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Motor Cortex Excitability in Acute Cerebellar Infarct

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Abstract

Limited evidence to date has demonstrated changes in excitability that develops over the contralateral motor cortex after a cerebellar infarct. As such, the present study investigated changes in excitability over the contra- (contraM1) and ipsilateral motor cortices (ipsiM1), in patients with acute cerebellar infarct, to determine whether the changes may have functional relevance. Paired-pulse transcranial magnetic stimulation, combined with detailed clinical assessment, was undertaken in ten patients presenting with acute unilateral cerebellar infarct. Studies were undertaken within 1 week of ictus and followed longitudinally at 3-, 6-, and 12-month periods. Comparisons were made with 15 age-matched controls. Immediately following a stroke, short-interval intracortical inhibition (SICI) was significantly reduced over the contraM1 in all patients (P = 0.01), while reduced over the ipsiM1 in those with severe functional impairment (P = 0.01). Moreover, ipsiM1 SICI correlated with impairment (r = 0.69, P = 0.03), such that less SICI was observed in those patients with most impairment. Cortical excitability changes persisted over the follow-up period in the context of clinical improvement. Following an acute cerebellar infarct, excitability abnormalities develop over both motor cortices, more prominently in patients with severe functional impairment. The cortical changes, particularly over the ipsilateral motor cortex, may represent a functionally relevant plastic process that may guide future therapeutic strategies to better facilitate recovery.

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Abbreviations

BI:

Barthel Index

Contra-M1:

Contralateral primary motor cortex

DCN:

Deep cerebellar nuclei

FM:

Fugl–Meyer score

ICF:

Intracortical facilitation

Ipsi-M1:

Ipsilateral primary motor cortex

M1:

Primary motor cortex

MEP:

Motor evoked potential

mRS:

Modified Rankin scale

NIBS:

Non-invasive brain stimulation

NIHSS:

National Institutes of Health Stroke Scale

PICA:

Posterior inferior cerebellar artery

RMT:

Resting motor threshold

SARA:

Scale for the assessment and rating of ataxia

SCA:

Superior cerebellar artery

SICI:

Short-interval intracortical inhibition

tDCS:

Transcranial direct current stimulation

TMS:

Transcranial magnetic stimulation

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Acknowledgments

WH is receiving the postgraduate scholarship from the National Health & Medical Research Council of Australia (NHMRC). AK was supported by an NHMRC Career Development Award (grant 568680).

Conflict of Interest

The authors have no conflicts of interest.

Finanical Disclosure

WH is receiving the NHMRC postgraduate medical scholarship.

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Authors and Affiliations

  1. Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Kensington, Sydney, NSW, Australia

    William Huynh, Steve Vucic & Matthew C. Kiernan

  2. School of Medical Sciences, University of New South Wales, Kensington, Sydney, NSW, Australia

    Arun V. Krishnan & Cindy S-Y. Lin

  3. University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia

    Matthew C. Kiernan

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  1. William Huynh
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  2. Arun V. Krishnan
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  3. Steve Vucic
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  5. Matthew C. Kiernan
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Correspondence to William Huynh or Matthew C. Kiernan.

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Huynh, W., Krishnan, A.V., Vucic, S. et al. Motor Cortex Excitability in Acute Cerebellar Infarct. Cerebellum 12, 826–834 (2013). https://doi.org/10.1007/s12311-013-0493-8

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