Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
Neurorehabil Neural Repair. 2024 Dec;38(11-12):845-862. doi: 10.1177/15459683241281299. Epub 2024 Sep 14.
Intracortical inhibitory/faciliatory measures are affected after stroke; however, the evidence is conflicting.
This meta-analysis aimed to investigate the changes in motor threshold (MT), motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), and identify sources of study variability using a machine learning approach.
We identified studies that objectively evaluated corticospinal excitability and intracortical inhibition/facilitation after stroke using transcranial magnetic stimulation. Pooled within- (ie, affected hemisphere [] vs unaffected hemisphere []) and between-subjects (ie, and vs ) standardized mean differences were computed. Decision trees determined which factors accurately predicted studies that showed alterations in corticospinal excitability and intracortical inhibition/facilitation.
A total of 35 studies (625 stroke patients and 328 healthy controls) were included. MT was significantly increased and MEP was significantly decreased (ie, reduced excitability) in the when compared with the and ( < .01). SICI was increased (ie, reduced inhibition) for the when compared with the , and for the and when compared with ( < .001). ICF was significantly increased (ie, increased facilitation) in the when compared with ( = .016) and decreased in when compared with ( < 0.001). Decision trees indicated that demographic and methodological factors accurately predicted (73%-86%) studies that showed alterations in corticospinal and intracortical excitability measures.
The findings indicate that stroke alters corticospinal and intracortical excitability measures. Alterations in SICI and ICF may reflect disinhibition of the motor cortex after stroke, which is contrary to the notion that stroke increases inhibition of the affected side.
皮质内抑制/易化措施在中风后会受到影响；然而，证据相互矛盾。
本荟萃分析旨在通过机器学习方法调查运动阈值（MT）、运动诱发电位（MEP）、短程皮质内抑制（SICI）和皮质内易化（ICF）的变化，并确定研究变异性的来源。
我们确定了使用经颅磁刺激客观评估中风后皮质脊髓兴奋性和皮质内抑制/易化的研究。计算了内（即患侧[ ]与健侧[ ]）和受试者间（即 和 与 ）标准化均数差的合并。决策树确定了哪些因素能准确预测皮质脊髓兴奋性和皮质内抑制/易化发生改变的研究。
共纳入 35 项研究（625 例中风患者和 328 例健康对照者）。与健侧和对侧相比，患侧 MT 显著增加，MEP 显著降低（即兴奋性降低）（ < .01）。与健侧相比，患侧 SICI 增加（即抑制减少），与健侧和对侧相比，对侧 SICI 增加（ < .001）。与健侧相比，患侧 ICF 显著增加（即易化增加）（ = .016），与健侧相比，患侧 ICF 减少（ < 0.001）。决策树表明，人口统计学和方法学因素能准确预测（73%-86%）皮质脊髓和皮质内兴奋性测量值发生改变的研究。
这些发现表明中风改变了皮质脊髓和皮质内的兴奋性测量值。SICI 和 ICF 的改变可能反映了中风后运动皮质的去抑制，这与中风增加患侧抑制的观点相反。
