Volz L J, Rehme A K, Michely J, Nettekoven C, Eickhoff S B, Fink G R, Grefkes C
Department of Neurology, University Hospital Cologne, Cologne, Germany.
Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA.
Cereb Cortex. 2016 Jun;26(6):2882-2894. doi: 10.1093/cercor/bhw034. Epub 2016 Mar 14.
Neural plasticity is a major factor driving cortical reorganization after stroke. We here tested whether repetitively enhancing motor cortex plasticity by means of intermittent theta-burst stimulation (iTBS) prior to physiotherapy might promote recovery of function early after stroke. Functional magnetic resonance imaging (fMRI) was used to elucidate underlying neural mechanisms. Twenty-six hospitalized, first-ever stroke patients (time since stroke: 1-16 days) with hand motor deficits were enrolled in a sham-controlled design and pseudo-randomized into 2 groups. iTBS was administered prior to physiotherapy on 5 consecutive days either over ipsilesional primary motor cortex (M1-stimulation group) or parieto-occipital vertex (control-stimulation group). Hand motor function, cortical excitability, and resting-state fMRI were assessed 1 day prior to the first stimulation and 1 day after the last stimulation. Recovery of grip strength was significantly stronger in the M1-stimulation compared to the control-stimulation group. Higher levels of motor network connectivity were associated with better motor outcome. Consistently, control-stimulated patients featured a decrease in intra- and interhemispheric connectivity of the motor network, which was absent in the M1-stimulation group. Hence, adding iTBS to prime physiotherapy in recovering stroke patients seems to interfere with motor network degradation, possibly reflecting alleviation of post-stroke diaschisis.
神经可塑性是中风后驱动皮质重组的主要因素。我们在此测试了在物理治疗前通过间歇性θ波爆发刺激(iTBS)反复增强运动皮质可塑性是否可能促进中风后早期功能恢复。功能磁共振成像(fMRI)用于阐明潜在的神经机制。26名住院的首次中风患者(中风后时间:1 - 16天),伴有手部运动功能障碍,纳入假对照设计并伪随机分为2组。在连续5天的物理治疗前,对患侧初级运动皮质(M1刺激组)或顶枕叶顶点(对照刺激组)进行iTBS治疗。在首次刺激前1天和最后一次刺激后1天评估手部运动功能、皮质兴奋性和静息态fMRI。与对照刺激组相比,M1刺激组握力恢复明显更强。更高水平的运动网络连通性与更好的运动结果相关。一致地,对照刺激组患者的运动网络半球内和半球间连通性降低,而M1刺激组没有这种情况。因此,在中风康复患者的初始物理治疗中添加iTBS似乎可以干扰运动网络退化,这可能反映了中风后失联络的减轻。