My Editor’s Choice

Professor Ulf Ziemann,Editor-in-Chief, Clinical Neurophysiology

Professor Ulf Ziemann
Editor-in-Chief, Clinical Neurophysiology

The Editor’s Choice—

Stratifying chronic stroke patients based on the influence of contralesional motor cortices: An inter-hemispheric inhibition study

Clinical Neurophysiology Volume 131, Issue 10 (October 2020)

Lin YL, Potter-Baker KA, Cunningham DA, Li M, Sankarasubramanian V, Lee J, Jones S, Sakaie K, Wang X, Machado AG, Plow EB (2020) Stratifying chronic stroke patients based on the influence of contralesional motor cortices: An inter-hemispheric inhibition study. Clin Neurophysiol 131:2516–2525

Stroke is the leading cause of permanent disability in adulthood. Enhancing the efficacy of neurorehabilitation is a strong medical need. One important strategy is personalized treatment. The role of the contralesional hemisphere depends on the severity of the clinical motor deficit: non-supportive or even detrimental with slight-to-moderate deficit but supportive with severe deficit. An important but unresolved question is how to predict the effects of treatment targeted to the contralesional hemisphere. Lin and colleagues show in this issue of Clinical Neurophysiology in chronic stroke patients that the ipsilateral silent period (ISP), a measure of interhemispheric inhibition from the contralesional to ipsilesional motor cortex, is related to the upper extremity motor deficit (assessed by the Fugl-Meyer score, range 0–66, with 0 indicating maximal deficit, 66 no deficit) by a quadratic function. Down from a cut-off value of 43, increasingly severely affected patients showed progressively less ISP, whereas down to the cut-off value increasingly severely affected patients showed progressively more ISP. At the group level, severely impaired patients who made clinically meaningful functional gains in rehabilitation showed further ISP reduction. The important message from these findings is that a criterion impairment-level can stratify patient subgroups of bimodal inhibitory influence of contralesional onto ipsilesional motor cortex. How this can be translated into a concrete strategy of personalized rehabilitation targeting the contralesional hemisphere warrants controlled clinical trials.

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