Affiliations: [a] Department of Rehabilitation, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands | [b] Department of Rehabilitation Medicine, Máxima Medical Center, Veldhoven, the Netherlands | [c] Department of Neurology/Clinical Neurophysiology, Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands | [d] Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences and Institute for Brain and Behaviour Amsterdam, the Netherlands | [e] Tolbrug Rehabilitation Centre, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands | [f] Department of Rehabilitation Medicine, Amsterdam University Medical Center, location VU University Medical Center, MOVE Research Institute Amsterdam and Amsterdam NeuroScience, the Netherlands
Correspondence:
[*]
Corresponding author: Chantal D. Bakker, Department of Rehabilitation, Máxima Medical Center Veldhoven, PO box 7777 5500 MB Veldhoven, The Netherlands. Tel.: +31 0 40 88 88 410; E-mail: chantal.bakker@mmc.nl.
Abstract: Background:Within the first 72 hours after stroke, active finger extension is a strong predictor of long-term dexterity. Transcranial magnetic stimulation may add prognostic value to clinical assessment, which is especially relevant for patients unable to follow instructions. Objective:The current prospective cohort study aims at determining whether amplitude of motor evoked potentials of the extensor digitorum communis (EDC) can improve clinical prediction after stroke when added to clinical tests. Methods:the amplitude of motor evoked potentials of the affected EDC muscle at rest was measured in 18 participants within 4 weeks after stroke, as were the ability to perform finger extension and the Fugl-Meyer Motor Assessment of the upper extremity (FMA_UE). These three determinants were related to the FMA_UE at 26 weeks after stroke (FMA_UE26), both directly, and via the proportional recovery prediction model. The relation between amplitude of the motor evoked potentials and FMA_UE26 was evaluated for EDC. For comparison, also the MEP amplitudes of biceps brachii and adductor digiti minimi muscles were recorded. Results:Patients’ ability to voluntarily extend the fingers was strongly related to FMA_UE26, in our cohort there were no false negative results for this predictor. Our data revealed that the relation between amplitude of motor evoked potential of EDC and FMA_UE26 was significant, but moderate (rs = 0.58) without added clinical value. The other tested muscles did not correlate significantly to FMA_UE26. Conclusions:Our study demonstrates no additional value of motor evoked potential amplitude of the affected EDC muscle to the clinical test of finger extension, the latter being more strongly related to FMA_UE26.
Keywords: Transcranial magnetic stimulation (TMS), upper extremity, prognosis
