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Brief description/objective

This randomized, double blind, placebo-controlled longitudinal study encompassing behavioural, neurophysiological and neuroimaging endpoints is designed to test our hypothesis, based on results from our previous pilot study, that serotonergic neuromodulation should increase perilesional neuroplasticity, leading to improved behavioural outcomes through a more efficient allocation of functional resources, greater structural reorganization and less remapping via alternative circuits.
The primary aims are to measure the effects of oral escitalopram administration on behavioural recovery by tracking skilled hand function over the first nine months after stroke, to measure the associated patterns of BOLD response and GMV change in the sensorimotor network with special focus on the perilesional PMC, to provide mechanistic insight into human post-stroke neuroplasticity by correlating BOLD and GMV
changes directly with behavioural scores, kinematic measures of hand function and physiological
measures of movement-related effort. The secondary aims are to longitudinally measure electrophysiological markers of neuroplasticity (through rTMS) and local glutamatergic neurotransmission (through MRS) and to assess the relationship of these markers with BOLD response and grey matter volume change.