Article

Non-invasive brain stimulation has been studied as a therapeutic
adjunct for upper-limb recovery in patients with stroke.
One type of stimulation,
paired associative stimulation (PAS), has effects on plasticity in both patients
and healthy participants. Lasting several hours, these effects are reversible and
topographically specific. OBJECTIVE: The goal was to investigate the presence of
a lasting increase in motor cortex plasticity for extensor wrist muscles -
extensor carpi radialis (ECR) - and an improvement in upper-limb function after 5
days of daily PAS in patients at the subacute post-stroke stage. METHODS: A total
of 24 patients (mean [SD] age 50.1 [12.1] years, weeks since stroke 10.1 [5.3])
were included in a double-blind, placebo-controlled trial and randomly assigned
to the PAS or sham group (n=13 and n=11). For the PAS group, patients underwent a
5-day course of electrical peripheral stimulation combined with magnetic cortical
stimulation applied to the ECR muscle in a single daily session at 0.1Hz for
30min; patients with sham treatment received minimal cortical stimulation. Both
patient groups underwent 2 hr of conventional physiotherapy. Variations in the
motor evoked potential (MEP) surface area of the ECR muscle and Fugl-Meyer
Assessment-Upper-Limb motor scores were analysed up to day 12. RESULTS: The 2
groups did not differ in electrophysiological or motor parameters. Repeated PAS
sessions seemed to affect only patients with low initial cortical excitability.
We found considerable variability in PAS effects between patients and across the
sessions. CONCLUSION: We failed to induce a lasting effect with PAS in the
present study. PAS does not seem to be the main method for post-stroke brain
stimulation. Perhaps recruitment of patients could be more selective, possibly
targeting those with a wide altered ipsilesional corticomotor pathway.
CI - Copyright (c) 2017 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS