Including Distal Motor Function within the NIHSS: Correlation with Motor Arm Function and IV rt-PA Treatment Response |
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| Affiliation: | 1. Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States;2. Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States;3. Department of Neurology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 1213, Brooklyn, NY 11203, United States;4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States;5. Department of Neurology, A.T. Still University, Mesa, AZ; Midwestern University, Glendale, AZ Honor Health Neurocritical care and Stroke Services, Phoenix, AZ, United States;6. The Stroke and Cognition Institute, The Rambam Health Care Campus, Haifa, Israel;7. Department of Neurology, Maine Medical Center, Portland, ME, United States;8. Departments of Neurology and Emergency Medicine, Stroke Center, SUNY Downstate Health Sciences University at Brooklyn, Brooklyn, NY, United States;9. Department of Neurology, Kings County Hospital Center, Brooklyn, NY, United States;10. Jaffe Stroke Center, Maimonides Medical Center, Brooklyn, NY, United States;1. Department of Neurology, University of Pecs, Medical School, Pecs, Hungary;2. Department of Anaesthesiology and Intensive Care, University of Pecs, Medical School, Pecs, Hungary;3. Department of Immunology and Biotechnology, University of Pecs, Medical School, Pecs, Hungary;4. Salisbury NHS Foundation Trust, Salisbury, United Kingdom;5. Department of Radiology, University of Örebro, Örebro, Sweeden;6. Department of Neurosurgery, University of Pecs, Medical School, Pecs, Hungary;1. Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang 110122, China;2. Department of Neurosurgery, the Fifth Medical Centre, Chinese PLA General Hospital (Former 307th hospital of the PLA), Beijing, 100071, China.;1. Department of Neurology, Boston University School of Medicine, Boston, MA, United States;2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States;3. Departments of Neurosurgery and Medicine (Infectious Disease), Boston University School of Medicine, Boston, MA and Boston Medical Center, Boston, MA, United States;1. Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, 510282, China;2. Department of Cerebrovascular Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China;3. Department of Neurosurgery, Shenzhen Baoan People''s Hospital, Southern Medical University, Shenzhen 518101, China;4. Southern Medical University, Guangzhou 510282, China |
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| Abstract: | ObjectivesThe Distal Motor Function (DMF) sub-score of the NIH Stroke Scale (NIHSS) was measured in the NINDS rt-PA Stroke Trials but is currently not included in the NIHSS. The correlation of DMF with the NIHSS Motor Arm Function (MAF) sub-score, the effect of IV tPA treatment on DMF, and whether adding DMF changes the utility of the NIHSS have not been analyzed.Materials and methodsMAF and DMF sub-scores were retrieved from the original NINDS rt-PA Stroke Trials for both sides of the body at baseline, 2 hours, 24 hours, 7–10 days, and 3 months after IV tPA treatment. MAF and DMF scores were correlated using Spearman correlation. Clustering of DMF and MAF scores was determined using a Bentler Comparative Fit Index (CFI) to estimate variation in NIHSS when adding DMF. The effect of IV tPA on DMF and MAF was assessed using a linear model comparing changes in scores from baseline to 3 months.ResultsMAF and DMF were highly correlated (p < 0.0001) across all time points for both dichotomous and continuous data on both sides. Intravenous tPA accounted for 21% of the change in DMF (p < 0.014, R2 = 0.0157, N = 423) and 39% of the change in MAF (p < 0.093, R2 = 0.0125, N = 547) from 0 to 3 months. On adding DMF to NIHSS, CFI decreased from 0.98 to 0.80 and DMF clustered with MAF, indicating that addition of DMF is unlikely to produce any discrepancy to NIHSS.ConclusionsIncluding DMF to the NIHSS does not appear to be of additional value. After IV tPA treatment, proximal and distal motor function in upper extremity strongly correlate over time but greater improvement in MAF is noted. Further research is needed on the role of IV tPA on minor strokes with deficits of DMF. |
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