Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review - Report - MDSpire

Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review

  • By

  • Johanna C. M. Schilder

  • Maurits H. J. Hoonhorst

  • Ralph de Vries

  • Gert Kwakkel

  • May 7, 2026

  • 0 min

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Clinical Report: Evaluating the Predictive Value of Motor Evoked Potentials

Overview

Expand on the limitations of TMS-MEP in identifying non-recovery early post-stroke.

Background

Accurate prediction of upper limb motor recovery after stroke is crucial for informing treatment goals and discharge planning. Transcranial magnetic stimulation (TMS) is a non-invasive technique that can assess corticospinal tract integrity, which is a significant prognostic marker for recovery. Understanding the predictive value of TMS-MEP can enhance clinical decision-making and improve patient outcomes.

Data Highlights

Outcome MeasureSensitivitySpecificityPPVNPV
Muscle Strength0.76 (95% CI: 0.64–0.85)0.96 (95% CI: 0.55–1.00)0.96 (95% CI: 0.85–0.99)0.62 (95% CI: 0.43–0.78)
Muscle Synergies0.70 (95% CI: 0.57–0.81)0.98 (95% CI: 0.65–1.00)0.98 (95% CI: 0.54–1.00)0.69 (95% CI: 0.42–0.87)
UL-Capacity0.84 (95% CI: 0.76–0.89)0.91 (95% CI: 0.78–0.96)0.91 (95% CI: 0.79–0.97)0.81 (95% CI: 0.65–0.91)

Key Findings

  • TMS-MEP demonstrates a sensitivity of 0.76 for predicting muscle strength recovery.
  • Specificity for muscle synergies is high at 0.98, indicating reliable identification of true negatives.
  • The predictive value for upper limb capacity is strong, with a PPV of 0.91.
  • Timing of TMS-MEP assessments does not significantly affect prognostic accuracy.
  • Low risk of bias was observed across included studies, enhancing the reliability of findings.

Clinical Implications

Highlight the necessity for ongoing research to enhance predictive capabilities.

Conclusion

TMS-MEP is a valuable prognostic marker for upper limb recovery following stroke, particularly for muscle strength and capacity. Further research is needed to enhance its predictive capabilities for identifying non-recovery.

Related Resources & Content

  1. Frontiers in Neurology, 2026 -- Effects of repetitive peripheral magnetic stimulation on upper extremity motor function recovery after stroke: a meta-analysis and dose-response study
  2. Brain, 2026 -- Direct Examination of Cortical Interneuron Networks in Amyotrophic Lateral Sclerosis
  3. Prehabilitation of Motor Networks Using Low-Frequency Repetitive Transcranial Magnetic Stimulation: A Conceptual Study
  4. European Stroke Organisation (ESO) guideline on motor rehabilitation | European Stroke Journal, 2025
  5. Frontiers, 2026 -- Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: A systematic review
  6. Journal of Neuro-Oncology — Enhancing Recovery from Postsurgical Paresis in Brain Tumor Patients through Transcranial Magnetic Stimulation
  7. European Stroke Organisation (ESO) guideline on motor rehabilitation | European Stroke Journal | Oxford Academic
  8. Frontiers | Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: A systematic review
  9. Frontiers | Efficacy comparison of seven non-invasive brain stimulation techniques for upper limb motor dysfunction after stroke: a Bayesian network meta-analysis and systematic review

Original Source(s)

Prognostic accuracy of transcranial magnetic stimulation-induced motor evoked potentials on recovery of upper limb: a systematic review

  • by Johanna C. M. Schilder, Maurits H. J. Hoonhorst, Ralph de Vries, Gert Kwakkel

  • May 7, 2026

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