Index > Vol. 41/2009 > Iss. 8/July > pp. 654-660 > Abstract
Original report

Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke

doi: 10.2340/16501977-0389

Abstract:

Objective: To determine the prognostic value of clinical assessment and motor evoked potentials for upper limb strength and functional recovery after acute stroke, and to establish the possible use of motor evoked potentials in rehabilitation.
Design: A prospective study.
Subjects: Fifty-two patients with hemiparesis were enrolled one month post-stroke; 38 patients concluded the study at 12 months.
Methods: Motor evoked potentials were recorded at baseline and after one month. Upper limb muscular strength (Medical Research Council Scale, MRC) and functional tests (Frenchay Arm Test, Barthel Index) were used as dependent outcome variables 12 months later. Motor evoked potentials were classified as present or absent. Predictive values of motor evoked potentials and MRC were evaluated.
Results: At 12 months, patients with baseline recordable motor evoked potentials showed a good functional reco­very (positive predictive value 94%). The absence of motor evoked potentials did not exclude muscular strength reco­very (negative predictive value 95%). Motor evoked potentials had a higher positive predictive value than MRC only in patients with MRC < 2.
Conclusion: Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients, especially those with severe initial paresis (MRC < 2) and/or with motor evoked potentials absent in the post-stroke acute phase.

Authors:

Assunta Pizzi, Riccardo Carrai, Catuscia Falsini, Monica Martini, Sonia Verdesca, Antonello Grippo

Key words:

motor evoked potentials, rehabilitation, stroke, upper limb, outcome.

References

  1. Rossini PM, Johnston CS. Facilitating acute stroke recovery with magnetic fields. Neurol 2005; 65: 353-354. Link to article
  2. H��non H, Godefroy O, Leys D, Mounier-Vehier F, Lucas C, Rondepierre P, et al. Early predictors of death and disability after acute cerebral ischemic event. Stroke 1995; 26: 392-398.
  3. Wade DT, Langton HR, Wood VA. The hemiplegic arm after stroke: measurement and recovery. J Neurol Neurosurg Psychiatry 1983; 46: 521-524. Link to article
  4. De Weerdt W, Lincoln NB, Harrison MA. Prediction of arm and hand function recovery in stroke patients. Int J Rehabil Res 1987; 10: 110-112.
  5. Hier D, Edelstein G. Deriving clinical prediction rules from stroke outcome research. Stroke 1991; 22: 1431-1436.
  6. Prescott RJ, Garraway WM, Akhtar AJ. Predicting functional outcome following functional outcome following acute stroke using a standard clinical examination. Stroke 1982; 13: 641-647.
  7. Saunders DE, Andrew GC, Brown MM. Measurement of infarct size using MRI predicts prognosis in middle cerebral artery infarction. Stroke 1995; 26: 2272-2276.
  8. Edwards DF, Chen YW, Diringer MN. Unified neurological stroke scale is valid in ischemic and hemorrhagic stroke. Stroke 1995; 26: 1852-1858.
  9. Catano A, Houa M, Caroyer JM, Ducarne H, Noel P. Magnetic transcranial stimulation in acute stroke: early excitation threshold and functional prognosis. Electroencephalogr Clin Neurophysiol 1996; 101: 233-239. Link to article
  10. Rapisarda G, Bastings E, de Noordhout AM, Pennisi G, Delwaide PJ. Can motor recovery in stroke patients be predicted by early transcranial magnetic stimulation? Stroke 1996; 27: 2191-2196.
  11. Timmerhuis TPG, Oosterloo SJ. Prognostic value of cortical magnetic stimulation in acute middle cerebral artery infarction compared to other parameters. Clin Neurol Neurosurg 1996; 98: 231-236. Link to article
  12. Trompetto C, Assini A, Buccolieri A, Marchese R, Abruzzese G. Motor recovery following stroke: a transcranial magnetic stimulation study. Clin Neurophysiol 2000; 111: 1860-1867. Link to article
  13. Alagona G, Delvaux V, Gerard P, De Pasqua P, Pennisi G, Delwaide PJ, et al. Ipsilateral motor responses to focal transcranial magnetic stimulation in healthy subjects and acute stroke patients. Stroke 2001; 32: 1304-1309.
  14. Escudero JV, Sancho J, Bautista D, Escudero M, Lopez-Trigo J. Prognostic value of motor evoked potentials obtained by transcranial magnetic brain stimulation in motor function recovery in patients with acute ischemic stroke. Stroke 1998; 29: 1854-1859.
  15. Cruz-Martinez A, Tejada J, Diez Tejedor E. Motor hand recovery after stroke. Prognostic yield of early transcranial magnetic stimulation. Electromyogr Clin Neurophysiol 1999; 39: 405-410.
  16. Palliyath S. Role of central conduction time and motor evoked response amplitude in predicting stroke outcome. Electromyogr Clin Neurophysiol 2000; 40: 315-332.
  17. Hendricks HT, Pasman JW, van Limbeek J, Zwarts MJ. Motor evoked potentials in predicting recovery from upper extremity paralysis after acute stroke. Cerebrovasc Dis 2003; 16: 265-271. Link to article
  18. Arac N, Sagduyu A, Binai S, Ertekin C. Prognostic value of transcranial magnetic stimulation in acute stroke. Stroke 1994; 25: 2183-2186.
  19. van Rijckevorsel-Harmant K, Boon V, de Barsy T. Central magnetic stimulation, somatosensory potentials, and clinical evolution during a rehabilitation treatment in hemiplegic patients. Electroencephalogr Clin Neurophysiol 1993; 87: S102.
  20. Binkofski F, Seitz RJ, Harnold S, Classen J, Benecke R, Freund HJ. Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Ann Neurol 1996; 39: 460-470. Link to article
  21. Feys H, Van Hees J, Bruyninckx F, Mercelis R, De Weerdt W. Value of somatosensory and motor evoked potentials in predicting arm recovery after a stroke. J Neurol Neurosurg Psychiatry 2000; 68: 323-331. Link to article
  22. WHO Special Report Stroke. 1989: recommendations on stroke patients: prevention, diagnosis and therapy. Stroke 1989; 20: 1407-1431.
  23. Bamford J, Sundercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarctions. Lancet 1991; 337: 1521-1526. Link to article
  24. Folstein MS, Folstein SE, McHugh PR. -Mini-mental state-. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198. Link to article
  25. Medical Research Council. Aids to the investigation of peri��pheral nerve injuries. War memorandum. London: HMSO; 1943, p. 11-46.
  26. De Souza LH, Hewer RL, Miller S. Assessment of recovery of arm control in hemiplegic stroke patients. 1. Arm function tests. Int Rehabil Med 1980; 2: 3-9.
  27. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965; 14: 61-65.
  28. Collin C, Wade BT, Davies S, Home V. The Barthel ADL Index: a reliability study. Int Disabil Stud 1988; 10: 61-63.
  29. Rothwell C, Hallett M, Berardelli A, Eisen A, Rossini P, Paulus W. Magnetic stimulation: motor evoked potentials. In: Deuschl G, Eisen AG, editors. Recommendations for the practice of clinical neurophysiology. Electroenceph Clin Neurophysiol 1999; Suppl 52: 97-103.
  30. Bobath B. Adult hemiplegia : evaluation and treatment. London: William Heinemann Medical Books, 1990, p. 1-190.
  31. Rossini PM, Tecchio F, Pizzella V, Lupoi D, Cassetta E. On the reorganization of the sensory hand areas after monohemispheric lesion: a functional (MEG)/anatomical (MRI) integrative study. Brain 1998; 782: 153-166. Link to article
  32. Heald A, Bates D, Cartlidge NE, French JM, Miller S. Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain 1993; 116: 1371-1385. Link to article
  33. Olsen TS. Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 1990; 2: 247-251.
  34. Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil 2002; 83: 1629-1637. Link to article
  35. Rossini PM, Calautti C, Pauri F, Baron JC. Post-stroke plastic reorganisation in the adult brain. Lancet Neurol 2003; 2: 493-502. Link to article