Choi Tae Woong, Jang Seung Gul, Yang Seung Nam, Pyun Sung-Bom
Department of Physical Medicine and Rehabilitation, Korea University Hospital, Korea University College of Medicine, Seoul, Korea.
Ann Rehabil Med. 2014 Feb;38(1):19-28. doi: 10.5535/arm.2014.38.1.19. Epub 2014 Feb 25.
To investigate the factors which affect the motor evoked potential (MEP) responsiveness and parameters and to find the correlation between the function of the upper extremities and the combined study of MEP with a diffusion tensor tractography (DTT) in patients with stroke.
A retrospective study design was used by analyzing medical records and neuroimaging data of 70 stroke patients who underwent a MEP test between June 2011 and March 2013. MEP parameters which were recorded from the abductor pollicis brevis muscle were the resting motor threshold, latency, amplitude, and their ratios. Functional variables, Brunnstrom stage of hand, upper extremity subscore of Fugl-Meyer assessment, Manual Function Test, and the Korean version of Modified Barthel Index (K-MBI) were collected together with the biographical and neurological data. The DTT parameters were fiber number, fractional anisotropy value and their ratios of affected corticospinal tract. The data were compared between two groups, built up according to the presence (MEP-P) or absence (MEP-N) of MEP on the affected hand.
Functional and DTT variables were significantly different between MEP-P and MEP-N groups (p<0.001). Among the MEP-P group, the amplitude ratio (unaffected/affected) was significantly correlated with the Brunnstrom stage of hand (r=-0.427, p=0.013), K-MBI (r=-0.380, p=0.029) and the time post-onset (r=-0.401, p=0.021). The functional scores were significantly better when both MEP response and DTT were present and decreased if one or both of the two studies were absent.
This study indicates MEP responsiveness and amplitude ratio are significantly associated with the upper extremity function and the activities of daily living performance, and the combined study of MEP and DTT provides useful information.
探讨影响运动诱发电位（MEP）反应性及参数的因素，并找出中风患者上肢功能与MEP联合弥散张量纤维束成像（DTT）研究之间的相关性。
采用回顾性研究设计，分析2011年6月至2013年3月期间接受MEP测试的70例中风患者的病历和神经影像数据。从拇短展肌记录的MEP参数包括静息运动阈值、潜伏期、波幅及其比值。收集功能变量、手的Brunnstrom分期、Fugl-Meyer评估上肢分项评分、手功能测试以及韩国版改良Barthel指数（K-MBI），同时收集患者的传记资料和神经学数据。DTT参数为患侧皮质脊髓束的纤维数量、分数各向异性值及其比值。根据患侧手是否存在MEP（MEP-P组）或不存在MEP（MEP-N组）将数据分为两组进行比较。
MEP-P组和MEP-N组之间的功能和DTT变量存在显著差异（p<0.001）。在MEP-P组中，波幅比值（健侧/患侧）与手的Brunnstrom分期（r=-0.427，p=0.013）、K-MBI（r=-0.380，p=0.029）以及发病时间（r=-0.401，p=0.021）显著相关。当MEP反应和DTT均存在时，功能评分显著更好，而如果两项研究中的一项或两项都不存在，则功能评分会降低。
本研究表明MEP反应性和波幅比值与上肢功能及日常生活活动能力显著相关，MEP与DTT的联合研究提供了有用信息。
