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July 17, 2015

Stroke subtype and motor impairment influence contralesional excitability

Gary W. Thickbroom, PhD, Mar Cortes, MD, Avrielle Rykman, MA, Bruce T. Volpe, MD, Felipe Fregni, MD, PhD, H. Igo Krebs, PhD, Alvaro Pascual-Leone, MD, PhD, and Dylan J. Edwards, PhDAuthors Info & Affiliations
August 11, 2015 issue
85 (6) 517-520
https://doi.org/10.1212/WNL.0000000000001828
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Abstract

Objective:

The nonlesioned motor cortex (M1NL) is thought to be hyperexcitable in patients with subacute or chronic stroke and offers a promising therapeutic target. However, whether M1NL excitability behaves the same for subcortical and cortical strokes is unknown. The aim of the present study was to determine whether cortical, or purely subcortical, strokes have a different effect on M1NL excitability.

Methods:

We looked for correlations between the Fugl-Meyer (FM) score and M1NL resting motor threshold (RMTNL) in 34 stroke survivors classified according to lesion location (cortico-subcortical or purely subcortical). In addition to the FM, the Wolf Motor Score and motor power were measured.

Results:

FM correlated with RMTNL for subcortical (r = 0.82; p = 0.001) but not for cortical strokes (r = 0.11; p = 0.62). Likewise, Wolf Motor Score (r = −0.62; p = 0.03) and motor power (r = 0.64; p = 0.023) were correlated with RMTNL for the subcortical group, but not for the cortical group.

Conclusion:

We show that the impact on M1NL depends on lesion location and conclude that protocols aimed at reducing M1NL cortical excitability may be worth exploring for subcortical but not for cortical stroke.

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Supplementary Material

File (table_e-1.pdf)

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Information & Authors

Information

Published In

Neurology®
Volume 85 • Number 6 • August 11, 2015
Pages: 517-520
PubMed: 26187228

Copyright

© 2015 American Academy of Neurology.

Publication History

Received: December 1, 2014
Accepted: April 10, 2015
Published online: July 17, 2015
Published in issue: August 11, 2015

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Disclosure

G. Thickbroom, M. Cortes, A. Rykman, B. Volpe, F. Fregni, and H. Igo Krebs report no disclosures relevant to the manuscript. A. Pascual-Leone serves on the scientific advisory boards for Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, Axilum Robotics, Magstim Inc., and Neosync; and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with EEG and MRI. D. Edwards reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

This study was supported by NICHD of the NIH, under award number R01HD069776. A.P.-L. is supported in part by grants from the Sidney R. Baer Jr. Foundation, the NIH (R01HD069776, R01NS073601, R21 MH099196, R21 NS082870, R21 NS085491, R21 HD07616), Harvard Catalyst | The Harvard Clinical and Translational Science Center (NCRR and the NCATS NIH, UL1 RR025758). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, the NIH, or the Sidney R. Baer Jr. Foundation.

Authors

Affiliations & Disclosures

Gary W. Thickbroom, PhD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Mar Cortes, MD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Avrielle Rykman, MA
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Bruce T. Volpe, MD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Bioelectronic Medicine
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH funded experiments produced the information iin this manuscript. Edwards is the PI I am a collaborator - he has the numbers in his COI.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Felipe Fregni, MD, PhD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
H. Igo Krebs, PhD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
(1) UK National Health Service - HTA sponsored study - RATULS (robot assisted training for the upper limb after stroke) -- NIHR Health Technology Assessment programme (project number 11/26/05).
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
(1) IEEE Transactions on Neural Systems and Rehabilitation Engineering, associate editor, 13 years
Patents:
1.
1. Krebs, ?Shelfship-Shelftainer: a new concept in container transport,? Japan Application Patent, Utility Model 102599, 31 August 1989.2. Hogan, Krebs, Sharon, Charnnarong, ?Interactive Robotic Therapist, ? US Patent No. 5,466,213, November 1995. 3. Hogan & Krebs, ?System and Method for Medical Imaging Utilizing a Robotic Device, and Robotic Device for Use in Medical Imaging,? US Patent No. 5,794,621, August 1998. 4. Hogan, Volpe, & Krebs, ?Testing Therapy Efficacy with Extremity and/or Joint Attachments,? US (submitted). 5.Krebs, Hogan, Williams, Celestino, ?Wrist And Upper Extremity Motion,? US Patent No. 7,618,381, November 2009. 6. Krebs, Hogan, Williams, Wheeler, ?Ankle Interface ? Robotic Device for Ankle Rehabilitation,? US Patent (submitted) 7. Krebs, Masia, ?Converting Rotational Motion into Radial Motion,? US Patent (submitted) 8. Krebs, Hogan, Roberts, ?Pelvis Interface ? Mobile Pelvis Manipulator or System and Method for Rehabilitation of Gait and Balance Utilizing Automation Technology and Robotic Devices,? US Patent No. 7,556,606, July 2009. 9. Krebs, Hogan, Roberts, ?Pelvis Interface,? US Patent No. 8,608,674B2, 17 Dec 2013. 10. Bosecker, Krebs, ?System and Method for Training Gait of Neurologically Impaired Patients via Gravity Augmentation,? Disclose to MIT TLO and MIT TLO waived its rights ? pursuing patent on my own ? Patent Application 13/191,105, Allowed September 2013, Issued 2014. 11. Bosecker, Krebs, ?Dynamic Lower Limb Rehabilitation Robotic Apparatus and Method of Rehabilitating Human Gait,? Disclose to MIT TLO and MIT TLO waived its rights ? pursuing patent on my own ? Patent Application 12/762,282, Allowed October 2013, Issued 2014.
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) Casper, Phillips & Assoc -- 1997 - 2013 (containercrane design and construction) (2)Schick (Warner-Lambert)-- 1998 - 2001 (razor design) (3)Block Engineering -- 2004 -- 2004 (chemical warfare detector) (4) Wyeth Pharmaceutical Inc -- 2006 - 2010 Design of robotic biomarker for stroke (5)Blythedale Childrens? Hospital-- 2008 - 2013 Design pediatric rehabilitation robotic program (6) Riley Childrens? Hospital -- 2010 - 2011 Design pediatric rehabilitation robotic program (7)Acorda Therapeutics, Inc -- 2010 - 2011 Board of Scientific Advisors on Cerebral Palsy (8) Johnson & Johnson (Janssen)-- 2010 - 2013 Design robotic biomarker for stroke
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
(1) Interactive Motion Technologies -- 1998 - present Founder & board of directors H. I. Krebs is a co-inventor in several MIT-held patents for robotic therapy. He holds equity positions in Interactive Motion Technologies, the company that manufactures this type of technology under license to MIT.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
This work was partially supported by NIH Grant R01HD069776 for salary support for H. I. Krebs
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
(1) Interactive Motion Technologies -- 1998 - present Founder & board of directors H. I. Krebs is a co-inventor in several MIT-held patents for robotic therapy. He holds equity positions in Interactive Motion Technologies, the company that manufactures this type of technology under license to MIT.
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
MIT distribute royalties paid by Interactive Motion Technologies and Intuitive Surgical.
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
(1) Interactive Motion Technologies -- 1998 - present Founder & board of directors H. I. Krebs is a co-inventor in several MIT-held patents for robotic therapy. He holds equity positions in Interactive Motion Technologies, the company that manufactures this type of technology under license to MIT.
Legal Proceedings:
1.
NONE
View all articles by this author
Alvaro Pascual-Leone, MD, PhD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
Serve on Scientific Advisory Board for Nexstim, Neosync, Starlab, Neuronix, Allied Minds, Axilum Robotics, Neuroelectrics, and Novavision
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Associate Editor for Annals of Neurology, European Journal of Neuroscience and Frontiers in Neuroscience
Patents:
1.
Listed as co-inventor in several patents related to real-time integration of TMS with EEG and functional imaging
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Nexstim, Neuronix
Research Support, Government Entities:
1.
Grants from National Institutes of Health (NEI, NINDS, NCRR, NIMH, NCATS)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Michael J Fox Foundation; Berenson-Allen Foundation; RJG Family Foundation, Sidney Baer Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Dylan J. Edwards, PhD
From the Laboratory for Non-Invasive Brain Stimulation and Human Motor Control (G.W.T., M.C., A.R., D.J.E.), Burke Medical Research Institute, White Plains; Department of Neurology (M.C., D.J.E.), Weill Cornell Medical College, New York; Feinstein Institute for Medical Research (B.T.V.), Manhasset, NY; Laboratory of Neuromodulation (F.F.), Spaulding Rehabilitation Hospital, Harvard Medical School, Boston; Mechanical Engineering Department (H.I.K.), Massachusetts Institute of Technology, Cambridge; Department of Neurology and Division of Rehabilitation (H.I.K.), School of Medicine, University of Maryland, Baltimore; Department of Physical Medicine and Rehabilitation (H.I.K.), Fujita Health University, Nagoya, Japan; Institute of Neuroscience (H.I.K.), University of Newcastle, Newcastle upon Tyne, UK; and Berenson-Allen Center for Non-Invasive Brain Stimulation (A.P.-L., D.J.E.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Disclosure
Scientific Advisory Boards:
1.
Data safety monitoring board - not for profit (Beth Israel Deaconess Medical Center)
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author

Notes

Correspondence to Dr. Edwards: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Gary Thickbroom: drafting/revising the manuscript, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval. Mar Cortes: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, obtaining funding. Avrielle Rykman: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, statistical analysis, study supervision. Bruce Volpe: drafting/revising the manuscript, study concept or design, accepts responsibility for conduct of research and will give final approval. Felipe Fregni: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, statistical analysis. Igo Krebs: study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, statistical analysis, study supervision. Alvaro Pascual-Leone: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, statistical analysis, study supervision, obtaining funding. Dylan Edwards: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, study supervision, obtaining funding.

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    • Mirjam Kouwenhoven,
    • Sebastiaan F.W. Neggers,
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