Usefulness of transcranial magnetic stimulation to predict the development of reflex sympathetic dystrophy poststroke: A pilot study

Objective: To investigate the predictive value of transcranial magnetic stimulation (TMS) for the development of reflex sympathetic dystrophy (RSD) poststroke. Design: Blind clinical assessment of 2 groups of stroke patients defined on the basis of absent or preserved motor evoked potentials (MEPs) on the affected side. Setting: Stroke rehabilitation center. Patients: Twenty stroke patients between the ages of 41 and 85 years, undergoing rehabilitation. Interventions: Not applicable. Main Outcome Measures: MEPs from upper limbs 30 days poststroke, Motricity Index, and scoring of RSD using the Enjalbert Scale 73 days poststroke. Results: A good correlation was found between Motricity Index and TMS results (P<.01). Average Enjalbert scores were significantly different between the 2 groups (P=.03). No significant correlation was found between Enjalbert scores and the Motricity Index. Conclusions: Although no significant relationship was found between upper-limb motor impairment and intensity of RSD 10 weeks after stroke, the TMS responses permitted the early categorization of patients into 2 groups that developed significantly different average Enjalbert scores 1 to 2 months later when this clinical condition was fully developed. (C) 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.