Annals of Rehabilitation Medicine

"Cortical excitability"

Original Articles

Changes in Intracortical Excitability of Affected and Unaffected Hemispheres After Stroke Evaluated by Paired-Pulse Transcranial Magnetic Stimulation: Ho Youn Seo, Gi-Wook Kim, Yu Hui Won, Sung-Hee Park, Jeong-Hwan Seo, Myoung-Hwan Ko; Ann Rehabil Med 2018;42(4):495-501. Published online August 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.4.495

Abstract
PDF

Objective
To assess the altered pattern of intracortical excitability of the affected and unaffected hemispheres in stroke patients using paired-pulse transcranial magnetic stimulation (TMS).
Methods
We evaluated intracortical inhibition (ICI) and intracortical facilitation (ICF) in both hemispheres at acute and subacute stages of 103 stroke patients using paired-pulse TMS. The patients were divided into two groups: mild-to-moderate patients whose motor evoked potential (MEP) was recorded in the affected hemisphere; and severe patients whose MEP was not recorded in the affected hemisphere.
Results
In mild-to-moderate patients, the value of ICI in the affected hemisphere was increased from 70.3% to 77.9% and the value of ICI in the unaffected hemisphere was decreased from 74.8% to 70.3% with eventual progression in acute to subacute stages of stroke. In severe patients, the value of ICI in the unaffected hemisphere was increased from 65.4% to 75.6%. The changes in ICF were not significantly different in this study.
Conclusion
We conclude that the unaffected hemisphere was more disinhibited than the affected hemisphere in acute phase of mild-to-moderate stroke, and the affected hemisphere was more disinhibited in the subacute stage. The unaffected hemisphere was inhibited in severe cases in acute-to-subacute phases of stroke. This finding facilitates appropriate neuromodulation of acute-to-subacute phases in mild-to-severe stroke patients.

Citations

Citations to this article as recorded by

Post-stroke Fatigue and Brain Excitability: An Exploratory TMS Study
Hui-Ting Goh, Jill C Stewart, Yu-Chen Chung, Kevin Becker, Ty Shang
Restorative Neurology and Neuroscience.2026; 44(1): 15. CrossRef
Primed low frequency repetitive transcranial magnetic stimulation rebalances cortical excitatory-inhibitory circuitry and improves functional outcomes in infantile cerebral palsy patients: A randomized controlled trial
Aliya Mufti, Suman Jain, Kanwal Preet Kochhar, Sheffali Gulati, Sanjay Wadhwa, Kapil Sikka, Rohit Saxena, Md Iqbal Alam
Journal of Neurorestoratology.2025; 13(1): 100169. CrossRef
Altered Corticospinal and Intracortical Excitability After Stroke: A Systematic Review With Meta-Analysis
Edward P. Washabaugh, Sierra A. Foley, Emily G. Czopek, Chandramouli Krishnan
Neurorehabilitation and Neural Repair.2024; 38(11-12): 845. CrossRef
Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients
Luciana Mendonça Barbosa, Fernanda Valerio, Valquíria Aparecida da Silva, Antônia Lilian de Lima Rodrigues, Ricardo Galhardoni, Lin Tchia Yeng, Jefferson Rosi Junior, Adriana Bastos Conforto, Leandro Tavares Lucato, Manoel Jacobsen Teixeira, Daniel Ciampi
Neurophysiologie Clinique.2023; 53(3): 102845. CrossRef
Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation?
Mahmut Martin Yüksel, Shiqi Sun, Charles Latchoumane, Jocelyne Bloch, Gregoire Courtine, Estelle Emeline Raffin, Friedhelm Christoph Hummel
IEEE Open Journal of Engineering in Medicine and Biology.2023; 4: 300. CrossRef
Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures
Daniel Fernando Arias Betancur, Maria da Graça Lopes Tarragó, Iraci Lucena da Silva Torres, Felipe Fregni, Wolnei Caumo
Frontiers in Neurology.2021;[Epub] CrossRef
Motor excitability in bilateral moyamoya vasculopathy and the impact of revascularization
Gueliz Acker, Davide Giampiccolo, Kerstin Rubarth, Robert Mertens, Anna Zdunczyk, Juliane Hardt, Daniel Jussen, Heike Schneider, Tizian Rosenstock, Vera Mueller, Thomas Picht, Peter Vajkoczy
Neurosurgical Focus.2021; 51(3): E7. CrossRef
Nabiximols plus robotic assisted gait training in improving motor performances in people with Multiple Sclerosis.
Rocco Salvatore Calabrò, Margherita Russo, Antonino Naro, Rossella Ciurleo, Giangaetano D'Aleo, Carmela Rifici, Tina Balletta, Cristian La Via, Massimo Destro, Placido Bramanti, Edoardo Sessa
Multiple Sclerosis and Related Disorders.2020; 43: 102177. CrossRef
The balance recovery bimodal model in stroke patients between evidence and speculation: Do recent studies support it?
Giovanni Di Pino, Vincenzo Di Lazzaro
Clinical Neurophysiology.2020; 131(10): 2488. CrossRef
Promotion of Poststroke Motor-Function Recovery with Repetitive Transcranial Magnetic Stimulation by Regulating the Interhemispheric Imbalance
Xiaoxia Yuan, Yuan Yang, Na Cao, Changhao Jiang
Brain Sciences.2020; 10(9): 648. CrossRef
Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial
Rocco Salvatore Calabrò, Maria Accorinti, Bruno Porcari, Luigi Carioti, Laura Ciatto, Luana Billeri, Veronica Agata Andronaco, Franco Galletti, Serena Filoni, Antonino Naro
Clinical Neurophysiology.2019; 130(5): 767. CrossRef
Association of Lesion Location With Long-Term Recovery in Post-stroke Aphasia and Language Deficits
Bomi Sul, Kyoung Bo Lee, Bo Young Hong, Joon Sung Kim, Jaewon Kim, Woo Seop Hwang, Seong Hoon Lim
Frontiers in Neurology.2019;[Epub] CrossRef

8,770 View
167 Download
12 Web of Science
12 Crossref

Effect of Stimulation Polarity of Transcranial Direct Current Stimulation on Non-dominant Hand Function: Min Kyun Sohn, Bong Ok Kim, Hyun Tak Song; Ann Rehabil Med 2012;36(1):1-7. Published online February 29, 2012; DOI: https://doi.org/10.5535/arm.2012.36.1.1

Abstract
PDF

Objective

To evaluate motor excitability and hand function on the non-dominant side according to the polarity of transcranial direct current stimulation (tDCS) on the motor cortex in a healthy person.

Method

tDCS was applied to the hand motor cortex for 15 minutes at an intensity of 1 mA in 28 healthy right-handed adults. Subjects were divided randomly into four groups: an anodal tDCS of the non-dominant hemisphere group, a cathodal tDCS of the non-dominant hemisphere group, an anodal tDCS of the dominant hemisphere group, and a sham group. We measured the motor evoked potential (MEP) in the abductor pollicis brevis and Jabsen-Taylor hand function test (JTT) in the non-dominant hand prior to and following tDCS. All study procedures were done under double-blind design.

Results

There was a significant increase in the MEP amplitude and a significant improvement in the JTT in the non-dominant hand following anodal tDCS of the non-dominant hemisphere (p<0.05). But there was no change in JTT and a significant decrease in the MEP amplitude in the non-dominant hand following cathodal tDCS on the non-dominant hemisphere and anodal tDCS of the dominant hemisphere.

Conclusion

Non-dominant hand function is improved by increased excitability of the motor cortex. Although motor cortex excitability is decreased in a healthy person, non-dominant hand function is maintained. A homeostatic mechanism in the brain might therefore be involved in preserving this function. Further studies are warranted to examine brain functions to clarify this mechanism.

Citations

Citations to this article as recorded by

The Influence of Transcranial Alternating Current Stimulation on the Excitability of the Unstimulated Contralateral Primary Motor Cortex
Erik W. Wilkins, Richard J. Young, Ryder Davidson, Reese Krider, George Alhwayek, Jonathan A. Park, Armaan C. Parikh, Zachary A. Riley, Brach Poston
Brain Sciences.2025; 15(5): 512. CrossRef
What are the optimal transcranial direct current stimulation parameters and design elements to modulate corticospinal excitability? A systematic review and longitudinal meta-analysis
Liam C. Tapsell, Matheus D. Pinto, Ann-Maree Vallence, Casey Whife, Maria Luciana Perez Armendariz, Shaswat Senger, Jack Andringa-Bate, Dana Hince, Myles C. Murphy
Neurological Research and Practice.2025;[Epub] CrossRef
Immediate Neuroplastic Changes in the Cortex After iTBS on the Cerebellum of Stroke Patients: A Preliminary fNIRS Study
Shuo Xu, Shaofan Chen, Ningling Chen, Zhengcong Zhang, Chenfang Liang, Hongwei Huang, Huijie Zou, Haoqing Jiang, Jacopo Lamanna
Neural Plasticity.2025;[Epub] CrossRef
Non-Dominant Hemisphere Excitability Is Unaffected during and after Transcranial Direct Current Stimulation of the Dominant Hemisphere
Erik W. Wilkins, Richard J. Young, Daniel Houston, Eric Kawana, Edgar Lopez Mora, Meghana S. Sunkara, Zachary A. Riley, Brach Poston
Brain Sciences.2024; 14(7): 694. CrossRef
Motor Evoked Potential Amplitude in Motor Behavior-based Transcranial Direct Current Stimulation Studies: A Systematic Review
Jennifer L. Ryan, Emily Eng, Darcy L. Fehlings, F. Virginia Wright, Danielle E. Levac, Deryk S. Beal
Journal of Motor Behavior.2023; 55(3): 313. CrossRef
Hemispheric Differences of 1 Hz rTMS over Motor and Premotor Cortex in Modulation of Neural Processing and Hand Function
Jitka Veldema, Dennis Alexander Nowak, Kathrin Bösl, Alireza Gharabaghi
Brain Sciences.2023; 13(5): 752. CrossRef
tDCS over the primary motor cortex contralateral to the trained hand enhances cross-limb transfer in older adults
Elisabeth Kaminski, Tom Maudrich, Pauline Bassler, Madeleine Ordnung, Arno Villringer, Patrick Ragert
Frontiers in Aging Neuroscience.2022;[Epub] CrossRef
Effects of Transcranial Direct Current Stimulation and High-Definition Transcranial Direct Current Stimulation Enhanced Motor Learning on Robotic Transcranial Magnetic Stimulation Motor Maps in Children
Adrianna Giuffre, Ephrem Zewdie, James G. Wrightson, Lauran Cole, Helen L. Carlson, Hsing-Ching Kuo, Ali Babwani, Adam Kirton
Frontiers in Human Neuroscience.2021;[Epub] CrossRef
Using Transcranial Electrical Stimulation in Audiological Practice: The Gaps to Be Filled
Mujda Nooristani, Thomas Augereau, Karina Moïn-Darbari, Benoit-Antoine Bacon, François Champoux
Frontiers in Human Neuroscience.2021;[Epub] CrossRef
The Impact of Transcranial Direct Current Stimulation on Upper-Limb Motor Performance in Healthy Adults: A Systematic Review and Meta-Analysis
Ronak Patel, James Ashcroft, Ashish Patel, Hutan Ashrafian, Adam J. Woods, Harsimrat Singh, Ara Darzi, Daniel Richard Leff
Frontiers in Neuroscience.2019;[Epub] CrossRef
No significant effect of transcranial direct current stimulation (tDCS) found on simple motor reaction time comparing 15 different simulation protocols
Jared Cooney Horvath, Olivia Carter, Jason D. Forte
Neuropsychologia.2016; 91: 544. CrossRef
Pediatric stroke and transcranial direct current stimulation: methods for rational individualized dose optimization
Bernadette T. Gillick, Adam Kirton, Jason B. Carmel, Preet Minhas, Marom Bikson
Frontiers in Human Neuroscience.2014;[Epub] CrossRef
Electrifying the motor engram: effects of tDCS on motor learning and control
Jean-Jacques Orban de Xivry, Reza Shadmehr
Experimental Brain Research.2014; 232(11): 3379. CrossRef
Differential behavioral and physiological effects of anodal transcranial direct current stimulation in healthy adults of younger and older age
Kirstin-Friederike Heise, Martina Niehoff, J.-F. Feldheim, Gianpiero Liuzzi, Christian Gerloff, Friedhelm C. Hummel
Frontiers in Aging Neuroscience.2014;[Epub] CrossRef

6,674 View
54 Download
14 Crossref

Facilitation of Cortical Excitability by Action Related Sentence.: Sohn, Min Kyun , Kim, Bong Ok , Choi, Pil Soon , Kim, Sung Kyum , Lee, Hae Jin; J Korean Acad Rehabil Med 2010;34(2):163-167.

Abstract
PDF

Objective
To investigate the effect of action related visual and auditory stimuli on the motor evoked potential (MEP) of hand. Method: Right handed fifteen healthy adults without neurological deficit were included. Visual lingual stimulation was given on the computer monitor with the sentence and auditory lingual stimulation was given 10 repetitions of the above sentence using computer speaker with eyes closed. MEPs from transcranial and transcervical magnetic stimulation were recorded on the abductor pollicis brevis of the right hand. Results: The latency of MEPs was shortened and the amplitude of MEPs with transcranial magnetic stimulation after lingual stimulation (p＜0.05). However, the latency and amplitude of with transcervical stimulation did not show significant changes. Conclusion: Cortical excitability was enhanced by action related visual or auditory stimuli. Exercise accompanied by visual or auditory lingual stimulation rather than simple exercise might be useful for facilitating cortical excitability. (J Korean Acad Rehab Med 2010; 34: 163-167)

1,981 View
6 Download

The Modulation of Cortical Excitability by Observation and/or Imagery of Action.: Choi, Eun Hee , Yoo, Woo Kyoung , Jung, Kwang Ik , Park, Dong Sik , Nam, Hee Seung , Jun, Ah Young; J Korean Acad Rehabil Med 2008;32(4):388-393.

Abstract
PDF

Objective: To better delineate the changes in cortical excitability that accompany perceptual to motor transformations when people are asked to observe and/or image two kinds of action. Method: Twenty right handed young adult without neurological deficit were included. Motor evoked potentials (MEPs) from transcranial magnetic stimulation were recorded in the abductor pollicis brevis of the dominant hand in six different conditions: (1) passive observation (PO) of the slow (1 Hz) action (abduction of right thumb); (2) imagery of the slow action; (3) active observation (AO) of the slow action; (4) PO of the fast (4 Hz) action; (5) imagery of the fast action; and (6) active observation of the fast action. MEPs were also recorded at resting state. Results: The mean amplitude of MEPs at rest condition was 0.85±0.84 mV; PO of the slow action, 1.27±1.13 mV; imagery of the slow action, 1.76±1.49 mV; AO of the slow action, 2.46±2.02 mV; PO of the fast action, 1.90±1.31 mV; imagery of the fast action, 2.35±1.32 mV; and AO of the fast action, 3.44±1.85 mV. And at a constant speed of action, AO produced the largest amplitude of MEPs. A comparison between the slow and fast action revealed the latter produced larger amplitude of MEPs than the former during each task. Conclusion: The observed and/or imagined action can alter cortical excitability without actual execution of movement. And active observation of the fast action might be more useful for facilitating cortical excitability. (J Korean Acad Rehab Med 2008; 32: 388-393)

1,739 View
9 Download

The After-effect of Sub-threshold 10 Hz Repetitive Transcranial Magnetic Stimulation on Motor Cortical Excitability.: Ko, Myoung Hwan , Jeong, Young Chang , Seo, Jeong Hwan , Kim, Yun Hee; J Korean Acad Rehabil Med 2006;30(5):436-440.

Abstract
PDF

Objective
To study the after effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex on cortical excitability Method: Twenty healthy volunteers received 1,000 stimuli of 10 Hz rTMS. Repetitive TMS was given over the 'motor hot spot' of the right first dorsal interosseus muscle using an intensity of 80% of resting motor threshold. We evaluated the amplitude of motor evoked potential (MEP) using single pulse TMS and intracortical inhibition and intracortical facilitation with paired pulse TMS paradigm. After baseline measurement, the amplitude was measured immediately after stimulation and 10, 20, 30 and 40 minutes afterrTMS. Results: The amplitude of MEP was significantly increased for 10 minutes after applying 1,000 stimuli of 10 Hz rTMS. Additionally, intracortical inhibition was significantly reduced and intracortical facilitation was significantly enhanced for 10 minutes after 10 Hz rTMS. Conclusion: These results showed that 1,000 stimuli of 10 Hz rTMS over primary motor cortex increased the corticospinal excitability for 10 minutes. In addition, 10 Hz rTMS induced a suppression of the intracortical inhibitory circuitry and facilitation of the excitatory circuity for 10 minutes. (J Korean Acad Rehab Med 2006; 30: 436-440)