Abstract
Stroke is the leading cause of disability in the United States. Despite the high incidence and mortality of stroke, sensitive and specific brain-based biomarkers predicting persisting disabilities are lacking. Both neuroimaging techniques like electroencephalography (EEG) and non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) have proven useful in predicting prognosis, recovery trajectories and response to rehabilitation in individuals with stroke. We propose, however, that additional synergetic effects can be achieved by simultaneously combining both approaches. Combined TMS-EEG is able to activate discrete cortical regions and directly assess local cortical reactivity and effective connectivity within the network independent of the integrity of descending fiber pathways and also outside the motor system. Studying cortical reactivity and connectivity in patients with stroke TMS-EEG may identify salient neural mechanisms underlying motor disabilities and lead to novel biomarkers of stroke pathophysiology which can then be used to assess, monitor, and refine rehabilitation approaches for individuals with significant disability to improve outcomes and quality of life after stroke.
Highlights
Stroke is the fourth leading cause of death (Kochanek et al, 2011) and the leading cause of long-term disability in the United States (Go et al, 2014)
Substantial progress has been made in the identification and treatment of strokerelated disability, but the majority of evidence is based on heterogeneous studies that cannot be used to support robust conclusions regarding optimal choice of intervention on a patient-by-patient basis (Pollock et al, 2014)
Concurrent transcranial magnetic stimulation (TMS)-EEG offers the capability to characterize causal connectivity between the stimulated cortical region and other nodes of a network rather than relying on correlative information provided by standalone or offline imaging approaches (e.g., TMS combined with structural imaging approaches such as diffusion imaging) (Bortoletto et al, 2015)
Summary
Stroke is the fourth leading cause of death (Kochanek et al, 2011) and the leading cause of long-term disability in the United States (Go et al, 2014). Combined TMS-EEG offers a powerful ‘‘perturb and measure’’ paradigm to study induced neural activity in local and distributed brain networks.
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