This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pennisi, G. Articles by Delwaide, P. J. Search for Related Content PubMed PubMed Citation Articles by Pennisi, G. Articles by Delwaide, P. J.

(Stroke. 1999;30:2666.)
© 1999 American Heart Association, Inc.

Original Contributions

Absence of Response to Early Transcranial Magnetic Stimulation in Ischemic Stroke Patients

Prognostic Value for Hand Motor Recovery

Giovanni Pennisi, MD; Giuseppe Rapisarda, MD; Rita Bella, MD; Vittorio Calabrese, MD; Alain Maertens de Noordhout, MD, PhD Paul Jean Delwaide, MD, PhD

From the University Department of Neurology (G.P., G.R., R.B.) and the Centre for Neurodegenerative Diseases Research (V.C.), Università degli Studi di Catania, Catania, Italy, and the University Department of Neurology (A.M.d.N., P.J.D.), Hôpital de la Citadelle, Liège, Belgium.

Correspondence to Prof G. Pennisi, University Department of Neurology, Azienda Policlinico Dell’Università, Via S. Sofia n.78, 95123 Catania, Italy. E-mail giovanni.pennisi{at}ctonline.it

Background and Purpose—Transcranial magnetic stimulation (TMS) has been proposed as a prognostic tool in stroke patients. Most of the previous studies agree in considering the presence of motor-evoked potentials (MEPs) in the first days after a stroke as an indicator of good outcome. In the present study, we have assessed the prognostic value of the absence of response to early TMS on hand motor recovery in stroke patients with complete hand palsy at onset due to ischemia in the area of the middle cerebral artery.

Methods—Fifteen patients submitted to TMS within 48 hours of stroke onset (defined as day 1) and again after 1 year. They were also evaluated clinically on day 1 by a scale derived from the Medical Research Council (MRC) and by the National Institutes of Health (NIH) stroke scale; they were reevaluated by the same scales and by Barthel Index on day 365.

Results—On day 1, all the patients had complete hand palsy and no response to TMS; their NIH scores showed great variability. After 1 year, 6 of 15 patients regained small and prolonged MEPs, together with a very poor and not functionally useful motor recovery. NIH scores were significantly improved. Barthel Index scores showed large interindividual differences and were not correlated with MRC scores.

Conclusions—We conclude that in patients with complete hand palsy, the absence of response to TMS in the first hours is predictive of absent or very poor, not useful, hand motor recovery.

Key Words: outcome • prognosis • stimulation, transcranial magnetic • stroke, ischemic

This article has been cited by other articles:

				R. E. Frye, A. Rotenberg, M. Ousley, and A. Pascual-Leone Transcranial Magnetic Stimulation in Child Neurology: Current and Future Directions J Child Neurol, January 1, 2008; 23(1): 79 - 96. [Abstract] [PDF]

				P. G. Lindberg, P. H. B. Skejo, E. Rounis, Z. Nagy, C. Schmitz, H. Wernegren, A. Bring, M. Engardt, H. Forssberg, and J. Borg Wallerian Degeneration of the Corticofugal Tracts in Chronic Stroke: A Pilot Study Relating Diffusion Tensor Imaging, Transcranial Magnetic Stimulation, and Hand Function Neurorehabil Neural Repair, December 1, 2007; 21(6): 551 - 560. [Abstract] [PDF]

				A. J Butler and S. L Wolf Putting the Brain on the Map: Use of Transcranial Magnetic Stimulation to Assess and Induce Cortical Plasticity of Upper-Extremity Movement Physical Therapy, June 1, 2007; 87(6): 719 - 736. [Abstract] [Full Text] [PDF]

				M. Desmurget, F. Bonnetblanc, and H. Duffau Contrasting acute and slow-growing lesions: a new door to brain plasticity Brain, April 1, 2007; 130(4): 898 - 914. [Abstract] [Full Text] [PDF]

				C. M. Stinear, P. A. Barber, P. R. Smale, J. P. Coxon, M. K. Fleming, and W. D. Byblow Functional potential in chronic stroke patients depends on corticospinal tract integrity Brain, January 1, 2007; 130(1): 170 - 180. [Abstract] [Full Text] [PDF]

				N. S. Ward, J. M. Newton, O. B. C. Swayne, L. Lee, A. J. Thompson, R. J. Greenwood, J. C. Rothwell, and R. S. J. Frackowiak Motor system activation after subcortical stroke depends on corticospinal system integrity Brain, March 1, 2006; 129(3): 809 - 819. [Abstract] [Full Text] [PDF]

				M.-H. Monfils, E. J. Plautz, and J. A. Kleim In Search of the Motor Engram: Motor Map Plasticity as a Mechanism for Encoding Motor Experience Neuroscientist, October 1, 2005; 11(5): 471 - 483. [Abstract] [PDF]

				N. S. Ward, M. M. Brown, A. J. Thompson, and R. S. J. Frackowiak Neural correlates of outcome after stroke: a cross-sectional fMRI study Brain, June 1, 2003; 126(6): 1430 - 1448. [Abstract] [Full Text] [PDF]

				G. F. Wittenberg, R. Chen, K. Ishii, K. O. Bushara, E. Taub, L. H. Gerber, M. Hallett, and L. G. Cohen Constraint-Induced Therapy in Stroke: Magnetic-Stimulation Motor Maps and Cerebral Activation Neurorehabil Neural Repair, March 1, 2003; 17(1): 48 - 57. [Abstract] [PDF]

				M. Staudt, W. Grodd, C. Gerloff, M. Erb, J. Stitz, and I. Krageloh-Mann Two types of ipsilateral reorganization in congenital hemiparesis: A TMS and fMRI study Brain, October 1, 2002; 125(10): 2222 - 2237. [Abstract] [Full Text] [PDF]

				A. Feydy, R. Carlier, A. Roby-Brami, B. Bussel, F. Cazalis, L. Pierot, Y. Burnod, and M.A. Maier Longitudinal Study of Motor Recovery After Stroke: Recruitment and Focusing of Brain Activation Stroke, June 1, 2002; 33(6): 1610 - 1617. [Abstract] [Full Text] [PDF]