prompting motor imagery as a ‘cortical reservoir’ in post-stroke motor rehabilitation.

Keywords: functional recovery; motor imagery; motor mapping; TMS.
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