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Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment

Department of Rehabilitation Medicine Radboud University Nijmegen Medical Centre, The Netherlands; Rehabilitation Centre Tolbrug, 's-Hertogenbosch, The Netherlands, a.v.kuijk{at}tolbrug.nl

Jaco W. Pasman, MD, PhD

Department of Clinical Neurophysiology, Radboud University, Nijmegen Medical Centre

Henk T. Hendricks, MD, PhD

Department of Clinical Neurophysiology, Radboud University, Nijmegen Medical Centre

Machiel J. Zwarts, MD, PhD

Department of Clinical Neurophysiology, Radboud University, Nijmegen Medical Centre

Alexander C. H. Geurts, MD, PhD

Department of Clinical Neurophysiology, Radboud University, Nijmegen Medical Centre

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

Key Words: Cerebrovascular disorders • Prognosis • Upper extremity • Motor evoked potentials • Stroke rehabilitation • Transcranial magnetic stimulation

This version was published on January 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 1, 45-51 (2009)
DOI: 10.1177/1545968308317578


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