Article

With the advent of novel brain stimulation techniques aimed at
improving functional outcome, understanding poststroke plasticity becomes
critical for the appropriate selection of patients and optimal timing to
introduce neuromodulatory interventions. OBJECTIVE: To better define the temporal
evolution of central and peripheral neuroplastic changes in the first 3 months
after stroke and their clinical implications. METHODS: Transcranial magnetic
stimulation, peripheral nerve excitability, and clinical assessments were
undertaken longitudinally in 31 acute stroke patients, comprising a total of 384
clinical studies. RESULTS: During the hyperacute phase (<7 days), short-interval
intracortical inhibition (SICI) was significantly reduced in lesioned (4.3% +/-
1.3%) and contralesional hemispheres (3.6% +/- 1.9%) compared with controls
(11.4% +/- 1.3%, P = .001). There were also significant alterations in
accommodative properties of motor axons in the affected limb. At follow-up, SICI
remained suppressed in both hemispheres in the context of significant clinical
improvement. CONCLUSION: Simultaneous assessment of central and peripheral motor
pathways has identified bilateral plastic changes that develop throughout the
neural axis in acute stroke patients. It is proposed that these changes represent
an adaptive response and that the persistent bihemispheric reduction in SICI may
act to promote stroke recovery through cortical reorganization.

Langue : ANGLAIS