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@ARTICLE{Volz:150583,
      author       = {Volz, L. J. and Sarfeld, A. S. and Diekhoff, S. and Rehme,
                      A. K. and Pool, Eva-Maria and Eickhoff, Simon and Fink, G.
                      R. and Grefkes, C.},
      title        = {{M}otor cortex excitability and connectivity in chronic
                      stroke: a multimodal model of functional reorganization.},
      journal      = {Brain structure $\&$ function},
      volume       = {220},
      number       = {2},
      issn         = {1863-2661},
      address      = {Berlin},
      publisher    = {Springer},
      reportid     = {FZJ-2014-00632},
      pages        = {1093–1107},
      year         = {2015},
      abstract     = {Cerebral ischemia triggers a cascade of cellular processes,
                      which induce neuroprotection, inflammation, apoptosis and
                      regeneration. At the neural network level, lesions
                      concomitantly induce cerebral plasticity. Yet, many stroke
                      survivors are left with a permanent motor deficit, and only
                      little is known about the neurobiological factors that
                      determine functional outcome after stroke. Transcranial
                      magnetic stimulation (TMS) and magnetic resonance imaging
                      (MRI) are non-invasive approaches that allow insights into
                      the functional (re-) organization of the cortical motor
                      system. We here combined neuronavigated TMS, MRI and
                      analyses of connectivity to investigate to which degree
                      recovery of hand function depends on corticospinal tract
                      (CST) damage and biomarkers of cerebral plasticity like
                      cortical excitability and motor network effective
                      connectivity. As expected, individual motor performance of
                      12 stroke patients with persistent motor deficits was found
                      to depend upon the degree of CST damage but also motor
                      cortex excitability and interhemispheric connectivity. In
                      addition, the data revealed a strong correlation between
                      reduced ipsilesional motor cortex excitability and reduced
                      interhemispheric inhibition in severely impaired patients.
                      Interindividual differences in ipsilesional motor cortex
                      excitability were stronger related to the motor deficit than
                      abnormal interhemispheric connectivity or CST damage.
                      Multivariate linear regression analysis combining the three
                      factors accounted for more than $80 \%$ of the variance in
                      functional impairment. The inter-relation of cortical
                      excitability and reduced interhemispheric inhibition
                      provides direct multi-modal evidence for the disinhibition
                      theory of the contralesional hemisphere following stroke.
                      Finally, our data reveal a key mechanism (i.e., the
                      excitability-related reduction in interhemispheric
                      inhibition) accounting for the rehabilitative potential of
                      novel therapeutic approaches which aim at modulating
                      cortical excitability in stroke patients.},
      cin          = {INM-1 / INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-1-20090406 / I:(DE-Juel1)INM-3-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:24415059},
      UT           = {WOS:000350350300030},
      doi          = {10.1007/s00429-013-0702-8},
      url          = {https://juser.fz-juelich.de/record/150583},
}