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Prognostic value of cortically induced motor evoked activity by TMS in chronic stroke: caveats from a very revealing single clinical case
Amengual, J. L.; Valero Cabré, Antoni; Veciana de las Heras, Misericordia; Rojo, N.; Froudist Walsh, S.; Ripollés, P.; Bodamer, N.; Mohammadi, B.; Montero Homs, Jordi; Grau Fonollosa, Carles; Münte, Thomas F.; Rodríguez Fornells, Antoni
Universitat de Barcelona
Background: We report the case of a chronic stroke patient (62 months after injury) showing total absence of motor activity evoked by transcranial magnetic stimulation (TMS) of spared regions of the left motor cortex, but near-to-complete recovery of motor abilities in the affected hand. Case presentation: Multimodal investigations included detailed TMS based motor mapping, motor evoked potentials (MEP), and Cortical Silent period (CSP) as well as functional magnetic resonance imaging (fMRI) of motor activity, MRI based lesion analysis and Diffusion Tensor Imaging (DTI) Tractography of corticospinal tract (CST). Anatomical analysis revealed a left hemisphere subinsular lesion interrupting the descending left CST at the level of the internal capsule. The absence of MEPs after intense TMS pulses to the ipsilesional M1, and the reversible suppression of ongoing electromyographic (EMG) activity (indexed by CSP) demonstrate a weak modulation of subcortical systems by the ipsilesional left frontal cortex, but an inability to induce efficient descending volleys from those cortical locations to right hand and forearm muscles. Functional MRI recordings under grasping and finger tapping patterns involving the affected hand showed slight signs of subcortical recruitment, as compared to the unaffected hand and hemisphere, as well as the expected cortical activations. Conclusions: The potential sources of motor voluntary activity for the affected hand in absence of MEPs are discussed. We conclude that multimodal analysis may contribute to a more accurate prognosis of stroke patients.
Malalties cerebrovasculars
Estudi de casos
Neurofisiologia
Cerebrovascular disease
Case studies
Neurophysiology
cc-by (c) Amengual, J.L. et al., 2012
http://creativecommons.org/licenses/by/3.0/es
Article
info:eu-repo/semantics/publishedVersion
BioMed Central
         

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Amengual, J. L.; Valero Cabré, Antoni; Veciana de las Heras, M.; Rojo, N.; Froudist Walsh, S.; Ripollés, P.; Bodamer, N.; Mohammadi, B.; Montero Homs, Jordi; Grau Fonollosa, Carles; Münte, T.; Rodríguez Fornells, Antoni
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Amengual, J. L.; Rojo, N.; Veciana De Las Heras, Misericordia; Marco Pallarés, Josep; Grau-Sánchez, J.; Schneider, S.; Vaquero, L.; Juncadella i Puig, Montserrat; Montero Homs, Jordi; Mohammadi, B.; Rubio, F.; Rueda, N.; Duarte, E.; Grau Fonollosa, Carles; Altenmuller, E.; Münte TF; Rodríguez Fornells, Antoni
Amengual, J. L.; Rojo, N.; Veciana De Las Heras, Misericordia; Marco-Pallarés, J.; Grau-Sánchez, J.; Schneider, S.; Vaquero, L.; Juncadella Puig, Montserrat; Montero Homs, Jordi; Mohammadi, B.; Rubio, F.; Rueda, N.; Duarte, E.; Grau Fonollosa, Carles; Altenmuller, E.; Münte TF; Rodríguez Fornells, Antoni
Amengual, J.L.; Rojo, N.; Veciana De Las Heras, Misericordia; Marco-Pallarés, J.; Grau-Sánchez, J.; Schneider, S.; Vaquero, L.; Juncadella Puig, Montserrat; Montero Homs, Jordi; Mohammadi, B.; Rubio, F.; Rueda, N.; Duarte, E.; Grau Fonollosa, Carles; Altenmuller, E.; Münte TF; Rodríguez Fornells, Antoni
 

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