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Vol. 24. Issue 1.
Pages 20-29 (01 January 2020)
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Vol. 24. Issue 1.
Pages 20-29 (01 January 2020)
Original Research
DOI: 10.1016/j.bjpt.2018.11.002
EMG breakthrough during cortical silent period in congenital hemiparesis: a descriptive case series
Maíra C. Lixandrãoa,b, James W. Stinearc, Tonya Richa, Chao-Ying Chena, Tim Feymad, Gregg D. Meekinse, Bernadette T. Gillicka,
Corresponding author

Corresponding author at: 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, United States.
a Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, United States
b Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
c New Zealand Movement Neuroscience Laboratory, Department of Exercise Sciences, Centre for Brain Research, The University of Auckland, Auckland, New Zealand
d Gillette Children's Specialty Healthcare, St. Paul, MN, United States
e Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States

  • Variability exists in the duration of ipsilesional and contralesional cortical silent period durations in children with congenital hemiparesis.

  • EMG breakthrough activity was consistently observed during ipsilesional CSP assessment.

  • The amplitude of ipsilesional EMG breakthrough was higher than contralesional EMG breakthrough.

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Tables (2)
Table 1. Demographic and clinical characteristics of the participants.
Table 2. Individual and group data of ipsilesional and contralesional resting motor threshold, cortical silent periods and EMG breakthrough activity during the CSP.
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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.


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.


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.


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 206ms and 81 to 150ms, 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 214μV (ipsilesional) and from 23 to 93μV (contralesional).


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 (

Spinal reflex
Cortical inhibition
Cerebral palsy


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