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@ARTICLE{Grefkes:8806,
      author       = {Grefkes, C. and Nowak, D. A. and Wang, L.E. and Dafotakis,
                      M. and Eickhoff, S. B. and Fink, G. R.},
      title        = {{M}odulating cortical connectivity in stroke patients by
                      r{TMS} assessed with f{MRI} and dynamic causal modeling},
      journal      = {NeuroImage},
      volume       = {50},
      issn         = {1053-8119},
      address      = {Orlando, Fla.},
      publisher    = {Academic Press},
      reportid     = {PreJuSER-8806},
      pages        = {233 - 242},
      year         = {2010},
      note         = {S.B.E. was funded by the Human Brain Project
                      (R01-MH074457-01A1) and the Initiative and Networking Fund
                      of the Helmholtz Association within the Helmholtz Alliance
                      on Systems Biology (Human Brain Model).},
      abstract     = {Data derived from transcranial magnetic stimulation (TMS)
                      studies suggest that transcallosal inhibition mechanisms
                      between the primary motor cortex of both hemispheres may
                      contribute to the reduced motor performance of stroke
                      patients. We here investigated the potential of modulating
                      pathological interactions between cortical motor areas by
                      means of repetitive TMS using functional magnetic resonance
                      imaging (fMRI) and dynamic causal modeling (DCM). Eleven
                      subacute stroke patients were scanned 1-3 months after
                      symptom onset while performing whole hand fist closure
                      movements. After a baseline scan, patients were stimulated
                      with inhibitory 1-Hz rTMS applied over two different
                      locations: (i) vertex (control stimulation) and (ii) primary
                      motor cortex (M1) of the unaffected (contralesional)
                      hemisphere. Changes in the endogenous and task-dependent
                      effective connectivity were assessed by DCM of a bilateral
                      network comprising M1, lateral premotor cortex, and the
                      supplementary motor area (SMA). The results showed that rTMS
                      applied over contralesional M1 significantly improved the
                      motor performance of the paretic hand. The connectivity
                      analysis revealed that the behavioral improvements were
                      significantly correlated with a reduction of the negative
                      influences originating from contralesional M1 during paretic
                      hand movements. Concurrently, endogenous coupling between
                      ipsilesional SMA and M1 was significantly enhanced only
                      after rTMS applied over contralesional M1. Therefore, rTMS
                      applied over contralesional M1 may be used to transiently
                      remodel the disturbed functional network architecture of the
                      motor system. The connectivity analyses suggest that both a
                      reduction of pathological transcallosal influences
                      (originating from contralesional M1) and a restitution of
                      ipsilesional effective connectivity between SMA and M1
                      underlie improved motor performance.},
      keywords     = {Adult / Cerebral Cortex: physiopathology / Female / Frontal
                      Lobe: physiopathology / Hand: physiology / Humans / Magnetic
                      Resonance Imaging: methods / Male / Middle Aged / Models,
                      Neurological / Motor Activity: physiology / Motor Cortex:
                      physiopathology / Neural Pathways: physiopathology /
                      Paresis: physiopathology / Stroke: physiopathology / Time
                      Factors / Transcranial Magnetic Stimulation: methods / Young
                      Adult / J (WoSType)},
      cin          = {INM-2 / INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-2-20090406 / I:(DE-Juel1)INM-3-20090406},
      pnm          = {Funktion und Dysfunktion des Nervensystems (FUEK409) /
                      89572 - (Dys-)function and Plasticity (POF2-89572)},
      pid          = {G:(DE-Juel1)FUEK409 / G:(DE-HGF)POF2-89572},
      shelfmark    = {Neurosciences / Neuroimaging / Radiology, Nuclear Medicine
                      $\&$ Medical Imaging},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:20005962},
      UT           = {WOS:000274810100023},
      doi          = {10.1016/j.neuroimage.2009.12.029},
      url          = {https://juser.fz-juelich.de/record/8806},
}