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We aim to find reliable interhemispheric measures in stroke patients with a not\u2010evocable motor\u2010evoked potential from the affected hemisphere, by combining transcranial magnetic stimulation (TMS) and electroencephalography. Ninteen stroke patients (seven females; 61.26\u2009\u00b1\u20099.8\u2009years) were studied for 6\u2009months after a first\u2010ever stroke in the middle cerebral artery territory. Patients underwent four evaluations: clinical, cortical, corticospinal, and structural. To test the reliability of our measures, the evaluations were repeated after 3\u2009weeks. To test the sensitivity, 14 age\u2010matched healthy controls were compared to stroke patients. In stroke patients, stimulation of the affected hemisphere did not result in any inhibition onto the unaffected. The stimulation of the unaffected hemisphere revealed a preservation of the inhibition mechanism onto the affected. This resulted in a remarkable interhemispheric imbalance, whereas this mechanism was steadily symmetric in healthy controls. This result was stable when cortical evaluation was repeated after 3\u2009weeks. Importantly, patients with a better recovery of the affected hand strength were the ones with a more stable interhemispheric balance. Finally, we found an association between microstructural integrity of callosal fibers, suppression of interhemispheric TMS\u2010evoked activity and interhemispheric connectivity. We provide direct and sensitive cortical measures of interhemispheric imbalance in stroke patients. These measures offer a reliable means of distinguishing healthy and pathological interhemispheric dynamics.<\/jats:p>","DOI":"10.1002\/hbm.25297","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T14:37:24Z","timestamp":1610721444000},"page":"1343-1358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":104,"title":["Evidence for interhemispheric imbalance in stroke patients as revealed by combining transcranial magnetic stimulation and electroencephalography"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5039-973X","authenticated-orcid":false,"given":"Elias Paolo","family":"Casula","sequence":"first","affiliation":[{"name":"Non\u2010Invasive Brain Stimulation Unit\/Department of Behavioral and Clinical Neurology Santa Lucia Foundation  Rome Italy"},{"name":"Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, 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