Published Online
on September 28, 2006

A more recent version of this article appeared on November 1, 2006

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Submitted on March 21, 2006
Revised on June 1, 2006
Accepted on July 6, 2006

Direct Demonstration That Repetitive Transcranial Magnetic Stimulation Can Enhance Corticospinal Excitability in Stroke

Vincenzo Di Lazzaro MD^*; Michele Dileone MD; Paolo Profice MD; Fabio Pilato MD; Beatrice Cioni MD; Mario Meglio MD; Fioravante Capone MD; Pietro A. Tonali MD; and John C. Rothwell PhD

From the Institutes of Neurology (V.D.L., M.D., P.P., F.P., F.C., P.A.T.) and Neurosurgery (B.C., M.M.), Università Cattolica, Rome, Italy; Fondazione Don C. Gnocchi (P.A.T.), Rome, Italy; and the Sobell Department of Neurophysiology (J.C.R.), Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, England.

^* To whom correspondence should be addressed. E-mail: vdilazzaro{at}rm.unicatt.it.

Background and Purpose--Preliminary studies suggest that electrical stimulation of the damaged cortex may be able to enhance motor recovery after stroke. The hypothesis has been that this increases cortical excitability, making it easier for the system to respond to and learn from conventional physiotherapy. However, there is no direct evidence that the cortex of patients with stroke can respond in this fashion; hence, the basis of these new approaches has been questioned.

Methods--We had the opportunity to evaluate directly the effects of noninvasive cortical stimulation on the excitability of corticospinal output from the damaged hemisphere of a chronic stroke patient who had epidural electrodes implanted in the upper dorsal cord for treatment of pain.

Results--We found that it was possible to enhance corticospinal activity evoked by single test stimuli.

Conclusions--This study confirms directly that it is possible to noninvasively manipulate cortical excitability in stroke.

Key words: motor cortex • stroke • transcranial brain stimulation

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