BACKGROUND Residual corticospinal connections are the precondition for poststroke motor recovery and necessary for targeted interventions. In severely affected patients, standard transcranial magnetic stimulation (TMS) may lead to false negative findings. OBJECTIVE Detecting the cortical representation of paralyzed forearm muscles by applying different stimulation techniques and maps beyond the hotspot. METHODS In seventeen chronic stroke patients with severe motor deficits, navigated biphasic single (SP) and monophasic paired-pulse (PP) TMS was applied at 100% stimulator output to an extended cortical area in the ipsilesional hemisphere, while recording surface EMG of the extensor carpi radialis muscle. RESULTS In eleven patients, residual connectivity to the paralyzed forearm was detected with either mapping technique (five SP and PP, four PP only, two SP only). In five patients, connections originated from non-primary motor areas. CONCLUSION These results could be instrumental for identifying candidates and stimulation targets for novel neuromodulation interventions in the context of neurorehabilitation.

中文翻译：

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用双相单相和单相配对脉冲 TMS 检测中风后皮质运动图

背景残留的皮质脊髓连接是中风后运动恢复的先决条件，也是有针对性的干预所必需的。在严重受影响的患者中，标准经颅磁刺激 (TMS) 可能会导致假阴性结果。目标通过应用不同的刺激技术和热点以外的地图来检测瘫痪前臂肌肉的皮质表现。方法 在 17 名有严重运动障碍的慢性卒中患者中，以 100% 刺激器输出将双相单相 (SP) 和单相双相双相脉冲 (PP) TMS 应用到同侧半球的扩展皮层区域，同时记录伸肌的表面肌电图桡侧腕肌。结果 在 11 名患者中，使用任一映射技术（5 个 SP 和 PP，仅四个 PP，仅两个 SP）。在五名患者中，连接起源于非主要运动区域。结论这些结果可能有助于确定神经康复背景下新型神经调节干预的候选者和刺激目标。