, 2007). Nonetheless, the lack of significant discrepancies in lesion location and size between our two subgroups of individuals

would in principle rule out damage extent as a major factor probably influencing the outcome of our rTMS regime. Hence, a possibility that remains to be demonstrated is that variability could emerge from the interaction of the 10 Hz rTMS regime, with different levels or patterns of ongoing local parietal activity at the time selleck compound of stimulation, which could be directly or indirectly related to the degree of recovery achieved spontaneously (Silvanto et al., 2007a,b). Considering interhemispheric rivalry principles, we inferred that the perilesional aMS cortex had a reduced excitability state. Given this, our data suggest that, in at least half of our subjects, excitatory rTMS patterns should have increased perilesional activity levels and caused visuospatial progress beyond spontaneous recovery levels. The lack of amelioration seen in the remaining subjects could have been caused by a state-dependent reduction in the likelihood of rTMS to induce further local perilesional excitation, more prone to yield insufficient regional modulations (Silvanto et al., 2007a) or

even reverse the direction of such local effects (Siebner et al., 2004). Fenbendazole Considering state-dependent principles as a factor explaining response INNO-406 differences to rTMS, and given that variability in local baseline activity in intact areas of the spared hemisphere might be less than on lesional and perilesional tissue, it is reasonable to hypothesize that the stimulation of the spared contralesional parietal regions with low-frequency rTMS could have led

this same cohort of animals to respond more consistently. In the absence of further data, this hypothesis remains speculative and future studies combining rTMS with neuroimaging techniques will have to demonstrate its likelihood. The long duration of the recovery achieved in the group of Responders, spanning at least 6 weeks beyond the end of the rTMS regime, strongly supports the notion that the beneficial rTMS-driven effects on visuospatial neglect reach a level of stability over time well beyond what has been demonstrated thus far in human patients (Shindo et al., 2006; Koch et al., 2012). Furthermore, our data indicate that, in contrast with the latter effects, ipsilesional orienting losses also generated by the stimulation regime in some subjects regressed as soon as the treatment was discontinued. In other words, stability was reached and maintained for adaptive but not for maladaptive outcomes.