Hendricks Henk T, Pasman Jaco W, van Limbeek Jacques, Zwarts Machiel J
Department of Rehabilitation Medicine, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
Cerebrovasc Dis. 2003;16(3):265-71. doi: 10.1159/000071126.
The use of motor evoked potentials (MEPs) in predicting recovery after stroke still appears to be somehow equivocal. We assessed the prognostic value of MEPs with respect to arm and hand motor recovery in acute stroke patients.
This cohort study included 43 consecutive acute stroke patients with complete paralysis of the upper extremity. MEPs of the abductor digiti minimi muscle (ADM) and the biceps brachii muscle (BB) were obtained within 10 days after stroke onset. The upper limb subset of the Fugl-Meyer Motor Assessment was used to evaluate the motor performance at regular intervals until 6 months after stroke.
The follow-up was complete in 40 patients (2 patients died and 1 patient had a recurrent stroke); 14 patients showed motor recovery of the arm and their mean 26-week arm motor score was 17.93 (range 3-30, SD 11.68); hand motor recovery occurred in 11 patients and their mean 26-week hand motor score was 11.09 (range 4-14, SD 4.10). Stepwise logistic regression revealed prognostic models for both arm and hand motor recovery based on BB MEPs (odds ratio 7.69, confidence interval, CI, 1.16-50.95) and ADM MEPs (odds ratio 16.20, CI 2.51-104.40), respectively.
The predictive significance of MEPs with respect to motor recovery of the upper extremity was obvious in our homogeneous sample of patients. This agrees with the paradigm that motor recovery after infarction is strongly dependent on a critical residual sparing of the corticospinal function. In this context, the test properties of MEPs in predicting motor recovery are discussed. The added value of MEPs with respect to motor recovery of the upper extremity should be regarded as established for patients with initial paralysis, especially since clinical examination alone lacks the possibility to detect the potential for motor recovery in these cases.
运动诱发电位（MEP）在预测中风后恢复情况方面似乎仍存在一定的不确定性。我们评估了MEP对急性中风患者手臂和手部运动恢复的预后价值。
这项队列研究纳入了43例连续的急性中风患者，这些患者上肢完全瘫痪。在中风发作后10天内获取小指展肌（ADM）和肱二头肌（BB）的MEP。使用Fugl-Meyer运动评估的上肢部分定期评估运动表现，直至中风后6个月。
40例患者完成随访（2例死亡，1例再次中风）；14例患者手臂出现运动恢复，其26周时手臂运动评分的平均值为17.93（范围3 - 30，标准差11.68）；11例患者手部出现运动恢复，其26周时手部运动评分的平均值为11.09（范围4 - 14，标准差4.10）。逐步逻辑回归分别揭示了基于BB的MEP（优势比7.69，置信区间，CI，1.16 - 50.95）和ADM的MEP（优势比16.20，CI 2.51 - 104.40）的手臂和手部运动恢复的预后模型。
在我们同质化的患者样本中，MEP对上肢运动恢复的预测意义明显。这与梗死灶后运动恢复强烈依赖皮质脊髓功能的关键残余保留这一范式相符。在此背景下，讨论了MEP在预测运动恢复方面的测试特性。对于初始瘫痪的患者，应认为MEP在上肢运动恢复方面具有附加价值，特别是因为仅靠临床检查无法检测这些病例中的运动恢复潜力。
