학술논문
The tmstroke study. Transcranial magnetic stimulation in acute ischemic stroke: Motor prognosis and neurophysiological features
Document Type
Dissertation/Thesis
Author
Source
TDX (Tesis Doctorals en Xarxa)
Subject
Language
English
Abstract
Introducción y objetivos El ictus es la principal causa de discapacidad en el mundo occidental. La estimulación magnética transcraneal es un instrumento versátil que permite estudiar la fisiología y fisiopatología del cerebro humano de forma no invasiva. El objetivo de este estudio es evaluar la correlación entre las características neurofisiológicas en pacientes con ictus agudo medidas en diferentes momentos y la discapacidad a los 3 meses, tanto en las vías motoras como sensitivas. Métodos Se incluyeron 78 pacientes con accidente cerebrovascular isquémico agudo (64,5±9,4 años; 62,8% hombres). Se realizó una batería de pruebas motoras neurofisiológicas (rMT, MEP, cSP, CMCT) y sensitivas (umbrales sensitivos y de dolor), así como una evaluación clínica extensa al ingreso y posteriormente el día 7 o al alta, correlacionando los datos con el estado funcional a los 3 meses según la escala de discapacidad funcional (mRS). Resultados Las características de MEP y el estado de las vías sensitivas se correlacionaron con el resultado funcional a los 3 meses de seguimiento. La presencia del MEP tanto en músculo proximal como en distal se asoció independientemente a una menor discapacidad (90,9% vs 13,6% p<0,0001). En particular una mejora de la amplitud de MEP de 0,5 mV (AUC 0,916 sensibilidad 74 %, especificidad 100 %) entre el estudio basal y a los 7 días se asoció con un buen pronóstico a los 3 meses. La excitabilidad cortical y una menor alteración sensitiva se relacionaron también con una mejor recuperación. Conclusiones El ictus provoca cambios significativos en la función cortical y el tracto piramidal. Esos cambios se encuentran estrictamente relacionados con el resultado funcional a los 3 meses. Un aumento de 0,5 mV en MEP entre las exploraciones basales y las del día 7 se relaciona con un mejor resultado funcional a los 3 meses, de la misma forma que un mejor rendimiento sensitivo y de excitabilidad cortical.
Introduction and aims Stroke is the leading cause for disability in the western world. Transcranial magnetic stimulation is a versatile instrument, which allows to study the physiology and pathophysiology of human brain non-invasively. The aim of this study is to explore the correlation between neurophysiological features in acute stroke patients measured at different time points and the disability at 3 months, both regarding the motor and the sensory pathways. Methods We enrolled 78 acute ischemic stroke patients (64.59.4 yo; 62.8% Males). A battery of neurophysiological motor (rMT, MEP, cSP, CMCT ) and sensory tests (sensory and pain thresholds) were performed, as well as extensive clinical evaluation at admission, day 7 or discharge correlating the data with the 3-monts outcome measured by functional disability scale (mRS) Results MEP features and sensory impairment correlated strongly with functional outcome at 3-months follow-up. The presence of the MEP by itself was associated to a good outcome (90.9% vs 13.6% p <0.001) both in the proximal and distal muscle studied. Cortical excitability was related to a better outcome, as well as sensory impairment. An improvement of MEP amplitude of 0.5mV (AUC 0.916; Sensitivity 74%, Specificity 100%) was independently associated with a good prognosis at 3-months (mRS ≥ 2). Conclusions Acute stroke provokes profound changes in the cortical function and pyramidal tract. Those changes are strictly related to functional outcome at 3-month. An increase of 0.5mV between basal and day 7 studies is related to a better functional outcome at 3months, and the degree of sensory impairment is related to the functional outcome as well.
Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina
Introduction and aims Stroke is the leading cause for disability in the western world. Transcranial magnetic stimulation is a versatile instrument, which allows to study the physiology and pathophysiology of human brain non-invasively. The aim of this study is to explore the correlation between neurophysiological features in acute stroke patients measured at different time points and the disability at 3 months, both regarding the motor and the sensory pathways. Methods We enrolled 78 acute ischemic stroke patients (64.59.4 yo; 62.8% Males). A battery of neurophysiological motor (rMT, MEP, cSP, CMCT ) and sensory tests (sensory and pain thresholds) were performed, as well as extensive clinical evaluation at admission, day 7 or discharge correlating the data with the 3-monts outcome measured by functional disability scale (mRS) Results MEP features and sensory impairment correlated strongly with functional outcome at 3-months follow-up. The presence of the MEP by itself was associated to a good outcome (90.9% vs 13.6% p <0.001) both in the proximal and distal muscle studied. Cortical excitability was related to a better outcome, as well as sensory impairment. An improvement of MEP amplitude of 0.5mV (AUC 0.916; Sensitivity 74%, Specificity 100%) was independently associated with a good prognosis at 3-months (mRS ≥ 2). Conclusions Acute stroke provokes profound changes in the cortical function and pyramidal tract. Those changes are strictly related to functional outcome at 3-month. An increase of 0.5mV between basal and day 7 studies is related to a better functional outcome at 3months, and the degree of sensory impairment is related to the functional outcome as well.
Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina