Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand.
Department of Medicine, The University of Auckland, Auckland, New Zealand.
J Neurol Neurosurg Psychiatry. 2024 Mar 13;95(4):348-355. doi: 10.1136/jnnp-2023-332018.
This observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and 6 months post-stroke.
Non-ambulatory participants were recruited 5 days post-stroke. Transcranial magnetic stimulation was used to determine tibialis anterior MEP status and clinical assessments (age, National Institutes of Health Stroke Scale (NIHSS), ankle dorsiflexion strength, LL motricity index, Berg Balance Test) were completed 1 week post-stroke. Functional Ambulation Category (FAC), use of AFO and walking aid were assessed 3 months and 6 months post-stroke. MEP status, alone and combined with clinical measures, and walking outcomes at 3 and 6 months were analysed with Pearson χ and multivariate binary logistic regression.
Ninety participants were included (median age 72 years (38-97 years)). Most participants (81%) walked independently (FAC ≥ 4), 17% used an AFO, and 49% used a walking aid 3 months post-stroke with similar findings at 6 months. Independent walking was better predicted by age, LL strength and Berg Balance Test (accuracy 92%, 95% CI 85% to 97%) than MEP status (accuracy 73%, 95% CI 63% to 83%). AFO use was better predicted by NIHSS and MEP status (accuracy 88%, 95% CI 79% to 94%) than MEP status alone (accuracy 76%, 95% CI 65% to 84%). No variables predicted use of walking aids.
The presence of LL MEPs 1-week post-stroke predicts independent walking at 3 and 6 months post-stroke. However, the absence of MEPs does not preclude independent walking. Clinical factors, particularly age, balance and stroke severity, more strongly predict independent walking than MEP status. LL MEP status adds little value as a biomarker for walking outcomes.
本观察性研究旨在探讨下肢（LL）运动诱发电位（MEPs）在卒中后 1 周是否可预测卒中后 3 个月和 6 个月时独立行走、使用踝足矫形器（AFO）或助行器的恢复情况。
在卒中后 5 天招募非卧床参与者。使用经颅磁刺激来确定胫骨前肌 MEP 状态，并在卒中后 1 周完成临床评估（年龄、国立卫生研究院卒中量表（NIHSS）、踝背屈力量、LL 运动指数、伯格平衡测试）。在卒中后 3 个月和 6 个月时评估功能性步行分类（FAC）、AFO 和助行器的使用情况。使用 Pearson χ 和多元二项逻辑回归分析 MEP 状态、临床测量值和 3 个月和 6 个月时的步行结果。
共纳入 90 名参与者（中位数年龄 72 岁[38-97 岁]）。大多数参与者（81%）独立行走（FAC≥4），17%在卒中后 3 个月时使用 AFO，49%使用助行器，6 个月时情况相似。独立行走的预测因素是年龄、LL 力量和伯格平衡测试（准确性 92%，95%CI 85%至 97%），优于 MEP 状态（准确性 73%，95%CI 63%至 83%）。AFO 使用的预测因素是 NIHSS 和 MEP 状态（准确性 88%，95%CI 79%至 94%），优于 MEP 状态（准确性 76%，95%CI 65%至 84%）。没有变量可以预测助行器的使用。
卒中后 1 周时存在 LL MEPs 可预测卒中后 3 个月和 6 个月时的独立行走。但是，MEPs 的缺失并不排除独立行走的可能性。临床因素，尤其是年龄、平衡和卒中严重程度，比 MEP 状态更能强烈预测独立行走。LL MEP 状态作为步行结果的生物标志物几乎没有价值。
