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  • Title: Cortical excitability and interhemispheric inhibition after subcortical pediatric stroke: plastic organization and effects of rTMS.
    Author: Kirton A, Deveber G, Gunraj C, Chen R.
    Journal: Clin Neurophysiol; 2010 Nov; 121(11):1922-9. PubMed ID: 20537584.
    Abstract:
    OBJECTIVE: Arterial ischemic stroke (AIS) causes disability in children but plastic developmental neurophysiology is unstudied. Imbalance of interhemispheric inhibition (IHI) in adult subcortical stroke is a therapeutic target. We hypothesized that IHI imbalance occurs in childhood AIS and is modifiable by rTMS. METHODS: Eligible SickKids Children's Stroke Program patients included children >7years with subcortical AIS (>2years previous) and functional hand impairment. TMS with electromyography over first dorsal interosseous measured baseline motor cortex (M1) rest and 1mV thresholds and stimulus-response curves (100-150%). Paired-pulse TMS studied bidirectional short (SIHI) and long (LIHI) interval IHI. Children were matched for age/weakness and randomized to contralesional inhibitory rTMS or sham (8days) with measures repeated. RESULTS: Ten children (mean 13.9 years) had variable weakness (4 mild/2 moderate/4 severe). Stroke M1 motor thresholds were elevated (75±25% versus 55±14%, p=0.05) and decreased with age. Baseline measures suggested excessive LIHI from non-stroke to stroke side (-46±17% versus -28±23%, p=0.08). Following inhibitory rTMS, increases in stroke side maximal MEP amplitudes were suggested and LIHI from stroke to non-stroke side appeared to increase (-20% to -40%). Procedures were well tolerated. CONCLUSION: TMS measurement of developmental plastic organization and rTMS interventions are feasible in childhood stroke and IHI imbalance may occur. SIGNIFICANCE: Improved understanding of developmental plasticity after childhood stroke will facilitate better rehabilitational therapy.
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