Predilection Values of Early SEPs For Recovery of Function and Guidance of Proper Rehabilitation Program for Stroke Patients

Author(s): Fayz S. Al-Shahryar, E. M. Sedgwick

Stroke assessment and prediction of recovery uses clinical evaluation and functional quantified outcome measures. These scales mainly depend on performing physical and cognitive tasks, direct quantitative sensory measures were rarely concerned. A quantified reliable and objective tool to investigate and monitor functional recovery of neurological cortical lesion must u used. Therefore, huge literature on Somatosensory evoked potentials (SEPs) indicate the possible use to elucidate differences in cortical activity associated with a stroke cases. The aim of this study is to investigate the possible prediction of recovery of stroke patients and possible early guidance of the rehabilitation program at an early stage.

Methods: 24 healthy control and 30 patients who had had a stroke and had a sensory-motor impairment in the arm were examined, and their SEPs were recorded upon study entry (onset to 5 weeks after the stroke), and at approximately 3 and 6 months after the stroke.

Results: The result showed 30% of the patients had N20 absent or severely affected at 1st visit. It was minimally affected on 35%, this 65% showed correlation of sensory motor impairment. At the 2nd visit N20 improved in amplitude correlated with improvement in sensory motor function in 70%. at the 3rd visit almost more than half of the population (65%) showed amplitude improvement which correlate with marked functional improvement. P25 was absent in 55% of the patients at initial visit, with sever or moderate impairment of some sensory modalities. N30 was absent or severely attenuated in almost 60% of the population at initial visit and weak in 10%. all have severe or moderate functional impairment. Statistical calculation of functional outcome shows statistically significant increase when 1st and 2nd visits were compared similarly the 2nd and 3rd and 1st and 3rd, p value less than 0.05.

Conclusion: the improvement of somatosensory waves amplitude correlate with the recovery of function in most cases. The limited amplitude improvement is crucial for functional recovery. Cases with no amplitude improvement has no functional recovery. The technique may be a useful tool to predict recovery and guide the inclusion criterion for rehab program.