Prediction of Motor Recovery Using Quantitative Parameters of Motor Evoked Potential in Patients With Stroke

다국어 초록 (Multilingual Abstract)

Objective To investigate the clinical significance of quantitative parameters in transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP) which can be adopted to predict functional recovery of the upper limb in stroke patients in the early subacute phase.Methods One hundred thirteen patients (61 men, 52 women; mean age 57.8±12.2 years) who suffered faiarst-ever stroke were included in this study. All participants underwent TMS-induced MEP session to assess the corticospinal excitability of both hand motor cortices within 3 weeks after stroke onset. After the resting motor threshold (rMT) was assessed, five sweeps of MEP were performed, and the mean amplitude of the MEP was measured. Latency of MEP, volume of the MEP output curve, recruitment ratios, and intracortical inhibition and facilitation were also measured. Motor function was assessed using the Fugl-Meyer Assessment scale (FMA) within 3 weeks and at 3 months after stroke onset. Correlation analysis was performed between TMS-induced MEP derived measures and FMA scores. Results In the MEP response group, rMT and rMT ratio measures within 3 weeks after stroke onset showed a significant negative correlation with the total and upper limb FMA scores at 3 months after stroke (p<0.001). Multiple regression analysis revealed that FMA score and rMT ratio, but not rMT within 3 weeks were independent prognostic factors for FMA scores at 3 months after stroke.Conclusion These results indicated that the quantitative parameter of TMS-induced MEP, especially rMT ratio in the early subacute phase, could be used as a parameter to predict motor function in patients with stroke.

참고문헌 (Reference)

1 Song Z, "Why do stroke patients with negative motor evoked potential show poor limb motor function recovery?" 8 : 2713-2724, 2013

2 Nitsche MA, "Timing-dependent modulation of associative plasticity by general network excitability in the human motor cortex" 27 : 3807-3812, 2007

3 McConnell KA, "The transcranial magnetic stimulation motor threshold depends on the distance from coil to underlying cortex: a replication in healthy adults comparing two methods of assessing the distance to cortex" 49 : 454-459, 2001

4 Nitsche MA, "Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans" 57 : 1899-1901, 2001

5 Paulus W, "State of the art: Pharmacologic effects on cortical excitability measures tested by transcranial magnetic stimulation" 1 : 151-163, 2008

6 Hallett M, "Reorganization in motor cortex in amputees and in normal volunteers after ischemic limb deafferentation" 51 : 183-187, 1999

7 Lee SY, "Prediction of good functional recovery after stroke based on combined motor and somatosensory evoked potential findings" 42 : 16-20, 2010

8 Rossini PM, "Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee" 126 : 1071-1107, 2015

9 Lotze M, "Motor learning elicited by voluntary drive" 126 (126): 866-872, 2003

10 Nascimbeni A, "Motor evoked potentials: prognostic value in motor recovery after stroke" 21 : 199-203, 2006

11 Hendricks HT, "Motor evoked potentials in predicting recovery from upper extremity paralysis after acute stroke" 16 : 265-271, 2003

12 Matamala JM, "Motor evoked potentials by transcranial magnetic stimulation in healthy elderly people" 30 : 201-205, 2013

13 Manganotti P, "Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke" 113 : 936-943, 2002

14 Shimizu T, "Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke" 125 (125): 1896-1907, 2002

15 Liepert J, "Motor cortex disinhibition of the unaffected hemisphere after acute stroke" 23 : 1761-1763, 2000

16 Takeuchi N, "Motor control and neural plasticity through interhemispheric interactions" 2012 : 823285-, 2012

17 Duncan PW, "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements" 23 : 1084-1089, 1992

18 Takechi U, "Longitudinal changes of motor cortical excitability and transcallosal inhibition after subcortical stroke" 125 : 2055-2069, 2014

19 Cicinelli P, "Interhemispheric asymmetries of motor cortex excitability in the postacute stroke stage: a paired-pulse transcranial magnetic stimulation study" 34 : 2653-2658, 2003

20 Nardone R, "Inhibitory and excitatory circuits of cerebral cortex after ischaemic stroke: prognostic value of the transcranial magnetic stimulation" 42 : 131-136, 2002

21 Kothari M, "Influence of position and stimulation parameters on intracortical inhibition and facilitation in human tongue motor cortex" 1557 : 83-89, 2014

22 Morishita T, "Increased excitability and reduced intracortical inhibition in the ipsilateral primary motor cortex during a fine-motor manipulation task" 1371 : 65-73, 2011

23 Garry MI, "Hemispheric differences in the relationship between corticomotor excitability changes following a fine-motor task and motor learning" 91 : 1570-1578, 2004

24 Tae Woong Choi, "Factors Affecting the Motor Evoked Potential Responsiveness and Parameters in Patients With Supratentorial Stroke" 대한재활의학회 38 (38): 19-28, 2014

25 Nelles G, "Evolution of functional reorganization in hemiplegic stroke: a serial positron emission tomographic activation study" 46 : 901-909, 1999

26 Prashantha DK, "Evaluation of the motor cortical excitability changes after ischemic stroke" 16 : 394-397, 2013

27 Ziemann U, "Effects of antiepileptic drugs on motor cortex excitability in humans: a transcranial magnetic stimulation study" 40 : 367-378, 1996

28 Shelton FN, "Effect of lesion location on upper limb motor recovery after stroke" 32 : 107-112, 2001

29 Minino AM, "Deaths:final data for 2008" 59 : 1-126, 2011

30 Groisser BN, "Corticospinal tract diffusion abnormalities early after stroke predict motor outcome" 28 : 751-760, 2014

31 Blicher JU, "Cortical excitability in chronic stroke and modulation by training: a TMS study" 23 : 486-493, 2009

32 Blicher JU, "Cortical and spinal excitability changes after robotic gait training in healthy participants" 23 : 143-149, 2009

33 Takeuchi N, "Correlation of motor function with transcallosal and intracortical inhibition after stroke" 42 : 962-966, 2010

34 Kwon YH, "Combined study of transcranial magnetic stimulation and diffusion tensor tractography for prediction of motor outcome in patients with corona radiata infarct" 43 : 430-434, 2011

35 Zhang X, "Changes in corticomotor excitability and intracortical inhibition of the primary motor cortex forearm area induced by anodal tDCS" 9 : e101496-, 2014

36 Rapisarda G, "Can motor recovery in stroke patients be predicted by early transcranial magnetic stimulation?" 27 : 2191-2196, 1996

37 김기욱, "Can Motor Evoked Potentials Be an Objective Parameter to Assess Extremity Function at the Acute or Subacute Stroke Stage?" 대한재활의학회 39 (39): 253-261, 2015

38 Uhm KE, "BDNF genotype influence the efficacy of rTMS in stroke patients" 594 : 117-121, 2015

39 Pennisi G, "Absence of response to early transcranial magnetic stimulation in ischemic stroke patients: prognostic value for hand motor recovery" 30 : 2666-2670, 1999

40 Groppa S, "A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee" 123 : 858-882, 2012