Comparison of TMS and DTT for predicting motor outcome in intracerebral hemorrhage.
BACKGROUND
TMS (transcranial magnetic stimulation) and DTT (diffusion tensor tractography) have different advantages in evaluating stroke patients. TMS has good clinical accessibility and economical benefit. On the contrary, DTT has a unique advantage to visualize neural tracts three-dimensionally although it requires an expensive and large MRI machine. Many studies have demonstrated that TMS and DTT have predictive values for motor outcome in stroke patients. However, there has been no study on the comparison of these two evaluation tools. In the current study, we compared the abilities of TMS and DTT to predict upper motor outcome in patients with ICH (intracerebral hemorrhage).


METHODS
Fifty-three consecutive patients with severe motor weakness were evaluated by TMS and DTT at the early stage (7-28 days) of ICH. Modified Brunnstrom classification (MBC) and the motricity index of upper extremity (UMI) were evaluated at onset and 6 months after onset.


RESULTS
Patients with the presence of a motor evoked potential (MEP) in TMS or a preserved corticospinal tract (CST) in DTT showed better motor outcomes than those without (p=0.000). TMS showed higher positive predictive value than DTT. In contrast, DTT showed higher negative predictive value than TMS.


CONCLUSIONS
TMS and DTT had different advantages in predicting motor outcome, and this result could be a reference to predict final neurological deficit at the early stage of ICH.
Jang
Sung Ho
SH
Department of Physical Medicine and Rehabilitation, Yeungnam University, Republic of Korea. strokerehab@hanmail.neta
Ahn
Sang Ho
SH
Sakong
Joon
J
Byun
Woo Mok
WM
Choi
Byung Yun
BY
Chang
Chul Hoon
CH
Bai
Daiseg
D
Son
Su Min
SM
D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004185:Disability Evaluation; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology; D009069:Movement Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011712:Pyramidal Tracts / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000379:methods*