scholarly journals Predictors for early motor improvement in patients with ischemic stroke

2019 ◽  
Vol 10 (Vol.10, No.3) ◽  
pp. 236-242 ◽  
Author(s):  
Ioana C. STANESCU ◽  
Angelo C. BULBOACA ◽  
Gabriela B. DOGARU ◽  
Gabriel GUSETU ◽  
Dana M. FODOR
Keyword(s):  
Ischemic Stroke ◽  
Motor Evoked Potentials ◽  
Continuous Process ◽  
Complete Recovery ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Key Words Ischemic Stroke ◽  
Clinical Methods ◽  
Motor Improvement

Disability as a stroke consequence is reported by 3% males and 2% females in general population. Motor deficits are common in stroke patients, but their complete recovery is seen only in a minority of cases. Assessment of motor deficits uses clinical methods, especially standardized scales, but also electrophysiological and imagistic methods. The motor recovery is a continuous process, maximal in the first month after stroke, decreasing gradually over the first 6 months. Most powerful predictors for motor recovery are clinical parameters: severity of motor deficit, onset of first voluntary movements after stroke in the first 48-72 hours, a continuous improvement in motor function during the first 8 weeks, a good postural control during the first month, young age, male sex, left hemispheric stroke and absence of other neurological impairments are strong positive predictors. Presence of motor-evoked potentials in paretic muscles and imagistic parameters as location, stroke volume and motor pathways integrity are paraclinical predictors for recovery. There are no specific biomarker which is efficient in predicting recovery. In patients with poor chances for recovery according to actual predictors, the development of more precise algorithms to assess functional outcome is needed, in order to support the choice of appropriate methods and intensity of rehabilitation treatment. Key words: ischemic stroke rehabilitation, functional assessment, motor improvement, recovery predictors, prognostic factors,

scholarly journals Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Davide Giampiccolo ◽  
Cristiano Parisi ◽  
Pietro Meneghelli ◽  
Vincenzo Tramontano ◽  
Federica Basaldella ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Brain Tumour ◽  
Evoked Potential ◽  
Corticospinal Tract ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Brain Tumour Surgery

Abstract Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel–lesion–symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

Abstract TP106: Automated Assessment of Behavioral Function After Experimental Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Terrance Chiang ◽  
Sean Harvey ◽  
Arjun V Pendharkar ◽  
Michelle Y Cheng ◽  
Gary K Steinberg
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Stroke Models ◽  
Cerebral Artery Occlusion ◽  
Significant Motor

Introduction: Manual scoring of behavior tests is commonly used for assessing motor deficits after stroke, however, it is labor intensive and subject to bias. These limitations lead to inconsistent assessment between research groups and non-reproducible data. In this study, we investigated the feasibility of an automated motor deficit assessment system, Erasmus ladder, in two ischemic stroke models. Methods: Distal middle cerebral artery occlusion (dMCAO n=10) or transient middle cerebral artery occlusion (tMCAO 30 minutes, n=15) were performed on male C57BL6J mice (11-13 weeks) to generate cortical ischemic stroke, with. Naïve mice (n=10) were used as controls. Immunohistochemistry was performed on brains collected at post-stroke day (PD) 30 to assess for infarct size (MAP2) and inflammation (CD68). Mice without infarct in both cortex and striatum were excluded from the study. Behavior was assessed using Erasmus ladder at pre-stroke baseline (4 unperturbed and 4 perturbed sessions) and on PD 7, 14, 21, and 28 (all perturbed sessions). Results: Erasmus ladder detected significant motor deficits in the tMCAO model, specifically in the pre- and post- perturbed times as well as several key step types (HH long). Analyses in the tMCAO model reveal changes in various step patterns and their capability to react to the perturbation (obstacle). These significant motor deficits after tMCAO were detectable until PD28. We also observed a sustained decline in the use of affected limb compared to unaffected limb until PD28. While this trend is also present in dMCAO model, motor deficits were detected in the dMCAO only at early timepoints (PD7) and the difference subsided by PD28. Conclusion: We have assessed the data collected by Erasmus ladder on mice that underwent two commonly used stroke models (tMCAO and dMCAO). Our data showed that Erasmus ladder can detect long term motor deficit including reduced use of affected limb, step pattern, and motor reaction to obstacle. This automated instrument is effective in detecting motor deficits in the tMCAO model and thus, can be used to evaluate treatments for enhancing recovery after stroke.

Intraoperative vascular complications during 2278 cerebral endovascular procedures with multimodality IONM: relationship between signal change, complication, intervention and postoperative outcome

2020 ◽  
pp. neurintsurg-2020-016604
Author(s):  
W Bryan Wilent ◽  
Olga Belyakina ◽  
Eric Korsgaard ◽  
Stavropoula I Tjoumakaris ◽  
M Reid Gooch ◽  
...  
Keyword(s):  
Endovascular Procedures ◽  
Motor Evoked Potentials ◽  
Vascular Complications ◽  
Postoperative Outcome ◽  
Complete Loss ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Likelihood Ratios ◽  
Arterial Complication ◽  
The Impact

BackgroundIntraoperative neuromonitoring (IONM) is often used during cerebral endovascular procedures.ObjectiveTo investigate the relationship between intraoperative vascular complications and IONM signal changes, and the impact of interventions on signal resolution and postoperative outcomes.MethodsA series of 2278 cerebral endovascular procedures conducted under general anesthesia and using electroencephalography and somatosensory evoked potential monitoring were retrospectively reviewed. A subset of 763 procedures also included motor evoked potentials (MEPs). IONM alerts were categorized as either a partial attenuation or complete loss of signal. Vascular complications were subcategorized as due to rupture, emboli, instrumentation, or vasospasm. Odds ratios (ORs) for new postoperative motor deficits were calculated and diagnostic accuracy was measured using sensitivity, specificity, and likelihood ratios.ResultsThe overall incidence of new postoperative motor deficit was 1.2%; 20.4% in cases with an IONM alert and 0.09% in cases without an alert. Relative to procedures with no alerts, odds of a new deficit increased if there was partial signal attenuation (OR=210.9, 95% CI 44.3 to 1003.5, p<0.0001) and increased further with complete loss of signal (OR=1437.3, 95% CI 297.3 to 6948.2, p<0.0001). Relative to procedures with unresolved alerts, odds of a new deficit decreased if the alert was fully resolved (OR=0.039, 95% CI 0.005 to 0.306, p<0.002). Procedures using MEPs had slightly higher sensitivity (92.3% vs 85.7%) but slightly lower specificity (96.7% vs 98.2%).ConclusionsAn IONM alert associated with an arterial complication is associated with a dramatic increase in odds of a new postoperative deficit; however, if there is resolution of the alert prior to closure, odds of a new deficit decrease significantly.

scholarly journals Multimodal DTI-TMS assessment of the motor system in patients with chronic ischemic stroke

2019 ◽  
Author(s):  
M. Nazarova ◽  
S. Kulikova ◽  
M. Piradov ◽  
A. Limonova ◽  
L. Dobrynina ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Upper Limb ◽  
Motor System ◽  
Diffusion Tensor ◽  
Motor Evoked Potentials ◽  
Statistical Tests ◽  
Motor Recovery ◽  
System Parameters ◽  
Tree Classifier ◽  
Recovery Groups

AbstractBackground and PurposeDespite the continuing efforts in multimodal assessment of the motor system after stroke, conclusive findings on the complementarity of functional and structural metrics of the corticospinal tract (CST) integrity and the role of the contralesional hemisphere are still missing. The aim of this work was to find the best combination of the motor system parameters, allowing classification of patients into three predefined groups of upper limb motor recovery.Methods35 chronic ischemic stroke patients (47 [26–66] y.o., 29 [6–58] months post-stroke) with only supratentorial lesion and unilateral upper extremity weakness were enrolled. Patients were divided into three groups depending on the upper limb motor recovery. Non-parametric statistical tests and regression analysis were used to investigate the relationships among structural and functional motor system parameters, probed by diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS). In addition, stratification rules were tested, using a decision tree classifier to identify parameters explaining motor recovery.ResultsFractional anisotropy (FA) ratio in the internal capsule (IC) and absence/presence of motor evoked potentials (MEPs), were equally discriminative of the worst motor outcome group (96% accuracy). MEP presence diverged for two investigated hand muscles. Concurrently, for the three recovery groups’ classification, the best parameter combination was: IC FA ratio and Fréchet distance between the contralesional and ipsilesional CST FA profiles (91% accuracy). No other metrics had any additional value for patients’ classification.ConclusionsThis study demonstrates that IC FA ratio and MEPs absence are equally important markers for poor recovery. Importantly, we found that MEPs should be controlled in more than one hand muscle. Finally, we show that better separation between different motor recovery groups may be achieved when considering the whole CST FA profile.

scholarly journals Feasibility of intraoperative motor evoked potential monitoring during tethered cord surgery in infants younger than 12 months

2021 ◽  
Author(s):  
Johannes Herta ◽  
Erdem Yildiz ◽  
Daniela Marhofer ◽  
Thomas Czech ◽  
Andrea Reinprecht ◽  
...  
Keyword(s):  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Tethered Cord ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Irreversible Loss ◽  
Intravenous Anesthesia ◽  
Evoked Potential Monitoring ◽  
Transcranial Motor Evoked Potentials ◽  
Clinical Records

Abstract Purpose Feasibility, reliability, and safety assessment of transcranial motor evoked potentials (MEPs) in infants less than 12 months of age. Methods A total of 22 patients with a mean age of 33 (range 13–49) weeks that underwent neurosurgery for tethered cord were investigated. Data from intraoperative MEPs, anesthesia protocols, and clinical records were reviewed. Anesthesia during surgery was maintained by total intravenous anesthesia (TIVA). Results MEPs were present in all patients for the upper extremities and in 21 out of 22 infants for the lower extremities. Mean baseline stimulation intensity was 101 ± 20 mA. If MEPs were present at the end of surgery, no new motor deficit occurred. In the only case of MEP loss, preoperative paresis was present, and high baseline intensity thresholds were needed. MEP monitoring did not lead to any complications. TIVA was maintained with an average propofol infusion rate of 123.5 ± 38.2 µg/kg/min and 0.46 ± 0.17 µg/kg/min for remifentanil. Conclusion In spinal cord release surgery, the use of intraoperative MEP monitoring is indicated regardless of the patient’s age. We could demonstrate the feasibility and safety of MEP monitoring in infants if an adequate anesthetic regimen is applied. More data is needed to verify whether an irreversible loss of robust MEPs leads to motor deficits in this young age group.

scholarly journals C-Reactive Protein - A Predictable Biomarker in Ischemic Stroke

2019 ◽  
Vol 70 (6) ◽  
pp. 2290-2293 ◽  
Author(s):  
Maria Totan ◽  
Elisabeta Antonescu ◽  
Maria Gabriela Catana ◽  
Maria Mihaela Cernusca-Mitariu ◽  
Lavinia Duica ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Inflammatory Marker ◽  
Protein A ◽  
Motor Deficit ◽  
Motor Deficits ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Associated Risk Factors

C-reactive protein (CRP) is a non-specific inflammatory marker, correlated with the severity and prognosis of ischemic stroke. We performed a retrospective study in which were included 81 patients diagnosed with acute ischemic stroke admitted between January and July 2017 in the Department of Neurology, Sibiu Emergency Clinical Hospital. CRP values were classified on three levels (0 - 5 mg / L, 5 - 50 mg / l and] 50 mg / l). We examined the correlation between CRP levels according to the type of ischemic (lacunar / territorial) stroke, the degree of motor deficit (quantified by the mRC scale), the associated risk factors and the mortality rate. PCR values above 50 mg / L were found in patients with territorial stroke (15%). Moderate motor deficits predominate, with PCR values ranging from 5-50 mg / L. The most important risk factors found in the patients included in our study were hypertension and atherosclerosis. We made correlations between these risk factors and the PCR values. In most cases with these two risk factors were recorded a mean PCR value (5-50 mg / L).For atherosclerosis the results were statistically significant, p = 0.021. Most patients (56%) had CRP levels ranging from 5 to 50 mg / L. These values recorded highest death rates. PCR it is an important marker of inflammation and it is important to be determined in all patients with acute ischemic stroke, especially which is thought to be correlated with the prognosis of these patients.

scholarly journals Does Measurement of Corticospinal Tract Involvement Add Value to Clinical Behavioral Biomarkers in Predicting Motor Recovery after Stroke?

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jong Youb Lim ◽  
Mi-Kyoung Oh ◽  
Jihong Park ◽  
Nam-Jong Paik
Keyword(s):  
Upper Extremity ◽  
Corticospinal Tract ◽  
Prediction Models ◽  
Explanatory Power ◽  
Brain Magnetic Resonance Imaging ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Unique Contribution

Background. The prediction of motor recovery after stroke is an important issue, and various prediction models have been proposed using either clinical behavioral or neurological biomarkers. This study sought to identify the effects of clinical behavioral biomarkers combined with corticospinal tract (CST) injury measurement on the prediction of motor recovery after stroke. Methods. The region of interest was drawn on the normalized brain magnetic resonance imaging scans of patients with first-ever unilateral hemispheric stroke, and the degree of CST injury was calculated in a total of 67 such subjects. Patients who had initial minor deficits and showed a ceiling effect on motor recovery were excluded. To predict the follow-up Fugl-Meyer assessment (FMA) scores, correlation and regression analyses were performed using various clinical behavioral biomarkers, including age, sex, lesion location, and initial FMA scores and CST injury measurements. Results. Only the initial FMA-upper extremity (UE) score was statistically correlated with the follow-up FMA-UE score at ≥2 months after the onset (adjusted R 2 = 0.626 ), and the relationship between CST injury and follow-up FMA-UE score was unclear ( n = 53 ). Hierarchical clustering between the initial and follow-up FMA-UE scores showed three clusters. After exclusion of a cluster with an initial FMA-UE ≥ 35, the prediction of the follow-up FMA-UE score was possible by incorporating the initial FMA-UE score and CST injury measurements ( n = 39 ). However, the explanatory power decreased (adjusted R 2 = 0.445 ), and the unique contribution of the CST injury (10.1%) was lower than that of the initial FMA-UE score (26.7%). With respect to the FMA-lower extremity score, CST injury was not related to recovery. Conclusions. Motor recovery of the upper and lower extremities after stroke could be predicted using the initial FMA score. CST injury was significant for the prediction of motor recovery of the upper extremity in patients with severe initial motor deficits (FMA-UE < 35); however, its portion of prediction of motor recovery was low. The prediction of poststroke motor recovery using the initial motor deficit was not improved by the addition of CST injury measurements.

scholarly journals Brain responsivity provides an individual readout for motor recovery after stroke

Brain ◽  
2020 ◽  
Vol 143 (6) ◽  
pp. 1873-1888 ◽  
Author(s):  
Caroline Tscherpel ◽  
Sebastian Dern ◽  
Lukas Hensel ◽  
Ulf Ziemann ◽  
Gereon R Fink ◽  
...  
Keyword(s):  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Recovery Of Function ◽  
Motor Recovery ◽  
Motor Deficit ◽  
Individual Response ◽  
Stroke Patients ◽  
Time Frequency ◽  
Post Stroke ◽  
Stroke Research

Abstract Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual’s level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after &gt;3 months post-stroke. In the early post-stroke phase (6.7 ± 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after &gt;3 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.

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.

scholarly journals Is segmental muscle strength recovery different in patients with dominant versus non-dominant hemispheric ischemic stroke?

2019 ◽  
Vol 10 (10.2) ◽  
pp. 129-133
Author(s):  
Dana Marieta Fodor ◽  
Ingrid Mutter ◽  
Ioana Cristina Stănescu ◽  
Marius Fodor ◽  
Angelo Bulboaca ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Muscle Strength ◽  
Statistical Significance ◽  
Clinical Findings ◽  
Motor Recovery ◽  
Hemispheric Dominance ◽  
Motor Deficit ◽  
Dominant Hemisphere ◽  
Functional Laterality ◽  
Significant Difference

Abstract Introduction & objectives: Starting from the well-known functional hemispheric asymmetry and concomitantly, from the clinical findings of practitioners involved in the post-stroke rehabilitation process, the aim of this study was to evaluate whether ischemic stroke in the dominant hemisphere results in more severe initial motor deficit and if its motor recovery is decreased compared to that of the non-dominant hemisphere. Material and method: This was a retrospective study, comprising 39 patients with ischemic stroke in the middle cerebral artery territory, divided into two groups depending on the hemispheric location of the lesion (left/right). They were evaluated for their segmental muscle strength using the Medical Research Council Muscle Strength Grading Scale, both in terms of initial value and evolution between two successive admissions. Results and conclusions: No significant difference was found for motor deficit evaluated on the occasion of the first admission between patients with left-side stroke and those with right-side stroke. Motor recovery was more obvious proximally in the paretic limbs, but without statistical significance. Key words: hemispheric dominance, functional laterality, stroke, motor rehabilitation,

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