TMS: Using brain plasticity to treat chronic poststroke symptoms
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In this issue of Neurology, two articles evaluate treatment options for patients who had a stroke at least 2 years before the study. The topic and rationale for each study are remarkably different, but both demonstrate cortical plasticity even long after acute stroke.1,2⇓ In both articles, plasticity in the affected and the contralateral hemisphere was assessed by means of transcranial magnetic stimulation (TMS).
The leading theory of cortical plasticity is that changes in long-term potentiation (LTP)3 confer persistent changes in synaptic efficacy.4 Two different forms of LTP have been postulated: it can occur conditionally at an input to a postsynaptic cell 1) by concomitant or synchronous activation of another input to the same cell4 or 2) by a concomitant or synchronous postsynaptic depolarization.5 This model provides the basic rationale to synchronously pair low-frequency peripheral stimulation of somatosensory afferents with central TMS to induce motor cortical plasticity.6 Based …
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