Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review.
TMS motor evoked potentials predict good upper-limb capacity recovery after stroke with 84% sensitivity
Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review.
Prospective prognostic studies examining transcranial magnetic stimulation-induced motor evoked potentials (TMS-MEP) as predictors of upper limb (upper limb) motor function and capacity following stroke are influenced by variations in TMS procedures, outcome measures, and the timing of assessments.
This prognostic review investigated three key areas: 1) the technical and methodological quality of TMS-MEP studies; 2) the prognostic accuracy for outcome related to muscle strength, muscle synergies and upper limb-capacity; and 3) the influence of the timing of TMS-MEP on outcomes.
With the Quality Assessment of Prognostic Accuracy Studies (Quality Assessment of Prognostic Accuracy Studies) tool and Chipchase checklist the risk of bias (risk of bias) and technical quality of TMS-MEP studies were assessed, respectively.
TMS correctly flags 84% of patients who go on to regain good arm use
Three studies reported all the recommended technical items for TMS testing.
After pooling the data, muscle strength showed a sensitivity of 0.76 (95% CI: 0.64-0.85), specificity of 0.96 (95% CI: 0.55-1.00), positive predicted values of 0.96 (95% CI: 0.85-0.99) and negative predicted values of 0.62 (95% CI: 0.43-0.78).
For muscle synergies, sensitivity was 0.70 (95% CI: 0.57-0.81), specificity was 0.98 (95% CI: 0.65-1.00), positive predicted values was 0.98 (95% CI: 0.54-1.00) and negative predicted values was 0.69 (95% CI: 0.42-0.87).
TMS-MEP accurately predicts favorable upper limb-motor recovery regarding muscle strength, muscle synergy, and upper limb-capacity.
However, its accuracy in identifying individuals who do not regain upper limb motor function and capacity remains limited early post-stroke.