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The Role of TMS for Predicting Motor Recovery and Outcomes After Stroke

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Translational Research in Stroke

Part of the book series: Translational Medicine Research ((TRAMERE))

Abstract

Transcranial magnetic stimulation (TMS) is a safe, non-invasive technique for studying the human motor system. It can be used to evaluate primary motor cortex (M1) function after stroke, by stimulating the ipsilesional M1 and recording motor-evoked potentials (MEPs) from the paretic limbs. In this chapter, we first outline the measures of M1, intracortical and interhemispheric function that can be made with TMS. The presence or absence of MEPs is the simplest and most reliable measure that can be made with TMS. In general, patients in whom TMS can elicit MEPs from the paretic limbs make a better motor recovery and experience better functional outcomes than those patients without MEPs. We provide an overview of recent research showing that MEP status is a particularly useful biomarker for patients with initially severe motor impairment. The limitations and potential benefits of MEP status as a biomarker for patient selection in stroke rehabilitation trials are discussed.

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Abbreviations

AMT:

Active motor threshold

CST:

Corticospinal tract

ECR:

Extensor carpi radialis

EMG:

Electromyography

FM-UE:

Fugl-Meyer Upper Extremity Scale

GABA:

Gamma-aminobutyric acid

IHI:

Interhemispheric inhibition

iSP:

Ipsilateral silent period

M1:

Primary motor cortex

MEP:

Motor-evoked potential

MRC:

Medical Research Council

MRI:

Magnetic resonance imaging

MSO:

Maximum stimulator output

NPV:

Negative predictive value

PLIC:

Posterior limb of the internal capsule

PPV:

Positive predictive value

RMT:

Resting motor threshold

SAFE:

Shoulder abduction finger extension

SICI:

Short-latency intracortical inhibition

SP:

Silent period

TMS:

Transcranial magnetic stimulation

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Authors and Affiliations

  1. Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Cathy M. Stinear

  2. Department of Exercise Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Winston D. Byblow

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  1. Cathy M. Stinear
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  2. Winston D. Byblow
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Correspondence to Cathy M. Stinear .

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Editors and Affiliations

  1. Department of Neurology & Neurosurgery, Cedars-Sinai Medical Center, Advanced Health Sciences Pavilion, Los Angeles, California, USA

    Paul A. Lapchak

  2. Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

    Guo-Yuan Yang

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Stinear, C.M., Byblow, W.D. (2017). The Role of TMS for Predicting Motor Recovery and Outcomes After Stroke. In: Lapchak, P., Yang, GY. (eds) Translational Research in Stroke. Translational Medicine Research. Springer, Singapore. https://doi.org/10.1007/978-981-10-5804-2_25

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