Utility of Transcranial Magnetic Stimulation and Diffusion Tensor Imaging for Prediction of Upper-Limb Motor Recovery in Acute Ischemic Stroke Patients

Pradeep Kumar; Manya Prasad; Animesh Das; Deepti Vibha; Ajay Garg; Vinay Goyal; Achal K Srivastava

doi:10.4103/aian.aian_254_21

Utility of Transcranial Magnetic Stimulation and Diffusion Tensor Imaging for Prediction of Upper-Limb Motor Recovery in Acute Ischemic Stroke Patients

Ann Indian Acad Neurol. 2022 Jan-Feb;25(1):54-59. doi: 10.4103/aian.aian_254_21. Epub 2021 Sep 27.

Authors

Pradeep Kumar¹, Manya Prasad², Animesh Das¹, Deepti Vibha¹, Ajay Garg³, Vinay Goyal¹, Achal K Srivastava¹

Affiliations

¹ Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India.
³ Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: The recovery of the upper-limb (UL) motor function after ischemic stroke (IS) remains a major scientific, clinical, and patient concern and it is hard to predict alone from the clinical symptoms.

Objective: To determine the accuracy of the prediction of the recovery of UL motor function in patients with acute ischemic middle cerebral artery (MCA) stroke using individual clinical, transcranial magnetic stimulation (TMS) or diffusion tensor imaging (DTI) parameters or their combination.

Methods and material: The first-ever acute ischemic MCA stroke patients within 7 days of the stroke onset who had an obvious UL motor deficit underwent TMS for the presence of motor-evoked potential (MEP) and DTI to evaluate the integrity of corticospinal tracts. Multivariate logistic regression analysis was done to test for the accuracy of the prediction of the recovery of UL motor function.

Results: Twenty-nine acute ischemic MCA stroke patients (21 males and 8 females) with a mean age of 51.45 ± 14.26 years were recruited. Model-I included clinical scales (Fugl-Meyer Assessment [FMA] + Motricity Index [MI]) + TMS (MEP) + DTI (fractional anisotropy [FA]) were found to be the most accurate predictive model, with the overall predictive ability (93.3%; 95% confidence interval [CI]: 0.87-0.99) and sensitivity: 94.9% (95% CI: 0.87-1.0) and specificity: 95.8% (95% CI: 0.89-1.0); respectively.

Conclusion: The accuracy of UL motor recovery can be predicted through the clinical battery and their elements as well as TMS (MEP) and DTI (FA) parameters. Further, well-designed prospective studies are needed to confirm our findings.

Keywords: Acute stroke; diffusion tensor imaging; motor function; motor-evoked potential; transcranial magnetic stimulation; upper-limb recovery.