Absence of response to early transcranial magnetic stimulation in ischemicstroke patients - Prognostic value for hand motor recovery

Background and Purpose-Transcranial magnetic stimulation (TMS) has been pro posed 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 pals y 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 clinical ly 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 reevalua ted 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 pa tients 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 no t correlated with MRC scores. Conclusions-We conclude that in patients with complete hand palsy, the abse nce of response to TMS in the first hours is predictive of absent or very p oor, not useful, hand motor recovery.