Universität zu Köln

Tscherpel, Caroline, Dern, Sebastian, Hensel, Lukas, Ziemann, Ulf, Fink, Gereon R. ORCID: 0000-0002-8230-1856 and Grefkes, Christian ORCID: 0000-0002-1656-720X (2020). Brain responsivity provides an individual readout for motor recovery after stroke. Brain, 143. S. 1873 - 1889. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2156

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Abstract

Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual's level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after 43 months post-stroke. In the early post-stroke phase (6.7 +/- 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after 43 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Tscherpel, Caroline UNSPECIFIED UNSPECIFIED UNSPECIFIED Dern, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Hensel, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziemann, Ulf UNSPECIFIED UNSPECIFIED UNSPECIFIED Fink, Gereon R. UNSPECIFIED orcid.org/0000-0002-8230-1856 UNSPECIFIED Grefkes, Christian UNSPECIFIED orcid.org/0000-0002-1656-720X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-331654
DOI:	10.1093/brain/awaa127
Journal or Publication Title:	Brain
Volume:	143
Page Range:	S. 1873 - 1889
Date:	2020
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2156
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TRANSCRANIAL MAGNETIC STIMULATION; CORTICAL EFFECTIVE CONNECTIVITY; UPPER-LIMB FUNCTION; TMS-EEG; FUNCTIONAL RECOVERY; CORTEX; MECHANISMS; PREDICTION; CONSCIOUSNESS; EXCITABILITY Multiple languages Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33165