Peripheral Nerve Conduction Abnormalities and Their Association with Clinical Outcomes in Patients with Unilateral Hemiplegia Secondary to Stroke

Background/Objectives: Peripheral nerve conduction abnormalities may occur after stroke, but their clinical relevance in chronic hemiplegia remains unclear. This study aimed to characterize these abnormalities and examine their associations with motor and functional outcomes. Methods: This single-center, cross-sectional observational study included 72 patients with unilateral hemiplegia ≥ 6 months after ischemic or hemorrhagic stroke. Bilateral lower-extremity nerve conduction studies (NCS) were performed in all participants. In participants without findings suggestive of distal symmetric polyneuropathy (DSP), bilateral upper-extremity NCS were also performed to assess focal entrapment neuropathies; when DSP was suspected from lower-extremity findings, one upper extremity was examined to confirm upper-extremity involvement. Clinical assessments included the Fugl-Meyer Assessment, Functional Independence Measure, Timed Up and Go test, and computerized posturographic fall-risk assessment. Associations between NCS findings and clinical outcomes were examined using adjusted regression analyses. Results: Mean age was 61.75 ± 12.56 years, and stroke duration was 42.85 ± 38.14 months. Normal NCS findings were present in 18 (25.0%) patients. Most participants (86.1%) had high posturographic fall-risk. DSP was identified in 38 participants (52.8%). The most frequent focal neuropathy was median nerve entrapment at the wrist (17/72, 23.6%). DSP was more frequent in participants with diabetes than in those without diabetes (85.7% vs. 31.8%; p < 0.001). Ulnar sensory nerve action potential amplitude was lower on the paretic side (adjusted p = 0.028). Neither DSP nor median nerve entrapment was significantly associated with motor function, functional mobility, or functional independence in adjusted analyses; posturographic fall-risk classifications also did not differ according to these NCS findings in unadjusted exact tests. Conclusions: Peripheral nerve conduction abnormalities, particularly DSP and median nerve entrapment, were common in ambulatory individuals with chronic post-stroke hemiplegia. Despite their frequency, no statistically significant associations with motor or functional performance were identified, although clinically meaningful associations cannot be excluded.