Conditioning stimulation techniques for enhancement of transcranially elicited evoked motor responses

Journée, H. L.; Polak, H; Kleuver, Marinus de

doi:10.1016/j.neucli.2007.10.002

Cited by 54 publications

(21 citation statements)

References 21 publications

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“…In contrary, reliable MEP monitoring was difficult to be obtained in very young children. However, the success rate of intraoperative MEP monitoring in this study is much higher than previous reports [14,[19][20][21][22]. In a previous study with 341 consecutive orthopedic procedures, the success rate for monitoring upper extremity MEP was 94.8%, while only 66.6% for the lower extremity [13].…”

Section: Discussioncontrasting

confidence: 67%

“…The major reason for low successful rate of MEP recordings was assumed as the electrophysiologic maturation of the corticospinal tract is not complete until 11-13 years [22]. The improvement of MEP in children below 7 years by spatial or temporal facilitation [14,19] may provide negative support to the hypothesis of the corticospinal tract immaturity. In a previous report, low-dose propofol can be effectively used as a supplement to ketamine-based anesthesia during intraoperative monitoring of myogenic MEP [23].…”

Section: Discussionmentioning

confidence: 99%

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Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children

et al. 2011

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children

et al. 2011

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“…28 Because younger children have more immature myelinated fibers, monitoring of motor evoked potentials may require double-train stimulation to obtain useful motor evoked potential amplitudes. 31,32 The difficulty of obtaining free-run electromyograms should be noted when electrocautery is used. 6 Stimulated electromyography, however, allows for identification of functional nerve roots and delineation of nervous tissue from filum and scar elements.…”

Section: Intraoperative Monitoringmentioning

confidence: 99%

Lipomyelomeningocele: pathology, treatment, and outcomes

Sarris

Tomei²,

Carmel³

et al. 2012

FOC

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Lipomyelomeningocele represents a rare but complex neurological disorder that may present with neurological deterioration secondary to an inherent tethered spinal cord. Radiological testing is beneficial in determining the morphology of the malformation. Specialized testing such as urodynamic studies and neurophysiological testing may be beneficial in assessing for neurological dysfunction secondary to the lipomyelomeningocele. Early surgical intervention may be beneficial in preventing further neurological decline.

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“…Even so, responses can always be obtained when no halogenated agents are administered and patients do not have severe neurological deficits (8,23). And also, using double train stimulation compensates the relative hyperpolarisation of motor neurons resulting in reliable MEP responses in this situation (5,6). It is only a worthy of notice feature that EEG cup electrode usage is recommended for young children.…”

Section: █ Discussionmentioning

confidence: 99%

Multimodal intraoperative neurophysiologic monitoring in the spinal cord surgery

Taşkıran

Brandmeier²,

Özek³

et al. 2015

Turkish Neurosurgery

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Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods to monitor the functional integrity of critical neural structures during surgery. IONM can predict an increased risk of injury during surgery based on electrophysiological changes. The most commonly used electrophysiological modalities are evoked potentials (Somatosensory Evoked Potentials -SSEP and Motor Evoked Potentials -MEP) and electromyography (EMG) in spinal cord █ INTRODUCTION S pinal surgeries carry a very high risk of injury to the spinal cord, spinal nerves and/or blood vessels. Neurological deficits, such as paralysis, muscle weakness, pain, bladder/bowel disturbances and sexual dysfunction, which emerge after these surgeries can seriously affect basic human functions and increase morbidity (1,3,11,14).AIm: Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015. mATERIAl and mEThODS:We had twenty-six cases. Location of the lesions, surgery, neurological findings, and electrophysiological findings intraoperatively and postoperatively were documented. RESUlTS:The combination of motor evoked potential (MEP), somatosensorial evoked potential (SSEP), free-run and trigger electromyography (EMG) were performed according to lesion localization. MEPs plus SSEPs were run in 23 patients and MEPs with triggered EMG were performed in 4 patients. In only one patient, optimal recording could not be elicited because of technical problems. MEP and SSEP changes were recorded in 12 and 3 patients respectively. Postoperative neurological deficits were observed in 2 patients. Deficits were transient in one case and permanent in the other. While baseline MEP responses were either absent or low amplitude (<50 microvolt) in 7 patients, following resection they were either visible or increased in amplitude. Surgery was ended in one patient with C7-T2 intramedullary tumour after the right distal MEP response disappeared. CONClUSION:Multimodal IONM is an important method to monitor the neural structures under risk in spine surgery and to keep the surgery within safety limits, especially for intramedullary spinal cord lesion surgery.

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Conditioning stimulation techniques for enhancement of transcranially elicited evoked motor responses

Cited by 54 publications

References 21 publications

Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children

Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children

Lipomyelomeningocele: pathology, treatment, and outcomes

Multimodal intraoperative neurophysiologic monitoring in the spinal cord surgery

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