EMG breakthrough during cortical silent period in congenital hemiparesis: a descriptive case series

Maíra C. Lixandrão, James W. Stinear, Tonya Rich, Chao Ying Chen, Tim Feyma, Gregg D. Meekins, Bernadette T. Gillick

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Background: The cortical silent period is a transient suppression of electromyographic activity after a transcranial magnetic stimulation pulse, attributed to spinal and supraspinal inhibitory mechanisms. Electromyographic breakthrough activity has been observed in healthy adults as a result of a spinal reflex response within the cortical silent period. Objectives: The objective of this case series is to report the ipsilesional and contralesional cortical silent period and the electromyographic breakthrough activity of 7 children with congenital hemiparesis. Methods: TMS was delivered over the ipsilesional and contralesional primary motor cortices with resting motor threshold and cortical silent period measures recorded from first dorsal interosseous muscle. Results: Seven children (13 ± 2 years) were included. Ipsilesional and contralesional resting motor thresholds ranged from 49 to 80% and from 38 to 63% of maximum stimulator output, respectively. Ipsilesional (n = 4) and contralesional (n = 7) cortical silent period duration ranged from 49 to 206 ms and 81 to 150 ms, respectively. Electromyographic breakthrough activity was observed ipsilesionally in 3/4 (75%) and contralesionally in 3/7 (42.8%) participants. In the 3 children with ipsilesional breakthrough activity during the cortical silent period, all testing trials showed breakthrough. Contralesional breakthrough activity was observed in only one of the analyzable trials in each of those 3 participants. The mean peak amplitude of breakthrough activity ranged from 45 to 214 μV (ipsilesional) and from 23 to 93 μV (contralesional). Conclusion: Further research is warranted to understand the mechanisms and significance of electromyographic breakthrough activity within the cortical silent period in congenital hemiparesis. Understanding these mechanisms may lead to the design of tailored neuromodulation interventions for physical rehabilitation. Trial registration: NCT02250092 (https://clinicaltrials.gov/ct2/show/NCT02250092)

Original languageEnglish (US)
Pages (from-to)20-29
Number of pages10
JournalBrazilian Journal of Physical Therapy
Issue number1
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
This work was supported by the following funding agencies: São Paulo Research Foundation (Process no. 2015/16744-4); NIH/NICHD 5 K01-HD078484-02, Cerebral Palsy Foundation, Foundation for Physical Therapy, UMN Marie Louise Wales Fellowship, Minnesota's Discovery, Research, and Innovation Economy Fellowship.


  • Cerebral palsy
  • Cortical inhibition
  • Electromyography
  • Rehabilitation
  • Spinal reflex

PubMed: MeSH publication types

  • Journal Article

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