Comparison of TMS and DTT for predicting motor outcome in intracerebral hemorrhage
Received 21 August 2009; received in revised form 16 October 2009; accepted 21 October 2009. published online 16 November 2009.
Abstract
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 (7–28days) of ICH. Modified Brunnstrom classification (MBC) and the motricity index of upper extremity (UMI) were evaluated at onset and 6months 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.
aDepartment of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
bDepartment of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Republic of Korea
cDepartment of Diagnostic Radiology, College of Medicine, Yeungnam University, Republic of Korea
dDepartment of Neurosurgery, College of Medicine, Yeungnam University, Republic of Korea
eDepartment of Psychiatry, Yeungnam University Hospital, Republic of Korea
Corresponding author. Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea. Tel.: +82 53 620 4682; fax: +82 53 625 3508.
ABSTRACT