The Effect of Low versus High Frequency Electrical Acupoint Stimulation on Motor Recovery After Ischemic Stroke by Motor Evoked Potentials Study

2008 ◽  
Vol 36 (01) ◽  
pp. 45-54 ◽  
Author(s):  
Young Suk Kim ◽  
Jin Woo Hong ◽  
Byung Jo Na ◽  
Seong Uk Park ◽  
Woo Sang Jung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Evoked Potentials ◽  
High Frequency ◽  
Motor Evoked Potentials ◽  
Low Frequency ◽  
Motor Recovery ◽  
Motor Dysfunction ◽  
Stroke Patients ◽  
Affected Side ◽  
Acupoint Stimulation

Electrical acupoint stimulation (EAS) has been used to treat motor dysfunction of stroke patients with reportedly effective results. When we operate EAS treatment, we can modulate the intensity and frequency of stimulation. The purpose of this study is to evaluate the effect of different frequencies in treating motor dysfunction of ischemic stroke patients with EAS. The subjects of this study were 62 ischemic stroke patients with motor dysfunction in Kyunghee oriental medical center. They have been hospitalized after 1 week to 1 month from onset. They were treated with 2 Hz or 120 Hz EAS for 2 weeks, and had motor evoked potentials (MEPs) tests before and after 2 weeks of EAS treatment. We measured latency, central motor conduction time (CMCT) and amplitude of MEPs. After 2 weeks of treatment, we compared MEPs data of the affected side between the 2 Hz group and the 120 Hz group. The 2 Hz group showed more significant improvement than the 120 Hz group in latency, CMCT and amplitude ( p = 0.008, 0.002, 0.002). In the case of the affected side MEPs data divided by normal side MEPs data, the 2 Hz group also showed higher improvement rate than the 120 Hz group in latency, CMCT and amplitude with significant differences ( p = 0.003, 0.000, 0.008). These results suggest that low frequency EAS activates the central motor conduction system better than high frequency EAS, and EAS with low frequency could be more helpful for motor recovery after ischemic stroke than that with high frequency.

Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment

2008 ◽  
Vol 23 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Annette A. van Kuijk ◽  
Jaco W. Pasman ◽  
Henk T. Hendricks ◽  
Machiel J. Zwarts ◽  
Alexander C. H. Geurts
Keyword(s):  
Lower Extremity ◽  
Evoked Potentials ◽  
Upper Extremity ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Motor Evoked Potentials ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Abductor Digiti Minimi

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

scholarly journals Intraarterial heparin flushing effect on motor evoked potentials in chronic ischemic stroke patients

2019 ◽  
Vol 8 (2) ◽  
pp. 540
Author(s):  
Terawan Agus Putranto ◽  
Tugas Ratmono ◽  
Irawan Yusuf ◽  
Bachtiar Murtala ◽  
Andi Wijaya
Keyword(s):  
Ischemic Stroke ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Stroke Patients

scholarly journals New Insights Into Vertigo Attack Frequency as a Predictor of Ischemic Stroke

2020 ◽  
Vol 11 ◽  
Author(s):  
Dongxu Qiu ◽  
Lei Zhang ◽  
Jun Deng ◽  
Zhiwei Xia ◽  
Jingfeng Duan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Frequency ◽  
Low Frequency ◽  
Medical Intervention ◽  
Emergency Department Visits ◽  
Arterial Stenosis ◽  
Clinical Parameters ◽  
Ischemic Infarction ◽  
Frequency Group ◽  
Attacks Of Vertigo

Background: Recurrent attacks of vertigo account for 2.6 million emergency department visits per year in the USA, of which more than 4% are attributable to ischemic infarction. However, few studies have investigated the frequency of attacks of vertigo before an ischemic stroke.Methods: We conducted this retrospective analysis and manually screened the medical records of 231 patients who experienced recurrent attacks of vertigo prior to an ischemic stroke. Patients were divided into four different groups based on the frequency of vertigo attacks as well as the region of ischemic infarction. Those with ≤2 attacks of vertigo preceding the ischemic stroke were defined as the low-frequency group. Those with ≥3 attacks were defined as the high-frequency group. Clinical parameters, including vascular risk factors, average National Institutes of Health Stroke Scale (NIHSS) score, and infarction volume, were compared between the groups.Results: On analysis, we found that patients with posterior infarction in the high-frequency group exhibited a higher prevalence of vertebral artery stenosis. However, the incidence of diabetes mellitus (DM) was higher in the low-frequency group. In addition, patients with posterior infarction in the low-frequency group were more active in seeking medical intervention after an attack of vertigo. Notably, the brain stem, especially the lateral medullary region, had a higher probability of being involved in posterior infarction in the high-frequency group. However, the cerebellum was more commonly involved in posterior infarction in the low-frequency group.Conclusions: Our findings indicate that the clinical parameters, including arterial stenosis, DM, and magnetic resonance imaging (MRI) findings, differed between the low- and high-frequency groups. We also found that patients in the low-frequency group were more willing to seek medical intervention after the attacks of vertigo. These findings could be valuable for clinicians to focus on specific examination of the patients according to the frequency of vertigo attacks.

Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients

2021 ◽  
pp. 1-16
Author(s):  
Qing-Mei Chen ◽  
Fei-Rong Yao ◽  
Hai-Wei Sun ◽  
Zhi-Guo Chen ◽  
Jun Ke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Motor Function ◽  
Magnetic Stimulation ◽  
Sham Group ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Dysfunction ◽  
Gaba Level ◽  
Stroke Patients ◽  
Before And After

Background: The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. Objectives: To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. Methods: 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. Results: The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). Conclusions: Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves

2006 ◽  
Vol 104 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Minoru Fujiki ◽  
Yoshie Furukawa ◽  
Tohru Kamida ◽  
Mitsuhiro Anan ◽  
Ryo Inoue ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Motor Function ◽  
Wave Amplitude ◽  
Motor Evoked Potentials ◽  
Motor Dysfunction ◽  
Cortical Gray Matter ◽  
Group A ◽  
Group B ◽  
Group D ◽  
D Wave

Object The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function. Methods Muscle and spinal MEPs were simultaneously recorded during surgery in 80 patients harboring brain tumors. Each case was assigned to one of four groups according to final changes in the MEPs: 1) Group A, in which there was an increased amplitude in the muscle MEP with an increased I3 wave amplitude (12 cases); 2) Group B, in which there was no significant change in the MEP (43 cases); 3) Group C, in which there was a decreased muscle MEP amplitude (< 35% of the control) with a decreased I wave amplitude but an unchanged D wave (15 cases); or 4) Group D, in which there was an absent muscle MEP with a decreased D wave amplitude (10 cases). In patients in Group A, the increase in the amplitude of the muscle MEP (range of increase 128–280%, mean increase 188.75 ± 48.79%) was well correlated with the increase in the I3 wave in corticospinal MEPs. Most of these patterns were observed in patients harboring meningiomas (10 [83.3%] of 12 cases). Patients in Group B displayed no changes in muscle and corticospinal MEPs and no signs of postoperative neurological deterioration. Patients in Group C showed a substantial decrease in the amplitude of the muscle MEP (range of decrease 5.3–34.8% based on the control waveform, mean change 21.81 ± 10.93%) without deterioration in the corticospinal D wave, and exhibited severe immediate postoperative motor dysfunction. This indicates dysfunction of the cortical gray matter, including the motor cortices, which are supposed to generate I waves. Patients in Group D exhibited decreases in the corticospinal D wave (range of decrease 21.5–55%, mean decrease 39.75 ± 11.45%) and an immediate cessation of the muscle MEP as well as severe permanent motor paresis. Conclusions These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).

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