Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?
Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?
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DOI：
10.1177/1545968318785044
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发表时间：
2018-08
影响因子：
4.2
通讯作者：
Kwakkel G
中科院分区：
文献类型：
--
作者：
Hoonhorst MHJ;Nijland RHM;van den Berg PJS;Emmelot CH;Kollen BJ;Kwakkel G
背景。经颅磁刺激（TMS）诱发的运动诱发电位（MEPs）在脑卒中后早期上肢临床建模中的附加预后价值尚不清楚。目标。目的：探讨脑卒中后48小时及11天内指内收肌TMS （TMS- adm）对基于自愿肩外展（SA）和手指伸展（FE）的临床模型的附加预后价值。方法。这是一项前瞻性队列研究，采用3个逻辑回归模型，用于预测中风后6个月的上肢功能。第一个模型显示脑卒中后48小时内和11天内测量的SA和FE的预测价值。第二个模型包括TMS-ADM，而第三个模型结合了临床和TMS-ADM信息。推导出的模型之间的差异用受试者工作特性曲线分析进行检验。结果。共有51例严重的首次缺血性中风患者被纳入研究。在48小时内，TMS-ADM对临床造模没有显著的增加价值（P = .369）。两种模型在脑卒中后48小时内的阴性预测值都相对较低。脑卒中后11天，TMS-ADM联合SA和FE （SAFE）的准确性显著高于单独TMS-ADM （P = 0.039）。结论。在脑卒中后48小时内测量TMS-ADM对临床建模没有增加价值，而SAFE联合TMS-ADM在脑卒中后11天达到最佳预测。我们的研究结果表明，TMS-ADM预测上肢运动功能的准确性主要取决于卒中发作后早期评估的时间。
Background. The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke. Objective. To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. Methods. This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke. The first model showed the predictive value of SA and FE measured within 48 hours and at 11 days poststroke. The second model included TMS-ADM, whereas the third model combined clinical and TMS-ADM information. Differences between derived models were tested with receiver operating characteristic curve analyses. Results. A total of 51 patients with severe, first-ever ischemic stroke were included. Within 48 hours, no significant added value of TMS-ADM to clinical modeling was found (P = .369). Both models suffered from a relatively low negative predictive value within 48 hours poststroke. TMS-ADM combined with SA and FE (SAFE) showed significantly more accuracy than TMS-ADM alone at 11 days poststroke (P = .039). Conclusion. TMS-ADM showed no added value to clinical modeling when measured within first 48 hours poststroke, whereas optimal prediction is achieved by SAFE combined with TMS-ADM at 11 days poststroke. Our findings suggest that accuracy of predicting upper-limb motor function by TMS-ADM is mainly determined by the time of assessment early after stroke onset.
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DOI：
10.1016/j.apmr.2015.06.009
发表时间：
2015-10-01
影响因子：
4.3
作者：
Hoonhorst, Maurits H.;Nijland, Rinske H.;Kwakkel, Gert
通讯作者：
Kwakkel, Gert
影响因子：
8.3
作者：
Goldstein, LB;Samsa, GP
通讯作者：
Samsa, GP
DOI：
10.1016/j.clinph.2012.01.010
发表时间：
2012-05
期刊：
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
影响因子：
--
作者：
Groppa S;Oliviero A;Eisen A;Quartarone A;Cohen LG;Mall V;Kaelin-Lang A;Mima T;Rossi S;Thickbroom GW;Rossini PM;Ziemann U;Valls-Solé J;Siebner HR
通讯作者：
Siebner HR
影响因子：
11.2
作者：
Byblow, Winston D.;Stinear, Cathy M.;Ackerley, Suzanne J.
通讯作者：
Ackerley, Suzanne J.
影响因子：
19.7
作者：
HANLEY, JA;MCNEIL, BJ
通讯作者：
MCNEIL, BJ