Affiliations: Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Institution, Baltimore, MD, USA | Department of Neurology, Johns Hopkins Medical Institution, Baltimore, MD, USA | Department of Neuroscience, Johns Hopkins Medical Institution, Baltimore, MD, USA
Note: [] Corresponding author: Pablo A. Celnik, MD, The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps 174, Baltimore, MD 21287, USA. Tel.: 410 502 4457; Fax: 410 502 4900; E-mail: pcelnik@jhmi.edu
Abstract: Stroke is the leading cause of long-term disability. Understanding how people recover from stroke and other brain lesions remain one of the biggest conundrums in neuroscience. As a result, concerted efforts in recent years have focused on investigating the neurophysiological changes that occur in the brain after stroke, and in developing novel strategies to enhance motor recovery. In particular, transcranial magnetic stimulation (TMS) is a non-invasive tool that has been used to investigate the brain plasticity changes resulting from stroke and as a therapeutic modality to safely improve motor function. In this review, we discuss the contributions of TMS to understand how different motor areas, such as the ipsilesional hemisphere, secondary motor areas, and contralesional hemisphere are involved in motor recovery. We also consider recent studies using repetitive TMS (rTMS) in stroke patients to enhance upper extremity function. Although further studies are needed, these investigations provide an important starting point to understand the stimulation parameters and patient characteristics that may influence the optimal response to non-invasive brain stimulation. Future directions of rTMS are discussed in the context of post-stroke motor recovery.
Keywords: Transcranial magnetic stimulation, stroke, plasticity
