Features of white matter degeneration in ALS patients with different onset and spreading pattern by using DTI / 西安交通大学学报(医学版)

【Objective】 To explore the characteristics of white matter degeneration in amyotrophic lateral sclerosis (ALS) patients with different onset and spreading patterns by using diffusion tensor imaging (DTI). 【Methods】 We enrolled 86 ALS patients and 44 healthy controls. The patients were divided into bulbar- and spinal-onset subgroups according to their onset site, as well as horizon, vertical, interpose/skip, and caudal-rostral subgroups based on the spreading direction of the involved regions. The white matter fiber tracts corresponding to the motor network were set as the region of interest. We used tract-based spatial statistics to evaluate differences between the above groups and the normal controls, with family-wise error (FWE) correction and P<0.05 as statistical significance. 【Results】 The white matter degeneration of ALS patients with bulbar onset was mainly limited to the corona radiation part of the corticospinal tract, while those with spinal onset showed extensive degeneration of corticospinal tract and corpus callosum Ⅲ area (FWE correction, P<0.05). In patients with horizontal and vertical dissemination, decreased integrity of the entire corticospinal tract was found, with patients in the latter group showed extra degeneration in the Ⅲ part of the corpus callosum. Restricted degeneration of the corticospinal tract within bilateral corona radiata was detected in patients with caudal-rostral and interposed/skip spreading pattens (FWE correction, P<0.05). 【Conclusion】 Different onset and disease spread patterns of ALS patients correspond to divergent brain degeneration patterns. The diagnosis, treatment, and management of ALS should fully consider the heterogeneity of the disease.

Corticospinal tract integrity and the upper limb motor functioning of stroke survivors treated with repetitive transcranial magnetic stimulation / 中华物理医学与康复杂志

Objective:To observe any relationship between corticospinal tract integrity and the upper limb motor function of stroke survivors treated with repetitive transcranial magnetic stimulation (rTMS).Methods:Bilateral corticospinal tracts (CSTs) were reconstructed in ischemic or hemorrhagic stroke survivors with upper limb motor dysfunction using diffusion tensor imaging (DTI). Thirty patients with good CST integrity (rFA>0.5) and 30 with rFA≤0.5 were further divided into a high frequency rTMS group (HF, n=10), a low frequency group (LF, n=10), and a control group ( n=10). All groups were given routine rehabilitation, while the high and low frequency groups were additionally provided with 5Hz and 1Hz rTMS respectively applied over the M1 area of the contralesional hemisphere. Before and after 3 weeks of treatment, all of the subjects were evaluated using the Fugl-Meyer upper extremity scale (F-M UE), the Wolf Motor Function Test (WMFT) and the Modified Barthel Index (MBI). Results:For the high CST integrity group, significant improvement was observed in the average scores of all measurements, with the average FMA-UE, WMFT and MBI scores of the LF group [(38.10±5.71), (43.20±5.32) and (78.00±11.35)] significantly better than those of the other 2 groups. Among the low CST integrity group, the HF subgroup showed greater improvement than the other 2 on average.Conclusions:For patients with good CST integrity, LF-rTMS over the contralesional cortex is superior to HF-rTMS in promoting upper limb motor function, while for patients with low CST integrity HF-rTMS over the contralesional cortex has a better effect than LF-rTMS or sham stimulation in terms of improving upper limb motor function after a stroke.

Effects of Mirror Therapy on Upper Limb Motor Function and Corticospinal Tract Remodeling after Stroke: A Diffusion Tensor Imaging Study / 中国康复理论与实践

Objective:To explore the effects of mirror therapy on upper limb motor function recovery and corticospinal tract remodeling after stroke. Methods:From March, 2017 to March, 2019, 42 subcortical stroke patients with upper limb dysfunction from Shanghai Fifth People's Hospital were randomly divided into control group (n = 21) and observation group (n = 21). Both groups received routine rehabiliation, while the observation group received mirror therapy additionally, for twelve weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), and scanned with diffusion tensor imaging (DTI) before and after treatment. The fractional anisotropy (FA) in posterior limb of internal capsule (PLIC) was obtained. Results:The scores of FMA-UE improved in both groups after treatment (t > 9.560, P < 0.001), and improved more in the observation group than in the control group (t > 2.634, P < 0.05). FA decreased significantly in the affected-lateral PLIC compared with that in the unaffected-lateral PLIC in both groups (t > 11.368, P < 0.001). FA in the affected side increased significantly after treatment in the observation group (t = 2.385, P < 0.05), while there was no significant difference in the control group (t = -0.596, P > 0.05). FA increased more significantly in the observation group than in the control group (t = 2.306, P < 0.05). Conclusion:Mirror therapy can promote the recovery of motor function of upper limb and the corticospinal tract remodeling in stroke patients.

Effects of Acupuncture on Motor and Corticospinal Tract Impairment after Cerebral Infarction: Using Diffusion Tensor Imaging and Tractography / 中国康复理论与实践

Objective:To explore the effects of Tiaoren Tongdu Acupuncture on motor function and corticospinal tract (CST) remodeling after cerebral infarction. Methods:From February, 2017 to December, 2020, 54 patients with cerebral infarction were randomly divided into control group (n = 27) and acupuncture group (n = 27), each group was divided into subgroups 1, 2 and 3 according to the impairment of corticospinal tract, with nine cases for each subgroup. All the patients received routine medicine, while the acupuncture group received Tiaoren Tongdu Acupuncture, for four weeks. They were assessed with Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI) before and after treatment, and scanned with diffusion tensor imaging and diffusion tensor tractography, to obtain the fractional anisotropy (FA) and the bilateral FA ratio (rFA). Results:The scores of FMA and MBI, and FA and rFA increased in both groups (t > 2.841, P < 0.05) after treatment, and increased more in the acupuncture group than in the control group (t > 2.140, P < 0.05). Conclusion:Tiaoren Tongdu Acupuncture can promote the recovery of CST to improve motor function for patients with cerebral infarction.

El tracto cortico espinal: perspectiva histórica / The corticospinal tract: historical perspective

RESUMEN: La neuroanatomía y la neurofisiología han permitido en gran parte entender de forma más integrada las estructuras que conforman el sistema nervioso y los mecanismos asociados con la transmisión de los potenciales de acción, relacionados con la vía corticoespinal en la ejecución de movimientos voluntarios. Se realizó una revisión histórica sobre la vía corticoespinal, desde el punto de vista neuroanatómico y neurofisiológico mediante una revisión de literatura en distintas bases de datos y libros de texto dedicados a estas vías nerviosas. La información obtenida se ordenó cronológicamente, seleccionando los datos más relevantes que desde el punto de vista neuroanatómico y neurofisiológico han permitido comprender su mecanismo funcional. Actualmente se tiene un conocimiento muy depurado de los distintos elementos que componen la vía corticoespinal, lo que permitirá su aplicación en el campo de la salud y resolver múltiples problemas de la función motora.

SUMMARY: Neuroanatomy and Neurophysiology have, in large part, permitted a more thorough understanding of those structures that conform the nervous system and mechanisms associated with the transmission of action potentials associated with the corticospinal tract. This assertion is made based upon a literature review of various databases and textbooks dedicated to said nerve tracts. The information obtained was ordered chronologically, and data was selected that, from the neuroanatomical and neurophysiological viewpoints, were most relevant and have permitted the comprehension of its functional mechanism. The thorough understanding of those elements that compose the corticospinal tract will permit its application in the health field and resolve multiple motor function problems.

Mini-Review of Studies Reporting the Repeatability and Reproducibility of Diffusion Tensor Imaging

PURPOSE: Diffusion tensor imaging (DTI) data must be analyzed by an analyzer after data processing. Hence, the analyzed data of DTI might depend on the analyzer, making it a major limitation. This paper reviewed previous DTI studies reporting the repeatability and reproducibility of data from the corticospinal tract (CST), one of the most actively researched neural tracts on this topic. MATERIALS AND METHODS: Relevant studies published between January 1990 and December 2018 were identified by searching PubMed, Google Scholar, and MEDLINE electronic databases using the following keywords: DTI, diffusion tensor tractography, reliability, repeatability, reproducibility, and CST. As a result, 15 studies were selected. RESULTS: Measurements of the CSTs using region of interest methods on 2-dimensional DTI images generally showed excellent repeatability and reproducibility of more than 0.8 but high variability (0.29 to 1.00) between studies. In contrast, measurements of the CST using the 3-dimensional DTT method not only revealed excellent repeatability and reproducibility of more than 0.9 but also low variability (repeatability, 0.88 to 1.00; reproducibility, 0.82 to 0.99) between studies. CONCLUSION: Both 2-dimensional DTI and 3-dimensional DTT methods appeared to be reliable for measuring the CST but the 3-dimensional DTT method appeared to be more reliable.

Motor Evoked Potentials in the Upper Extremities of Children with Spastic Hemiplegic Cerebral Palsy

The aim of this study was to evaluate and compare the reorganization of corticospinal pathways innervating upper extremity muscles in patients with spastic hemiplegic cerebral palsy (CP). Thirty-2 patients (17 male, 15 female) with spastic hemiplegic CP were enrolled. The average age (mean ± standard deviation) was 7.5 ± 4.6 (range: 2–17) years. Transcranial magnetic stimulation (TMS) was applied to the unaffected and affected motor cortices in turn, and bilateral electromyographic recordings were made from the first dorsal interossei (FDI), the biceps brachii (BB), and the deltoid muscles during rest. The onset latency, central motor conduction time, and peak-to-peak amplitude of motor evoked potentials (MEPs) were measured for each muscle bilaterally. Whilst TMS of both affected and unaffected hemispheres elicited contralateral MEPs in all muscles, the number of MEPs evoked from the affected hemisphere was less than from the unaffected hemisphere for FDI and BB. TMS responses to stimulation of the affected side showed prolonged latency and reduced amplitude. The amplitudes of MEPs increased with age whereas the latencies were relatively constant. These results suggest that the corticospinal pathways to the proximal and distal muscles of the upper extremity undergo sequential maturation and reorganization patterns.

Application of diffusion tensor imaging of white matter fiber bundles in rhesus models of cerebral infarction / 中国脑血管病杂志

Objective To investigate the diagnostic value of MR diffusion tensor imaging (DTI) and diffusion tensor fiber bundle imaging (DTT) in white matter injury of cerebral infarction in different periods, and to observe the damage of white matter fiber bundles. Methods Four adult male rhesus monkeys, aging 8. 0 ± 1. 5 years old and weighted 9. 6 ± 1. 2 kg were experimented. Middle cerebral artery (Ml segment) embolization-reperfusion model was prepared by rhesus monkey autologous thrombosis and recanalization with recombinant tissue plasminogen activator 2. 5 h after embolization. Routine magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) and DTI were performed at 4 h, 7 d and 30 d after surgery, respectively. The anisotropic coefficient (FA) values and changes of the white matter fiber bundles in corresponding parts of cerebral white matter between the infarcted side and the healthy side were compared. Results FA and the number of fiber bundles in the infarct side showed a trend of decrease on day 7 and increase on day 30 after ischemia, and the difference was statistically significant (At 4 h, 7 d and 30 d after cerebral ischemia, FA was 0. 301 ± 0. 045, 0. 200 ± 0. 050 and 0. 305 ± 0. 026, respectively: The number of fiber bundles was 43. 0 ± 1. 6, 22. 8 ±11.0 and 31.3 ± 6. 4, respectively. F values were 8. 223 and 7. 861, respectively; all P 0. 05). Conclusion DTI and DTT can better evaluate the degree of white matter fiber bundle injury in cerebral infarction at different stages, which is of great value in guiding clinical diagnosis and predicting prognosis.

Comprehensive therapeutics targeting the corticospinal tract following spinal cord injury / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Spinal cord injury (SCI), which is much in the public eye, is still a refractory disease compromising the well-being of both patients and society. In spite of there being many methods dealing with the lesion, there is still a deficiency in comprehensive strategies covering all facets of this damage. Further, we should also mention the structure called the corticospinal tract (CST) which plays a crucial role in the motor responses of organisms, and it will be the focal point of our attention. In this review, we discuss a variety of strategies targeting different dimensions following SCI and some treatments that are especially efficacious to the CST are emphasized. Over recent decades, researchers have developed many effective tactics involving five approaches: (1) tackle more extensive regions; (2) provide a regenerative microenvironment; (3) provide a glial microenvironment; (4) transplantation; and (5) other auxiliary methods, for instance, rehabilitation training and electrical stimulation. We review the basic knowledge on this disease and correlative treatments. In addition, some well-formulated perspectives and hypotheses have been delineated. We emphasize that such a multifaceted problem needs combinatorial approaches, and we analyze some discrepancies in past studies. Finally, for the future, we present numerous brand-new latent tactics which have great promise for curbing SCI.

Sepsis Associated Encephalopathy Accompanied by Bilateral Corticospinal Tract Lesions in Diffusion Weighed Image

No abstract available.

Comparison of anterograde tracing methods of mouse corticospinal tract with adeno associated virus and biotinylated dextran amine / 基础医学与临床

Objective To compare the differences between adeno associated virus ( AAV) and biotinylated dextran amine ( BDA) in anterograde tracing of mouse corticospinal tract ( CST) , and to explore the advantages of the ap-plication of AAV in anterograde tracing of mouse CST axons as a neural tracer. Methods AAV8-CAG-GFP-2A and BDA were stereotactically injected into the mouse sensorimotor cortex of normal and spinal cord injury mice respec-tively, and immunohistochemistry was employed to observe the distribution of the labeled CST axons. The relative fluorescence of axon bundles and branches was analyzed. Results Both AAV and BDA labeled the bundles of cor-ticospinal tract and surrounding axon branches projecting into the gray matter of cervical and thoracic cords in both coronal and saggital sections of normal and spinal cord injury mice. Meanwhile, more axon branches were labeled in the AAV injected mice as compared with those in the BDA injected ones. Conclusions AAV exhibits more superior performance in mouse CST axon tracing in comparison with BDA, and can be applied as a better neural tracer for the morphological study of mouse CST and related neural circuits.

Gait Characteristic in a Stroke Patient with an Intact Corticospinal Tract and Corticoreticular Pathway: A Case Study

PURPOSE: The prefrontal lobe, supplementary motor area, cerebellum, and basal ganglia are activated during gait. In addition, gait is controlled by nerves, such as the corticospinal tract (CST) and corticoreticular pathway (CRP). In this study, the presence of an injury to the CST and CRP was identified by diffusion tensor imaging and the characteristics of the gait pattern were investigated according to inferior cerebral artery infarction. METHODS: One patient and six control subjects of a similar age participated. A 69-year-old female patient had an injury to the left basal ganglia, insular gyrus, corona radiata, dorsolateral prefrontal cortex, and postcentral gyrus due to an inferior cerebral artery infarction. Diffusion tensor imaging (DTI) data was acquired 4 weeks after the stroke. The kinematic and spatio-temporal parameters of gait were collected using a three-dimensional gait analysis system. RESULTS: On 4 weeks DTI, the CST and CRP in the affected hemisphere did not show injury to the affected and unaffected hemisphere. Gait analysis showed that the cadence of spatio-temporal parameter was decreased significantly in the patient. The angle of the knee joint was decreased significantly in the affected and unaffected sides compared to the control group. CONCLUSION: The results of diffusion tensor imaging showed that although the patient was evaluated to be capable of an independent gait, the quality and quantity of gait might be reduced. This study could help better understand the gait ability analysis of stroke patients and the abnormal gait pattern of patients with a brain injury.

Assessment Value of Disrupted Corticospinal Tract Secondary to Stroke Lesion for Motor Impairment: A Diffusion Tensor Tracking Study / 中国康复理论与实践

@#Objective To investigate the relationship between disrupted corticospinal tract (CST) and motor recovery after stroke by using diffusion tensor tracking (DTT). Methods From March, 2012 to June, 2013, 15 chronic stroke patients with left subcortical lesions and 15 age- and sex- matched healthy subjects were performed diffusion tensor imaging (DTI) examination. The CST was tracked by DTT technique, and the damaged values of the CST caused by the stroke lesions were quantified using a CST template generated from healthy controls. Furthermore, the correlations of the damaged values of the CST with Fugl-Meyer Assessment (FMA) were performed. Results The range of the damaged values of CST in stroke patients was 0.00% to 29.6%. There were very strong negative correlation between the damaged values of the CST and FMA scores (the wrist, r = -0.660; hand, r = -0.813; wrist plus hand, r = -0.795, respectively, P < 0.01). It also showed strong negative correlation between the damaged values of the CST and FMA scores (upper limb, r = -0.614; upper limb plus lower limb, r = -0.563, respectively, P < 0.05). Whereas, there was no correlation between the damaged values of the CST and FMA scores of lower limb (r = -0.270, P = 0.331). In addition, the lesion volumes of stroke and FMA scores were not significantly correlated (P > 0.05). Conclusion The severity of motor deficit after stroke was closely related to the overlap of lesions with CST. The damaged values of the CST based on DTT may be used as a potential biomarker to assess motor impairments of upper limbs, especially hand and wrist in stroke patients.

Advance in Corticospinal Tract and Motor Recovery after Stroke (review) / 中国康复理论与实践

@#Corticospinal tract (CST) is the major neuronal pathway that mediates voluntary movements, and the severity of injury may influence the recovery of motor function, especially that of the upper limbs, and involve to the long-term outcome. Axonal remodeling may happen in the CST after stroke, at the levels of spine and brain, which promotes the recovery of motor function. The mechanism of remodeling is complicated, and need more researched.

Relationship between Fractional Anisotropy of Corticospinal Tract and Motor Function in Stroke Patients Using Diffusion Tensor Imaging / 中国康复理论与实践

Objective To explore the relationship between fractional anisotropy (FA) of corticospinal tract (CST) and motor function in stroke patients using diffusion tensor imaging (DTI). Methods From January, 2013 to October, 2016, 36 stroke patients were evaluated with Fugl-Meyer Assessment (FMA), Japan Upper Limb Function Test and DTI before and eight weeks after rehabilitation. FA in posterior limb of internal capsule, cerebral peduncle and pons were obtained, including ipsilesional and contralesional CST. Results The FA values within three sections of CST were significantly lower in the ipsilesional side than in the contralesional side both before and after rehabilitation (t>5.330, P0.05) in the ipsilesional side, as well as in all the sections in the contralesional side (t0.05). The FA values were positively correlated with the scores of FMA and Japan Upper Limb Function Test in all the sections both before and after rehabilitation (r>0.43, P<0.05), especially the relationship between the FA value and the score of Japan Upper Limb Function Test in the posterior limb of internal capsule (r=0.67). Conclusion DTI can be used to evaluate CST injury and the relationship be-tween CST injury and motor function.

Diffusion Tensor Imaging of Changes of White Matter in Patients with Motor Neuron Disease / 华中科技大学学报(医学版)

Objective To quantitatively assess the changes of white matter in 15 patients with motor neuron disease by dif-fusion tensor imaging(DTI)and to explore the possible pathogenesis.Methods Fifteen patients with a diagnosis of motor neu-ron disease and sixteen age- and sex-matched controls without disorders affecting the central nervous system received 3.0T DTI;whole-brain white matter damage was examined using tract-based spatial statistics(TBSS),and fractional anisotropy(FA), mean diffusivity(MD),λ1,λ2,λ3were extracted from the damage region.The data were analyzed by t-test to disclose the differ-ences of white matter between patients and controls.Results As compared with the control group,FA was significantly de-creased(P=0.034)in the left corticospinal tract(CST),while λ2(P=0.124)and λ3(P=0.064)had a trend to increase,but FA(P=0.050)in the right CST had a trend to decrease in the experimental group.However,λ1and MD were not significantly different between the two groups.Conclusion DTI can quantitatively evaluate CST degeneration in patients with motor neuron disease,which may be caused by demyelination.

Diagnostic Challenge of Diffusion Tensor Imaging in a Patient With Hemiplegia After Traumatic Brain Injury

A 51-year-old man showed hemiplegia on his right side after a traumatic brain injury (TBI). On initial brain computed tomography (CT) scan, an acute subdural hemorrhage in the right cerebral convexity and severe degrees of midline shifting and subfalcine herniation to the left side were evident. On follow-up brain magnetic resonance imaging (MRI), there were multiple microhemorrhages in the left parietal and occipital subcortical regions. To explain the occurrence of right hemiplegia after brain damage which dominantly on the right side of brain, we used diffusion tensor imaging (DTI) to reconstruct the corticospinal tract (CST), which showed nearly complete injury on the left CST. We also performed motor-evoked potentials, and stimulation of left motor cortex evoked no response on both sides of upper extremity. We report a case of patient with hemiplegia after TBI and elucidation of the case by DTI rather than CT and MRI.

Optimal Factors of Diffusion Tensor Imaging Predicting Corticospinal Tract Injury in Patients with Brain Tumors

OBJECTIVE: To identify the optimal factors in diffusion tensor imaging for predicting corticospinal tract (CST) injury caused by brain tumors. MATERIALS AND METHODS: This prospective study included 33 patients with motor weakness and 64 patients with normal motor function. The movement of the CST, minimum distance between the CST and the tumor, and relative fractional anisotropy (rFA) of the CST on diffusion tensor imaging, were compared between patients with motor weakness and normal function. Logistic regression analysis was used to obtain the optimal factor predicting motor weakness. RESULTS: In patients with motor weakness, the displacement (8.44 ± 6.64 mm) of the CST (p = 0.009), minimum distance (3.98 ± 7.49 mm) between the CST and tumor (p < 0.001), and rFA (0.83 ± 0.11) of the CST (p < 0.001) were significantly different from those of the normal group (4.64 ± 6.65 mm, 14.87 ± 12.04 mm, and 0.98 ± 0.05, respectively) (p = 0.009, p < 0.001, and p < 0.001). The frequencies of patients with the CST passing through the tumor (6%, p = 0.002), CST close to the tumor (23%, p < 0.001), CST close to a malignant tumor (high grade glioma, metastasis, or lymphoma) (19%, p < 0.001), and CST passing through infiltrating edema (19%, p < 0.001) in the motor weakness group, were significantly different from those of the patients with normal motor function (0, 8, 1, and 10%, respectively). Logistic regression analysis showed that decreased rFA and CST close to a malignant tumor were effective variables related to motor weakness. CONCLUSION: Decreased fractional anisotropy, combined with closeness of a malignant tumor to the CST, is the optimal factor in predicting CST injury caused by a brain tumor.

Transcranial Magnetic Stimulation and Diffusion Tensor Tractography for Evaluating Ambulation after Stroke / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: We aimed to investigate the usefulness of combining transcranial magnetic stimulation (TMS) and diffusion tensor tractography (DTT) to evaluate corticospinal tract (CST) integrity and subsequently predict ambulatory function after middle cerebral artery (MCA) stroke. METHODS: Forty-three patients with first MCA stroke underwent TMS and DTT to evaluate CST integrity. Patients were classified into four groups according to the presence of motor-evoked potentials (MEPs) obtained from the tibialis anterior muscle and CST integrity. Motor impairment and functional status were assessed using the Fugl-Meyer Assessment, Functional Ambulation Category, and Korean modified Barthel Index, both at the time of admission and after 4 weeks of rehabilitation. RESULTS: Patients with the presence of both measurable MEPs and a preserved CST showed better motor recovery and ambulatory function than other groups at the 4-week follow-up. Intact CSTs were not visualized in patients without detectable MEPs. Among the patients displaying MEPs, those with preserved CSTs showed better recovery of paretic lower extremities. CONCLUSIONS: Combined assessment using TMS and DTT to evaluate CST integrity confers advantages in predicting motor and ambulation recovery in patients with MCA stroke.

Comparison of Diffusion Tensor Tractography and Motor Evoked Potentials for the Estimation of Clinical Status in Subacute Stroke

OBJECTIVE: To compare diffusion tensor tractography (DTT) and motor evoked potentials (MEPs) for estimation of clinical status in patients in the subacute stage of stroke. METHODS: Patients with hemiplegia due to stroke who were evaluated using both DTT and MEPs between May 2012 and April 2015 were recruited. Clinical assessments investigated upper extremity motor and functional status. Motor status was evaluated using Medical Research Council grading and the Fugl-Meyer Assessment of upper limb and hand (FMA-U and FMA-H). Functional status was measured using the Modified Barthel Index (MBI). Patients were classified into subgroups according to DTT findings, MEP presence, fractional anisotropy (FA) value, FA ratio (rFA), and central motor conduction time (CMCT). Correlations of clinical assessments with DTT parameters and MEPs were estimated. RESULTS: Fifty-five patients with hemiplegia were recruited. In motor assessments (FMA-U), MEPs had the highest sensitivity and negative predictive value (NPV) as well as the second highest specificity and positive predictive value (PPV). CMCT showed the highest specificity and PPV. Regarding functional status (MBI), FA showed the highest sensitivity and NPV, whereas CMCT had the highest specificity and PPV. Correlation analysis showed that the resting motor threshold (RMT) ratio was strongly associated with motor status of the upper limb, and MEP parameters were not associated with MBI. CONCLUSION: DTT and MEPs could be suitable complementary modalities for analyzing the motor and functional status of patients in the subacute stage of stroke. The RMT ratio was strongly correlated with motor status.