Fatigue-induced motor cortex excitability changes in subjects with spinal cord injury

• The physiological CoSP lengthening during fatigue was not observed in the SCI patients.
• These findings shed light on the role of exercise therapy in promoting brain reorganization.
• We provide physiological evidence of abnormal cortical behaviour during fatigue after SCI.

To further investigate the mechanisms of exercise-induced cortical plasticity after spinal cord injury (SCI), the cortical silent period (CoSP) evoked by transcranial magnetic stimulation (TMS) during a fatiguing muscle contraction was evaluated in 5 patients with incomplete cervical SCI and in 5 healthy subjects.The physiological lengthening of CoSP end latency during fatigue was not observed in the SCI patients.This reduced intracortical inhibition, probably secondary to decreased activity of the GABAergic inhibitory interneurons that modulate the corticomotoneuronal output, could represent a ‘positive’ neuroplastic response in an attempt to compensate for the loss of corticospinal axons.The investigation of motor cortex excitability during fatiguing exercise may shed light on the role of exercise therapy in promoting brain reorganization and functional recovery in humans.