ArticleMotor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study 1
Section snippets
Participants
Thirty-eight consecutive patients with acute ischemic stroke were recruited from the department of neurology at a university hospital during 1.5 years. The study population was from the region of Nijmegen, a middle-sized city in the eastern part of The Netherlands. Acute medical care for stroke patients is provided by several hospitals, including the university hospital. Stroke patients are admitted in an unselected manner, and, therefore, referral bias is not to be expected. Patients were
Results
Of the 38 initial patients, 30 had complete leg paralysis at inclusion (paralysis subgroup), and 8 had a combination of paresis of proximal muscles with paralysis of the crural muscles (paresis subgroup). Two patients in the paralysis subgroup died within 5 to 20 days after stroke onset, and another patient underwent an above-knee amputation (day 48) because of severe vasculopathy with ulceration at the heel. One patient in the paresis subgroup had a recurrent stroke (day 42). Twenty-seven
Discussion
Motor functions of the lower extremity represent an important determinant of the ability to regain ambulation after stroke.1, 2, 3 Based on this functional perspective, we examined the potential for motor recovery in acute-stroke patients with paralysis or severe paresis of the lower extremity. Compared with other studies, the recovery rate in our paralysis subgroup was high—66% experienced recovery of proximal motor functions—and in 33% of the patients, even crural motor recovery occurred
Conclusion
In patients with severe initial motor deficits of the lower extremity, considerable potential seems to exist for motor recovery, particularly for proximal leg muscles. Tibialis anterior muscle MEPs registered during the first week after stroke onset may provide important prognostic information, both for the motor recovery of crural muscles and for the ability to perform independent transfers. Vastus medialis muscle MEPs were not predictive of motor and functional recovery. The evidence
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