A Neural Signature of Cortical Excitability Measurements to Predict Upper-Limb Motor Recovery in Post-Stroke Patients

Pacheco-Barrios K.; Tangjade A.; Dodurgali M.R.; Fregni F. · American Journal of Physical Medicine and Rehabilitation (2026) · DOI: 10.1097/phm.0000000000002956

Resumen

Objective: – This study examines whether clinical assessments and cortical excitability measurements are associated with upper-limb motor recovery in patients with subacute and chronic stroke. Methods: – We conducted a secondary analysis of a double-blind, randomized trial (n=27) with 3 groups: 1 Hz rTMS with fluoxetine, sham rTMS with fluoxetine, and placebo fluoxetine with sham rTMS. Univariate and multivariate regression analyses assessed treatment response using FMA-UE and JTHF scores at 30 and 90 days, evaluating clinical variables and motor cortex excitability as predictors. Results: – At 30 days, FMA-UE improvement was predicted by higher intracortical inhibition in the undamaged hemisphere (P=0.03), motor-evoked potentials in the damaged hemisphere (P=0.02), more exercise (P=0.01), and early rehabilitation (P=0.037). JTHF improvement was linked to lower intracortical facilitation (P=0.002). At 90 days, less severe stroke (P=0.037) and early rehabilitation (P=0.007) predicted better outcomes. rTMS was not a key factor. Conclusions: – The presence of motor-evoked potentials in the damaged hemisphere and higher intracortical inhibition in the undamaged hemisphere are linked to motor recovery. Intracortical excitability measures may serve as biomarkers for upper-limb recovery, especially during early-phase rehabilitation, supporting the interhemispheric competition hypothesis. Copyright

Instituciones: Universidad San Ignacio de Loyola