Bilateral impairment of intracortical inhibition in delayed-onset posthemiplegic dystonia: pathophysiological implications

OBJECTIVE: To study short interval intracortical inhibition (SICI) in a rare patient with segmental dystonia of the left upper limb due to a vascular lesion in the contralateral putamen without corticospinal tract involvement. METHODS: Paired-pulse transcranial magnetic stimulation (TMS) was applied to both hemispheres in a conditioning-test paradigm. Six interstimulus intervals (ISIs) and 4 conditioning stimulation intensities were investigated in two separate sessions. RESULTS: Motor evoked potentials upon single-pulse TMS were within the normal range, whereas paired-pulse TMS revealed major changes in cortical excitability, proving that SICI was bilaterally absent. CONCLUSIONS: The bilateral impairment of SICI cannot be considered the cause of dystonic contractions, but just a predisposing factor. SIGNIFICANCE: The absence of SICI might be regarded as a condition able to promote maladaptive plastic changes triggered by focal lesions in the putamen.