Hospital District of Helsinki and Uusimaa, Helsinki, Finland.
Top Stroke Rehabil. 2012 Mar-Apr;19(2):182-92. doi: 10.1310/tsr1902-182.
To follow cortical excitability changes during recovery from stroke with navigated transcranial magnetic stimulation (nTMS), in particular, to characterize changes of short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF), to correlate them with recovery of upper extremity function, and to detect possible shifts of cortical hand representations.
Single and paired pulse nTMS were delivered to the hemisphere with infarction and to the hemisphere without infarction in 14 first-ever stroke patients at 1 (T1) and 3 months (T2) after stroke. Electromyographic responses to nTMS stimulation were recorded from the first dorsal interosseus muscles. nTMS was used to ensure an accurate coil repositioning in repeated measurements. Hand function recovery was clinically evaluated using the Action Research Arm Test (ARAT) and 9-hole peg test (9-HPT).
SICI and ICF were modulated in both hemispheres during recovery. Inhibition in the hemisphere without infarction correlated significantly with the affected hand performance at T2; stronger disinhibition (poor inhibition) was associated with worse hand performance. Location of hand muscle representations was shifted in 3 well-recovered patients out of 14 patients at T2.
In line with earlier studies, disinhibition in the hemisphere without infarction may be related to poor recovery of the affected hand. Usage of the affected hand during stroke recovery seems to influence these cortical excitability changes. nTMS is a valuable tool for tracking muscle cortical representation changes during brain reorganization.
通过导航经颅磁刺激（nTMS）来跟踪中风后皮质兴奋性的变化，特别是描述短程抑制（SICI）和皮质易化（ICF）的变化，将其与上肢功能的恢复相关联，并检测皮质手代表区可能发生的变化。
在 14 名首次中风患者中风后 1 个月（T1）和 3 个月（T2）时，在梗死半球和非梗死半球分别进行单次和双脉冲 nTMS。nTMS 刺激的肌电图反应从第一背骨间肌记录。nTMS 用于确保在重复测量中准确重新定位线圈。使用动作研究臂测试（ARAT）和 9 孔钉测试（9-HPT）对上肢功能恢复进行临床评估。
在恢复过程中，双侧半球的 SICI 和 ICF 均受到调节。非梗死半球的抑制与 T2 时患手的表现显著相关；抑制减弱（抑制不良）与手功能较差相关。在 14 名患者中有 3 名恢复良好的患者，其手部肌肉代表区在 T2 时发生了移位。
与早期研究一致，非梗死半球的去抑制可能与患手恢复不良有关。在中风恢复过程中使用患手似乎会影响这些皮质兴奋性的变化。nTMS 是跟踪大脑重组过程中肌肉皮质代表区变化的一种有价值的工具。
