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Évaluation de l’excitabilité cortico-spinale dans le déficit moteur du membre supérieur après AVC : l’apport de la stimulation magnétique transcrânienne

Abstract : Upper limb motor deficits resulting from a stroke can limit certain activities of daily living, notably grasping movements. The goal of this thesis is to determine which parameters acquired with Transcranial Magnetic Stimulation (TMS) best unravel the mechanisms implicated in upper limb (UL) motor deficits after stroke. The two studies presented in this doctoral work are based on a cohort of 40 patients suffering from UL motor deficits following ischemic stroke in the subacute and chronic phases. The first study aims to determine the correlations between different electrophysiological variables extracted from input-output curves and other parameters reflecting the function of the corticospinal tract (CST). The amplitude of motor evoked potentials (MEPs) measured at a single intensity seem sufficient to capture the function of the CST both in healthy subjects and stroke patients. The second study aims to identify factors capable of explaining the severity of UL deficits following stroke using a multimodal evaluation comprising clinical and TMS data as well as structural and functional neuroimaging data. The results show that the resting motor threshold (rMT) independently explains around 50% of the variance in motor function. This thesis highlights the importance of two parameters commonly acquired in TMS: the amplitude of MEPs and the rMT. An important result of this work is the rMT’s ability to independently explain residual UL motor function beyond the structural integrity of the CST. The rMT may therefore be used as a stratification factor or as a secondary efficacy outcome marker in interventional studies aiming to optimize post-stroke motor recovery.
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Submitted on : Monday, September 28, 2020 - 1:22:53 PM
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Claire Kemlin. Évaluation de l’excitabilité cortico-spinale dans le déficit moteur du membre supérieur après AVC : l’apport de la stimulation magnétique transcrânienne. Neurosciences [q-bio.NC]. Sorbonne Université, 2019. Français. ⟨NNT : 2019SORUS155⟩. ⟨tel-02950925⟩

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