| Objective: To investigate the role of motor evoked potential（MEP）,somatosensory evoked potential（SEP）and sympathetic skin response（SSR）in the assessment of upper limb motor function in convalescent stroke patients,and to provide theoretical basis for clinical diagnosis,treatment and prognosis assessment.Methods: From April 2021 to November 2021,48 patients with recovered stroke who met the inclusion criteria and were hospitalized in the Department of Rehabilitation Medicine of General Hospital in Jilin Province were collected.General data were collected: age,sex,disease duration and stroke site;motor evoked potential（MEP）,somatosensory evoked potential（SEP）and sympathetic skin response（SSR）tests of both upper limbs（hemiplegic and non-hemiplegic side）were performed on day 1 and day 20 after admission;Fugl-Meyer motor evaluation scale,Brunnstrom functional scale and Fugl-Meyer motor evaluation scale were performed on day 1 and day 20 after admission,respectively.The Fugl-Meyer Motor Evaluation Scale and Brunnstrom Functional Scale were used to evaluate the motor function of both upper limbs on the first and 20 th days after admission.The differences in the neurophysiological indices of the upper limbs on the hemiplegic and non-hemiplegic sides and the correlation with the subjective scales of Fugl-Meyer Motor Evaluation Scale and Brunnstrom Functional Scale to assess the motor functions of the limbs were analyzed.The data of this study were completed using SPSS25,and quantitative data were expressed as "X±s",and t-test was used when quantitative data met normal distribution;ANOVA was used for comparison between groups of quantitative data,and LSD was used for further two-by-two comparison;chi-square test was used for comparison of qualitative data;the correlation between indicators was analyzed by Spearman rank correlation was used for correlation analysis between indicators.*P < 0.05 is statistically significant,test level 0.05.Results: 1.Motor evoked potentials（MEP）: 1.1 MEP testing of both upper limbs（hemiplegic side and non-hemiplegic side）was performed in 48 stroke patients on day 1 after admission.43 cases（89.58%）had abnormal MEP in the upper limbs of the hemiplegic side,including 26 cases（54.17%）with missing waveforms,17 cases（35.42%）with prolonged latency,and 11 cases（22.92%）with prolonged CMCT;among the 26 cases with missing waveforms,bilateral Among the 26 cases with waveform deficiency,0 cases（0%）had simultaneous deficiency.The MEP of both upper extremities was reviewed in 29 stroke patients on the 20 th day after admission（19 cases were lost due to deterioration of the patient’s condition,sudden discharge,refusal to review again,etc.）,and the MEP of the upper extremity on the hemiplegic side was abnormal in 25 cases（86.20%）,including 12 cases（41.38%）with missing waveforms,4 cases（13.78%）with recurrence of waveforms compared with the first day after admission,and 13 cases（44.83%）with prolonged latency.（44.83%）,8 cases（27.59%）with shorter latency compared with the first day after admission,8 cases（27.59%）with prolonged CMCT,and 8 cases（27.59%）with shorter latency compared with the first day after admission.1.2 The MEP indexes of both upper extremities（hemiplegic and non-hemiplegic side）of 48 stroke patients were tested on day 1 after admission,and the latency and CMCT of the upper extremities on the hemiplegic side were statistically significant compared with normal values（P < 0.05）.The difference between the latency and CMCT of the upper limb on the hemiplegic side and the normal value was not statistically significant（P > 0.05）;the difference between the latency and CMCT of the upper limb on the hemiplegic side and the normal value was statistically significant（P < 0.05）in 29 stroke patients tested on the 20 th day after admission.There was no statistically significant difference between the latency and CMCT of the non-hemiplegic side of the upper limb and the normal value（P > 0.05）. 1.3 Forty-eight patients with stroke had their MEP indexes measured on both upper limbs（hemiplegic and non-hemiplegic side）on day 1 after admission.The differences in latency and CMCT of the upper limb on the hemiplegic side compared with those on the non-hemiplegic side were statistically significant（P < 0.05）.1.4 According to the different infarct sites,they were divided into 3 groups: cerebral cortex group,basal ganglia area group,and brainstem group.Among the 9 patients with cortical stroke,7（77.78%）had MEP abnormalities,including 6（85.71%）with waveform loss and 1（14.29%）with prolonged latency;among the 30 patients with basal ganglia stroke,27（90%）had MEP abnormalities,including 16（53.33%）with waveform loss and 11（36.67%）with prolonged latency.Among the 9 patients with stroke in the brainstem region,9（100%）had abnormal MEP,including 4（44.44%）with waveform loss and 5（55.56%）with prolonged latency.1.5 Of the 48 stroke patients admitted to the hospital,26（54.17%）had missing waveforms and 22（45.83%）had waveforms on both upper limbs（hemiplegic and nonhemiplegic sides）,and the differences were statistically significant（P < 0.05）between the scores on the FMA and BR scales for those with waveforms on the hemiplegic side and those with missing waveforms..For those with waveforms,the differences between the FMA scale and BR scale scores in the MEP latency and CMCT normal group were statistically significant（P < 0.05）compared with those with prolonged MEP latency and prolonged CMCT;and there was a negative correlation between MEP latency and FMA scores in the upper extremity on the hemiplegic side of MEP（r =-0.547,P < 0.01）and between CMCT and FMA scores in the upper extremity on the hemiplegic side of MEP scale scores（r=-0.471,P<0.01）,the longer the MEP latency CMCT,the lower the FMA scale scores and the worse the motor function.There was a negative correlation between CMCT on the hemiplegic side and BR scale score（r=-0.426,P<0.05）,and the longer the MEP latency and CMCT,the lower the BR scale score and the poorer the motor function.2.Somatosensory evoked potentials（SEP）: 2.1 Among 48 stroke patients,SEP was detected in both upper limbs（hemiplegic side and non-hemiplegic side）on day 1 after admission.24 cases（50%）had abnormal SEP N20 on the hemiplegic side,including 8 cases（16.67%）with no elicited SEP N20 waveform and 16 cases（33.3%）with prolonged latency;22 cases（45.83%）had unilateral abnormalities,2 cases（4.17%）had bilateral abnormalities),and 5 of the 8 cases with waveform deficiency（10.42%）were bilateral deficiencies.Of the 29 stroke patients who underwent SEP testing on day 20 after admission,13（44.83%）had abnormalities on the hemiplegic side,of which 6（20.69%）had absent waveforms,of which 2 had recurrence compared with day 1 after admission,7（24.14%）had prolonged latency,and 9 had shortened latency compared with day 1 after admission.There were 6 cases（20.69%）of SEP N20 abnormalities on the non-hemiplegic side,including 3 cases（10.34%）in which the SEP N20 waveform was not elicited,2 cases of recurrence compared with the first day of admission,and 4 cases（13.80%）with prolonged latency period;2 cases（10.42%）were absent bilaterally.2.2 In 48 stroke patients,the SEP index was measured on both upper extremities（hemiplegic and non-hemiplegic side）on day 1 after admission,and the latency of the upper extremity on the hemiplegic side was statistically significant compared with the normal value（P < 0.05）.There was a statistically significant difference between the latency and CMCT of the upper limb on the hemiplegic side and the normal value（P < 0.05）,and no statistically significant difference between the latency and the normal value of the upper limb on the non-hemiplegic side（P > 0.05）.2.3 SEP indexes were measured in both upper limbs（hemiplegic side and nonhemiplegic side）of 48 stroke patients on day 1 after admission,and the difference between the latency of the upper limb on the hemiplegic side and that on the nonhemiplegic side was statistically significant（P < 0.05）.2.4 According to the different infarct sites,they were divided into 3 groups: cerebral cortex group,basal ganglia area group,and brainstem group.Among the 9 cortical stroke patients,6（66.67%）had abnormal SEP,including 3（33.33%）with absent waveforms and 3（33.33%）with prolonged latency;12（40.00%）of the 30 basal ganglia stroke patients had abnormal SEP,including 3（10.00%）with absent waveforms and 9（30.00%）with prolonged latency;and 9（30.00%）of the 9 brainstem stroke patients had abnormal SEP.Of the 9 patients with stroke in the brainstem,8（88.87%） had abnormal SEP,including 0（0.00%）with waveform loss and 8（88.87%）with prolonged latency.2.5 The SEP index was tested on both upper limbs（hemiplegic and nonhemiplegic side）of 48 stroke patients on day 1 after admission,and the difference in latency between the upper limbs on the hemiplegic side and the non-hemiplegic side was statistically significant（P < 0.05）.2.6 The lower the FMA scale score and BR scale score when the SEP waveform was absent bilaterally.3.Sympathetic skin response（SSR）: 3.1 Among 48 stroke patients,SSR was measured in both upper limbs on day 1 after admission,and abnormal SSR was measured in 39 cases（81.25%）on the hemiplegic side,including 13 cases（27.08%）with waveform absence,15 cases（31.25%）with prolonged latency,22 cases（45.83%）with reduced amplitude,and 11 cases（22.92%）with both prolonged latency and reduced amplitude.22.92%).There were 41 cases（85.42%）of SSR abnormalities in the non-hemiplegic upper limb,including 10 cases（20.83%）with waveform loss,17 cases（35.42%）with prolonged latency,28 cases（58.33%）with reduced amplitude,and 14 cases（29.17%）with both prolonged latency and reduced amplitude.10 of the 13 cases with waveform loss were absent bilaterally.3.2 The SSR indexes of both upper limbs（hemiplegic side and non-hemiplegic side）of the 48 stroke patients were measured on the first day after admission,and the latency and wave amplitude of the hemiplegic side and the non-hemiplegic side were statistically significant compared with the normal values（P < 0.05）.3.3 SSR indexes were measured in both upper limbs（hemiplegic and nonhemiplegic side）of 48 stroke patients on the first day after admission,and the differences in latency and wave amplitude between the upper limbs on the hemiplegic side and those on the non-hemiplegic side were not statistically significant（P > 0.05）.3.4 According to the different infarct sites,they were divided into 3 groups: cerebral cortex group,basal ganglia area group,and brainstem group.Among the 9 cortical stroke patients,5（55.56%）had SSR abnormalities in the upper limb on the hemiplegic side,including 2（40.00%）with waveform absence,1（20.00%）with prolonged latency,3（60.00%）with reduced amplitude,and 1（20.00%）with prolonged latency and reduced amplitude;among the 30 basal ganglia stroke patients,28（93.33%）had SSR abnormalities in the upper limb on the hemiplegic side.Among the 30 patients with stroke in the basal ganglia region,28（93.33%）had abnormal SSR on the hemiplegic side,including 8（28.57%）with absent waveforms,10（35.71%）with prolonged latency,16（57.14%）with reduced amplitude,and 6（20.00%）with prolonged latency and reduced amplitude;among the 9 patients with stroke in the brainstem region,9（100%）had abnormal SSR on the hemiplegic side,including 3（33.33%）with absent waveforms and 1（20.00%）with reduced latency.Among the 9 patients with stroke in the brainstem,9（100%）had abnormal SSR in the upper limb on the hemiplegic side,including 3（33.33%）with absent waveform,3（33.33%）with prolonged latency,6（66.67%）with reduced amplitude,and 6（66.67%）with prolonged latency and reduced amplitude.33（68.75%）of the 48 stroke patients had bilateral SSR abnormalities,including 10（30.30%）with absent waveform and 23（69.70%）with reduced amplitude.3.5 The SSR abnormalities showed bilateral abnormalities,mainly SSR waveform amplitude reduction,and when the SSR waveform amplitude was lower,the FMA scale score and BR scale score were lower.Conclusions: 1.Motor evoked potentials（MEP）examination can assess the severity of upper limb motor dysfunction in patients recovering from stroke and is one of the sensitive neurophysiological indicators to assess upper limb motor function and prognosis.2.Somatosensory evoked potential（SEP）examination can be used as an index to assess the severity of neurological injury in patients recovering from stroke.However,it is not sensitive for the assessment of upper limb motor function in patients recovering from stroke.3.Sympathetic skin response（SSR）test is one of the indicators to assess the sympathetic functional status of patients recovering from stroke,but it has some limitations in assessing the motor function of upper limbs in patients recovering from stroke. |
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