Absence of response to early transcranial magnetic stimulation in ischemic stroke patients - Prognostic value for hand motor recovery
Absence of response to early transcranial magnetic stimulation in ischemic stroke patients - Prognostic value for hand motor recovery
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DOI：
10.1161/01.str.30.12.2666
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发表时间：
1999-12-01
期刊：
影响因子：
8.3
通讯作者：
Delwaide, PJ
中科院分区：
文献类型：
--
作者：
Pennisi, G;Rapisarda, G;Delwaide, PJ
背景与目的：经颅磁刺激（TMS）已被提出作为脑卒中患者的预后工具。大多数先前的研究都同意将卒中后第一天运动诱发电位（MEPs）的存在作为良好预后的指标。在本研究中，我们评估了早期经颅磁刺激无反应对脑卒中患者因大脑中动脉缺血而发作的完全性手瘫患者手部运动恢复的预后价值。方法：15例患者在卒中发作48小时内（定义为第1天）接受TMS治疗，1年后再次接受TMS治疗。在第1天，他们还通过医学研究委员会（MRC）和美国国立卫生研究院（NIH）中风量表进行临床评估；在第365天用相同的量表和Barthel指数对他们进行重新评估。结果：第1天，所有患者手部完全麻痹，经颅磁刺激无反应；他们的NIH分数表现出很大的差异。1年后，15例患者中有6例恢复了较小且延长的mep，同时运动恢复非常差且无功能。NIH评分显著提高，Barthel指数评分存在较大的个体间差异，且与MRC评分无相关性。结论：我们的结论是，对于完全性手瘫患者，在最初几个小时内对经颅磁刺激没有反应，预示着手部运动恢复没有或非常差，无用。
Background and Purpose-Transcranial magnetic stimulation (TMS) has been proposed as a prognostic tool in stroke patients. Most of the previous studies agree in considering the presence of motor-evoked potentials (MEPs) in the first days after a stroke as an indicator of good outcome. In the present study, we have assessed the prognostic value of the absence of response to early TMS on hand motor recovery in stroke patients with complete hand palsy at onset due to ischemia in the area of the middle cerebral artery.Methods-Fifteen patients submitted to TMS within 48 hours of stroke onset (defined as day 1) and again after 1 year. They were also evaluated clinically on day 1 by a scale derived from the Medical Research Council (MRC) and by the National Institutes of Health (NIH) stroke scale; they were reevaluated by the same scales and by Barthel Index on day 365.Results-On day 1, all the patients had complete hand palsy and no response to TMS; their NIH scores showed great variability. After 1 year, 6 of 15 patients regained small and prolonged MEPs, together with a very poor and not functionally useful motor recovery. NIH scores were significantly improved, Barthel Index scores showed large interindividual differences and were not correlated with MRC scores.Conclusions-We conclude that in patients with complete hand palsy, the absence of response to TMS in the first hours is predictive of absent or very poor, not useful, hand motor recovery.