Authors (including presenting author) :
Yeung MPE (1), Chung YKK (1), Fong CH (1), Mo MM (1), Cheng YY (1), Lam YF (1), Chung R (2), Cheung P (2), To J (2),Chan D (2),Yu KKT (1)
Affiliation :
(1)Department of Rehabilitation, Kowloon Hospital (2)Department of Occupational Therapy, Kowloon Hospital
Introduction :
Approximately 30% of stroke patients suffered from severe upper limb paresis. Recent literature suggested using motor evoked potential generated by transcranial magnetic stimulation can predict the potential of motor recovery in stroke patients.
Objectives :
Evaluation of the prognostic value of using motor evoked potential induced by transcranial magnetic stimulation (TMS) to predict the motor recovery of the affected upper limb in subacute stroke patients
Methodology :
Convenient sampling for all first stroke patients to Kowloon Hospital (KH). Inclusion criteria: aged 18 or above, first stroke with hemiparesis or hemiplegia and to KH around 2 weeks of post-stroke onset. The Shoulder Abduction Finger Extension (SAFE) score is <8 and patients could understand the study with abbreviated mental test (AMT) ≥6. No contraindication for TMS study after screening. Data collection: baseline demographic data, AMT, SAFE, Functional test for Hemiplegic Upper extremity (FTHUE), Fugl-Meyer assessment -Upper extremity (FMA-UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Motor evoked potentials (MEP) were obtained by single pulse TMS over both normal and affected motor cortex in all subjects.
Result & Outcome :
Total 32 patients were recruited. Patients with the present of MEP (n=17) showed better FTHUE(p=0.013), FMA-UE total(p=0.011) and ARAT total scores(p=0.006) as compared to MEP negative group (n=15) in both baseline and 12-week post-stroke. In subgroup analysis among those with initial poor upper limb function ie FTHUE ≤2 (n=21), there were no baseline difference between two MEP groups. The MEP positive group (n=8) showed better ARAT pinch (p=0.037) and FMA hand sub-score (p=0.045) as compared to MEP negative group (n=13). The overall sensitivity of using MEP to predicted excellent and good outcome was 70.6% and the specificity was 66.7%. The sensitivity of predicting poor outcome using MEP and initial FTHUE at 12 weeks was 81.8% and specificity was 80.9%. In multiple regression analysis, only initial FMA total score was correlated with the ARAT total score at 12-week post stroke (r2 =0.663, p=0.005). Conclusion: The functional performance of upper limb paresis in subacute stroke patients with the presence of MEP signal showed better clinical outcome as compared with those without MEP. For patients with poor initial upper limb functional state, the presence of MEP signal may predict better distal hand function.
