Absence of response to early transcranial magnetic stimulation in ischemic stroke patients: Prognostic value for hand motor recovery

• Published in: Stroke (1970) Vol. 30; no. 12; pp. 2666 - 2670
• Main Authors: PENNISI, G, RAPISARDA, G, BELLA, R, CALABRESE, V, DE NOORDHOUT, A. M, DELWAIDE, P. J
• Format: Journal Article Web Resource
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.1999; American Heart Association, Inc
• Subjects: Adult; Aged; Biological and medical sciences; Evoked Potentials, Motor - physiology; Female; Hand; Human health sciences; Humans; Infarction, Middle Cerebral Artery - physiopathology; Infarction, Middle Cerebral Artery - therapy; Infarction, Middle Cerebral Artery/physiopathology/therapy; Male; Medical sciences; Middle Aged; Motor Cortex - physiology; Neurologie; Neurology; Paralysis - physiopathology; Paralysis - therapy; Paralysis/physiopathology/therapy; Physical Stimulation - methods; Prognosis; Sciences de la santé humaine; Severity of Illness Index; Transcranial Magnetic Stimulation; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Stroke; Prognosis; Cardiovascular disease; Stimulation; Cerebral disorder; Vascular disease; Transcranial route; Magnetic; Ischemia; Central nervous system disease; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/01.STR.30.12.2666

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. 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. 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. 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.