Contribution of the ipsilateral motor cortex to recovery after chronic stroke

• Published in: Annals of neurology Vol. 54; no. 4; pp. 464 - 472
• Main Authors: Werhahn, Konrad J., Conforto, Adriana B., Kadom, Nadja, Hallett, Mark, Cohen, Leonardo G.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2003; Willey-Liss
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Brain Mapping; Chronic Disease; Cross-Sectional Studies; Electric Stimulation; Electromyography; Evoked Potentials, Motor - physiology; Female; Functional Laterality; Humans; Magnetic Resonance Imaging; Magnetics; Male; Medical sciences; Middle Aged; Motor Cortex - physiology; Neurology; Psychomotor Performance; Reaction Time; Recovery of Function - physiology; Stroke - physiopathology; Stroke Rehabilitation; Vascular diseases and vascular malformations of the nervous system; Vascular disease; Human; Nervous system diseases; Stroke; Hand function; Motor cortex; Central nervous system disease; Cardiovascular disease; Sequela; Recovery; Cerebrovascular disease; Cerebral disorder
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.10686

It has been proposed that the intact (ipsilateral) motor cortex play a significant role mediating recovery of motor function in the paretic hand of chronic stroke patients, but this hypothesis has not been tested experimentally. Here, we evaluated the effects of transcranial magnetic stimulation (TMS) on motor performance of the paretic hand of chronic stroke patients and healthy controls. We hypothesized that, if activity in the intact hemisphere contributes to functional recovery, TMS should result in abnormal motor behavior in the paretic hand. We found that stimulation of the intact hemisphere resulted in delayed simple reaction times (RTs) in the contralateral healthy but not in the ipsilateral paretic hand, whereas stimulation of the lesioned hemisphere led to a marked delay in RT in the contralateral paretic hand but not in the ipsilateral healthy hand. RT delays in the paretic hand correlated well with functional recovery. Finger tapping in the paretic hand was affected by TMS of the lesioned but not the intact hemisphere. These results are consistent with the idea that recovered motor function in the paretic hand of chronic stroke patients relies predominantly on reorganized activity within motor areas of the affected hemisphere.