Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke

Pizzi, A.; Carrai, Riccardo; Falsini, C.; Martini, Monica; Verdesca, Sonia; Grippo, Antonello

doi:10.2340/16501977-0389

Cited by 49 publications

(48 citation statements)

References 25 publications

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“…However, the accuracy of these predictions was only marginally better than chance (55%, Table 3). The addition of TMS biomarker information increased prediction accuracy to 70% for these patients, underlining the value of testing corticospinal tract function in patients with more severe motor impairment 21, 22. While PREP2 requires TMS for a smaller proportion of patients, this does not eliminate barriers to using this technique in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

PREP2: A biomarker‐based algorithm for predicting upper limb function after stroke

Stinear

Byblow

Ackerley

et al. 2017

Ann Clin Transl Neurol

254

321

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ObjectiveRecovery of motor function is important for regaining independence after stroke, but difficult to predict for individual patients. Our aim was to develop an efficient, accurate, and accessible algorithm for use in clinical settings. Clinical, neurophysiological, and neuroimaging biomarkers of corticospinal integrity obtained within days of stroke were combined to predict likely upper limb motor outcomes 3 months after stroke.MethodsData from 207 patients recruited within 3 days of stroke [103 females (50%), median age 72 (range 18–98) years] were included in a Classification and Regression Tree analysis to predict upper limb function 3 months poststroke.ResultsThe analysis produced an algorithm that sequentially combined a measure of upper limb impairment; age; the presence or absence of upper limb motor evoked potentials elicited with transcranial magnetic stimulation; and stroke lesion load obtained from MRI or stroke severity assessed with the NIHSS score. The algorithm makes correct predictions for 75% of patients. A key biomarker obtained with transcranial magnetic stimulation is required for one third of patients. This biomarker combined with NIHSS score can be used in place of more costly magnetic resonance imaging, with no loss of prediction accuracy.InterpretationThe new algorithm is more accurate, efficient, and accessible than its predecessors, which may support its use in clinical practice. While further work is needed to potentially incorporate sensory and cognitive factors, the algorithm can be used within days of stroke to provide accurate predictions of upper limb functional outcomes at 3 months after stroke. www.presto.auckland.ac.nz

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Section: Discussionmentioning

confidence: 99%

PREP2: A biomarker‐based algorithm for predicting upper limb function after stroke

Stinear

Byblow

Ackerley

et al. 2017

Ann Clin Transl Neurol

254

321

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“…Our data contribute to this issue, by suggesting that a combination of two relatively easily obtainable parameters could support decisions concerning the rehabilitation process. Some studies conducted in the acute phase of stroke showed, using MEP threshold and amplitude measures, a relationship between motor recovery and the degree of motor impairment (Pennisi et al, 1999;Pizzi et al, 2009;Rapisarda et al, 1996). The absence of MEPs, more than amplitude variations, seems to be predictive of recovery (Di Lazzaro et al, 2010), but consensus on this issue is still lacking.…”

Section: Discussionmentioning

confidence: 99%

TMS-evoked N100 responses as a prognostic factor in acute stroke

Manganotti

Acler²,

Masiero

et al. 2015

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SummaryRehabilitation programs, to be efficiently tailored, need clear prognostic markers. In acute stroke, neurophysiological measures, such as motor evoked potentials (MEPs), have been proposed, although with discordant results. The aim of this study was to identify a reliable neurophysiological measure of recovery in acute poststroke individuals by combining MEPs and the N100 component of transcranial magnetic stimulationevoked potentials (TEPs). Nine acute post-stroke subjects were included. Clinical evaluation performed in the first week after the event included administration of the European Stroke Scale and Barthel Index and recording of MEPs and TEPs; administration of the clinical scales was repeated after one and three months. The presence/absence of MEPs and TEPs showed correlations with motor outcome. Individuals with a poorer outcome showed absence of both MEPs and TEPs; absence of MEPs alone was related to a partial recovery. Given the results of this exploratory study, further investigation is needed to define the accuracy of combined use of MEPs and TEPs as an approach for predicting motor recovery after acute stroke.

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“…The ability to evoke a motor response in the abductor digiti minimi of the affected upper limb in paralyzed patients (MRC<2) 1 week after stroke is a strong predictor of some recovery of upper limb movement 1 year after stroke. 84 The predictive ability for upper limb recovery with an MEP is quite specific (99%), meaning there are no false positives. The sensitivity on the other hand ranges from 62% to 94%, because some patients without an MEP will still regain some motor function.…”

Section: Ambulationmentioning

confidence: 99%

Predictors of Functional Outcome Following Stroke

Harvey

2015

Physical Medicine and Rehabilitation Clinics of North America

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Prognostic value of motor evoked potentials in motor function recovery of upper limb after stroke

Abstract: Motor evoked potentials could be a supportive tool to increase the prognostic accuracy of upper limb motor and functional outcome in hemiparetic patients, especially those with severe initial paresis (MRC < 2) and/or with motor evoked potentials absent in the post-stroke acute phase.

Cited by 49 publications

References 25 publications

PREP2: A biomarker‐based algorithm for predicting upper limb function after stroke

PREP2: A biomarker‐based algorithm for predicting upper limb function after stroke

TMS-evoked N100 responses as a prognostic factor in acute stroke

Predictors of Functional Outcome Following Stroke

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