J Stroke.  2016 May;18(2):220-226. 10.5853/jos.2015.01767.

Transcranial Magnetic Stimulation and Diffusion Tensor Tractography for Evaluating Ambulation after Stroke

• Kim BR
• Moon WJ
• Kim H
• Jung E
• Lee J

• KMID: 2285616
• DOI: http://doi.org/10.5853/jos.2015.01767

Abstract

BACKGROUND AND PURPOSE
We aimed to investigate the usefulness of combining transcranial magnetic stimulation (TMS) and diffusion tensor tractography (DTT) to evaluate corticospinal tract (CST) integrity and subsequently predict ambulatory function after middle cerebral artery (MCA) stroke.
METHODS
Forty-three patients with first MCA stroke underwent TMS and DTT to evaluate CST integrity. Patients were classified into four groups according to the presence of motor-evoked potentials (MEPs) obtained from the tibialis anterior muscle and CST integrity. Motor impairment and functional status were assessed using the Fugl-Meyer Assessment, Functional Ambulation Category, and Korean modified Barthel Index, both at the time of admission and after 4 weeks of rehabilitation.
RESULTS
Patients with the presence of both measurable MEPs and a preserved CST showed better motor recovery and ambulatory function than other groups at the 4-week follow-up. Intact CSTs were not visualized in patients without detectable MEPs. Among the patients displaying MEPs, those with preserved CSTs showed better recovery of paretic lower extremities.
CONCLUSIONS
Combined assessment using TMS and DTT to evaluate CST integrity confers advantages in predicting motor and ambulation recovery in patients with MCA stroke.

Keyword

Stroke; Locomotion; Corticospinal tract; Rehabilitation

MeSH Terms

Diffusion*
Follow-Up Studies
Humans
Locomotion
Lower Extremity
Middle Cerebral Artery
Pyramidal Tracts
Rehabilitation
Stroke*
Transcranial Magnetic Stimulation*
Walking*