Simis Marcel, Di Lazzaro Vincenzo, Kirton Adam, Pennisi Giovanni, Bella Rita, Kim Yun-Hee, Takeuchi Naoyuki, Khedr Eman M, Rogers Lynn M, Harvey Richard, Koganemaru Satoko, Turman Bulent, Tarlacı Sultan, Gagliardi Rubens J, Fregni Felipe
Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Laboratory of Neuromodulation, Boston, USA; Santa Casa Medical School, Division of Neurology, Sao Paulo, Brazil; University of Sao Paulo Medical School General Hospital, Physical and Rehabilitation Medicine Institute, Sao Paulo, Brazil.
Università Campus Biomedico, Institute of Neurology, Rome, Italy.
Neurophysiol Clin. 2016 Feb;46(1):53-61. doi: 10.1016/j.neucli.2016.01.003. Epub 2016 Mar 9.
Transcranial magnetic stimulation (TMS) has been used to measure cortical excitability as a functional measurement of corticomotor pathways. Given its potential application as an assessment tool in stroke, we aimed to analyze the correlation of TMS parameters with clinical features in stroke using data from 10 different centers.
Data of 341 patients with a clinical diagnosis of stroke were collected from studies assessing cortical excitability using TMS. We used a multivariate regression model in which the baseline cortical excitability parameter "resting Motor Threshold (rMT)" was the main outcome and the demographic, anatomic and clinical characteristics were included as independent variables.
The variable "severity of motor deficit" consistently remained significant in predicting rMT in the affected hemisphere, with a positive β coefficient, in the multivariate models after sensitive analyses and adjusting for important confounders such as site center. Additionally, we found that the correlations between "age" or "time since stroke" and the rMT in the affected hemisphere were significant, as well as the interaction between "time since stroke" and "severity of motor deficit".
We have shown that severity of motor deficit is an important predictor for rMT in the affected hemisphere. Additionally, time since stroke seems to be an effect modifier for the correlation between motor deficit and rMT. In the unaffected motor cortex, these correlations were not significant. We discuss these findings in the context of stroke rehabilitation.
经颅磁刺激（TMS）已被用于测量皮质兴奋性，作为皮质运动通路的一种功能测量方法。鉴于其在中风评估工具方面的潜在应用，我们旨在利用来自10个不同中心的数据，分析中风患者TMS参数与临床特征之间的相关性。
从使用TMS评估皮质兴奋性的研究中收集了341例临床诊断为中风的患者的数据。我们使用了一个多元回归模型，其中基线皮质兴奋性参数“静息运动阈值（rMT）”是主要结果，人口统计学、解剖学和临床特征作为自变量纳入。
在进行敏感性分析并调整了如研究中心等重要混杂因素后，在多变量模型中，变量“运动功能缺损严重程度”在预测患侧半球的rMT时始终具有显著性，β系数为正。此外，我们发现“年龄”或“中风后时间”与患侧半球的rMT之间存在显著相关性，以及“中风后时间”与“运动功能缺损严重程度”之间的相互作用。
我们已经表明，运动功能缺损严重程度是患侧半球rMT的一个重要预测指标。此外，中风后时间似乎是运动功能缺损与rMT之间相关性的一个效应修饰因素。在未受影响的运动皮质中，这些相关性不显著。我们在中风康复的背景下讨论了这些发现。
