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TMS MEPs – Stroke Recovery Prognosis — SCE Neurology MCQ

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ModerateNeurorehabilitationTMS MEPs – Stroke Recovery PrognosisSCE Neurology

A 55-year-old man with ischaemic stroke has residual left arm weakness at 3 months. He has some voluntary shoulder movement (MRC 3/5 deltoid) and finger extension (MRC 2/5). His physiotherapist considers transcranial magnetic stimulation (TMS) to assess his corticospinal tract integrity. Motor evoked potentials (MEPs) are present but delayed in the affected arm. What does this finding suggest for prognosis?

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Correct answer: A — The presence of MEPs (even if delayed) indicates that the corticospinal tract is at least partially intact — this is associated with a better probability of upper limb motor recovery

TMS-evoked motor evoked potentials (MEPs) assess corticospinal tract integrity. In stroke, the presence of MEPs in the affected limb (even if delayed or reduced in amplitude) indicates at least partial preservation of the corticospinal tract, which is associated with a better prognosis for motor recovery. Absent MEPs indicate complete tract disruption and predict poor recovery — rehabilitation should focus on compensatory strategies. The PREP algorithm incorporates MEP assessment in its prediction model. A: Partial tract integrity supports recovery. C: MEPs are a strong prognostic indicator. D: Delayed MEPs indicate slowed but intact conduction. E: Complete recovery is not guaranteed.

Reference: PREP Algorithm (Stinear et al.); RCP Stroke Guidelines