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(Stroke. 2007;38:1551.)
© 2007 American Heart Association, Inc.

Original Contributions

Disinhibition of the Premotor Cortex Contributes to a Maladaptive Change in the Affected Hand After Stroke

Naoyuki Takeuchi, MD, PhD; Takeo Tada, MD, PhD; Takayo Chuma, MD; Yuichiro Matsuo, MD Katsunori Ikoma, MD, PhD

From the Department of Rehabilitation Medicine (N.T., T.C., Y.M., K.I.), Hospital of Hokkaido University, Sapporo, and the Department of Rehabilitation Medicine (T.T.), Hospital of Sasson, Otaru, Japan.

Correspondence to Naoyuki Takeuchi, MD, PhD, Department of Rehabilitation Medicine, Hospital of Hokkaido University, North 14 West 5, Sapporo 060-0814, Japan. E-mail naoyuki{at}med.hokudai.ac.jp

Background and Purpose— The mechanism of reorganization after stroke remains uncertain. Several studies that have measured reaction time (RT) delay by transcranial magnetic stimulation (TMS) have revealed some substrates responsible for the reorganization of motor recovery. In this study, we evaluated the RT delay and inhibitory functions by examining the silent period (SP) in the primary motor cortex (M1) and premotor cortex (PMC) of the affected hemisphere. Using these data, we investigated whether a change in the inhibitory system might influence motor recovery.

Methods— This study was performed in 20 patients with chronic subcortical stroke. To evaluate the RT delay, TMS was applied to the affected hemisphere 100 ms after showing the cue that indicated paretic finger movement. The SP was induced by TMS over the affected hemisphere during voluntary contraction of the paretic hand.

Results— The RT delays of the PMC were more prominent in patients with greater disability. The ratio of SP duration to RT delay in the PMC decreased with the decline in motor function. Moreover, upper arm function was better than hand function in patients with a decreased SP in the PMC.

Conclusions— The inhibitory function of the PMC was disturbed in patients with poor motor function. Stroke patients with poor motor ability appeared to depend not only on the motor pathway from M1 but also on other parallel motor circuits to move the paretic side. However, this brain reorganization might result in the sacrifice of function of the affected hand.

Key Words: disinhibition • stroke • transcranial magnetic stimulation