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
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
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DOI：
10.1093/brain/116.6.1371
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发表时间：
1993-12-01
期刊：
影响因子：
14.5
通讯作者：
MILLER, S
中科院分区：
文献类型：
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作者：
HEALD, A;BATES, D;MILLER, S
对118例首次中风患者进行了一项纵向研究，以评估中风后一段时间内中枢运动传导时间（CMCT）的神经生理测量，作为12个月功能结局和死亡率的预测因子。根据相关文章（Heald et al., 1993, Brain, 116, 1355-1370）对CMCT进行测量，在症状出现后12-72小时内识别出以下三组患者：正常反应组、延迟反应组和无反应组。在症状出现后12-72小时（指定为第1天）开始神经生理学和临床调查，并以设定的时间间隔重复调查，最长可达12个月。对受试者进行神经学检查，并使用肌肉力量运动指数、九孔Peg测试、日常生活活动Barthel评分和改进的Rankin量表评估功能结果。记录了住院时间和中风相关死亡的发生情况。在中风后的第一周，无反应与患者的症状和异常肌张力和肌腱反射的神经学观察密切相关。三组患者在第1天和第12个月的功能评分存在相关性。CMCT正常的患者在12个月的时间里得分一直较高，功能恢复也明显更好。在12个月期间，无反应的患者在神经和功能测试中表现不佳。延迟CMCT患者的神经和功能评分介于其他两组之间，但12个月的结果与正常反应组相似。当皮层刺激阈值异常高时，功能结果通常较差。无反应组死亡率最高，幸存者住院时间最长。总之，观察第1天的正常或延迟CMCT，可以确定一组患者的生存和功能恢复概率很高。在第1天对皮质刺激没有反应，这组患者在12个月时功能恢复不良的风险很高，在此期间卒中相关死亡的可能性更大。
A longitudinal study was performed on 118 first-ever stroke patients to evaluate neurophysiological measurements of central motor conduction time (CMCT) in the period immediately following stroke as predictors of functional outcome and mortality at 12 months. Measurements of CMCT were made as described in the accompanying article (Heald et al., 1993, Brain, 116, 1355-1370), in which the following three groups of patients were recognized within 12-72 h after the onset of symptoms: normal response group, delayed response group and no response group. Neurophysiological and clinical investigations were commenced 12-72 h (designated as day 1) after the onset of symptoms and repeated at set time intervals up to 12 months. The subjects were examined neurologically and assessed using the Motricity Index for muscle strength, the Nine-hole Peg Test to measure manual dexterity, the Barthel Score for activities of daily living and the modified Rankin Scale for functional outcome. The duration of stay in hospital and the occurrence of stroke-related death were noted. During the first week following stroke, absence of responses correlated closely with the patient's symptoms and neurological observations of abnormal muscle tone and tendon reflexes.Correlations were made in the three groups of patients of functional scores at day 1 and at 12 months. Patients with normal CMCT had consistently higher scores throughout the 12 month period and achieved significantly better functional recovery. Patients with no responses showed poor performance in neurological and functional tests throughout the 12 month period. Patients with delayed CMCT had neurological and functional scores intermediate between those of the other two groups, but outcome at 12 months was similar to those in the normal response group. Where the threshold to cortical stimulation was abnormally high, functional outcome was generally poor. Mortality was highest in the group with absent responses and the survivors spent the longest period in hospital.In conclusion, the observation of normal or delayed CMCT at day 1 identifies a group of patients with a high probability of survival and functional recovery. The absence of responses to cortical stimulation at day 1 identities a group of patients who are at high risk of poor functional recovery at 12 months and greater probability of stroke-related death during this period.