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TMS-evoked cortical responses can be measured using simultaneous electroencephalography (TMS-EEG) to directly quantify cortical connectivity in the human brain. The purpose of this study was to evaluate interhemispheric cortical connectivity between the primary motor cortices (M1s) in participants with chronic stroke and controls using TMS-EEG. Ten participants with chronic stroke and four controls were tested. TMS-evoked responses were recorded at rest and during a typical TMS assessment of transcallosal inhibition (TCI). EEG recordings from peri-central gyral electrodes (C3 and C4) were evaluated using imaginary phase coherence (IPC) analyses to quantify levels of effective interhemispheric connectivity. Significantly increased TMS-evoked beta (15-30Hz frequency range) IPC was observed in the stroke group during ipsilesional M1 stimulation compared to controls during TCI assessment but not at rest. TMS-evoked beta IPC values were associated with TMS measures of transcallosal inhibition across groups. These results suggest TMS-evoked EEG responses can index abnormal effective interhemispheric connectivity in chronic stroke., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the relationship of transcallosal pathway microstructure and transcallosal inhibition (TCI) with motor function and impairment in chronic stroke., Methods: Diffusion-weighted magnetic resonance imaging and transcranial magnetic stimulation (TMS) data were collected from 24 participants with chronic stroke and 11 healthy older individuals. Post-stroke motor function (Wolf Motor Function Test) and level of motor impairment (Fugl-Meyer score) were evaluated., Results: Fractional anisotropy (FA) of transcallosal tracts between prefrontal cortices and the mean amplitude decrease in muscle activity during the ipsilateral silent period evoked by TMS over the non-lesioned hemisphere (termed NL-iSPmean) were significantly associated with level of motor impairment and motor function after stroke (p<0.05). A regression model including age, post-stroke duration, lesion volume, lesioned corticospinal tract FA, transcallosal prefrontal tract FA and NL-iSPmean accounted for 84% of variance in motor impairment (p<0.01). Both transcallosal prefrontal tract FA (ΔR(2)=0.12, p=0.04) and NL-iSPmean (ΔR(2)=0.09, p=0.04) accounted for unique variance in motor impairment level., Conclusions: Prefrontal transcallosal tract microstructure and TCI are each uniquely associated with motor impairment in chronic stroke., Significance: Utilizing a multi-modal approach to assess transcallosal pathways may improve our capacity to identify important neural substrates of motor impairment in the chronic phase of stroke., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that may facilitate mechanisms of motor learning. In a recent single-blind, pseudo-randomized study, we showed that 5-Hz rTMS over ipsilesional primary somatosensory cortex followed by practice of a skilled motor task enhanced motor learning compared with sham rTMS + practice in individuals with chronic stroke. However, the beneficial effect of stimulation was inconsistent. The current study examined how differences in sensorimotor cortex morphology might predict rTMS-related improvements in motor learning in these individuals. High-resolution T1-weighted magnetic resonance images were acquired and processed in FreeSurfer using a newly developed automated, whole brain parcellation technique. Gray matter and white matter volumes of the ipsilesional primary somatosensory and motor cortices were extracted. A significant positive association was observed between the volume of white matter in the primary somatosensory cortex and motor learning-related change, exclusively in the group that received active 5-Hz rTMS. A regression model with age, gray matter and white matter volumes as predictors was significant for predicting motor learning-related change in individuals who received active TMS. White matter volume predicted the greatest amount of variance (47.6%). The same model was non-significant when volumes of the primary motor cortex were considered. We conclude that white matter volume in the cortex underlying the TMS coil may be a novel predictor for behavioral response to 5-Hz rTMS over the ipsilesional primary somatosensory followed by motor practice., (© 2014 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)