Modulation of corticospinal excitability by paired associative stimulation after stroke

• Paired associative stimulation (PAS) modulates corticospinal excitability following stroke.¹
• Direct electrophysiology (PAS, corticospinal excitability) is relevant to motor recovery and plasticity after stroke.^{1 1}

Weekly enrichment (2026-07-20)

• The ScienceDirect source page timed out during enrichment, but bibliographic records identify the article as Ron Levy A, Treger I, Alyagon U, … Zangen A (corresponding author), “Modulation of corticospinal excitability by paired associative stimulation following stroke,” Clinical Neurophysiology, vol. 183, article 2111474 (2026); DOI 10.1016/j.clinph.2025.2111474.^{2 3}
• It is a peer-reviewed Letter from the Brain Healing Division / Department of Life Sciences at Ben-Gurion University of the Negev (Abraham Zangen’s group) together with clinicians at Soroka Medical Center, Israel.³
• Because the full text was not accessible, this study’s specific patient numbers, MEP amplitudes, interstimulus intervals, and other stimulation parameters are not reported here.²
• Paired associative stimulation (PAS) repeatedly pairs peripheral (or cortical) stimulation with M1 TMS pulses at fixed intervals to drive spike-timing-dependent, Hebbian-like plasticity, with corticospinal excitability read out as motor-evoked potential (MEP) amplitude.²
• The same group previously established interhemispheric cortico-cortical PAS of the prefrontal cortex that jointly modulates frontal asymmetry and emotional reactivity (Zibman et al., Brain Stimulation 2019), providing the conceptual basis for applying paired stimulation across motor cortices after stroke.²
• The rationale after stroke is to rebalance interhemispheric inhibition—excessive inhibition from the intact hemisphere over the lesioned one hinders recovery—so PAS protocols aim to raise ipsilesional and/or reduce contralesional excitability.^{2 4}
• A cited randomized, double-blind Phase II trial (Xing et al., Brain Communications 2024) reported that circuit-based paired stimulation can “rewire” the disordered connectome after stroke, situating this Letter within an emerging PAS-for-stroke-rehabilitation evidence base.⁴

Footnotes

1. https://www.sciencedirect.com/science/article/pii/S1388245725013264?dgcid=rss_sd_all ↩ ↩² ↩³

2. https://doi.org/10.1016/j.clinph.2025.2111474 ↩ ↩² ↩³ ↩⁴ ↩⁵

3. https://cris.bgu.ac.il/en/publications/modulation-of-corticospinal-excitability-by-paired-associative-st/ ↩ ↩²

4. https://doi.org/10.1093/braincomms/fcae437 ↩ ↩²