Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence

Morren, Geert; Walter, Susanna; Lindehammar, Hans; Hallböök, Olof; Sjödahl, Rune

doi:10.1007/bf02234288

Cited by 18 publications

(16 citation statements)

References 23 publications

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“…These sites were chosen based on our pilot studies and previous studies. 24, 25 We used between 50 – 100 % intensity (2 T) of magnetic stimulation to evoke MEPs, usually starting at 50 % intensity and in 5–10% increments until an optimal and reproducible MEP response (>10 µv) was obtained. At least five optimal responses were obtained at each site, and the three best responses were averaged to calculate the MEP responses.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we showed that MEPs provide a useful assessment of anorectal neuropathy in patients with spinal cord injury 19 . Although previous investigators have used translumbar magnetic stimulation to study cauda equina and pudendal nerve lesions in subjects with FI, 20,21 simultaneous evaluation of anal and rectal MEPs, and at lumbar and sacral regions has not been performed. Such a comprehensive assessment is needed because the anorectum has complex and diverse neurological innervation and neuropathy may affect only some of the neuronal tracts.…”

Section: Introductionmentioning

confidence: 99%

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Translumbar and Transsacral Magnetic Neurostimulation for the Assessment of Neuropathy in Fecal Incontinence

Rao

Coss‐Adame

Tantiphlachiva

et al. 2014

Diseases of the Colon &Amp; Rectum

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Background Neurological dysfunction causes fecal incontinence, but current techniques for its assessment are limited and controversial. Objective To investigate spino-rectal and spino-anal motor evoked potentials simultaneously using lumbar and sacral magnetic stimulation in fecal incontinence and healthy subjects, and to compare motor evoked potentials and pudendal nerve terminal motor latency in fecal incontinence subjects. Design Prospective observational study. Settings Two Tertiary Care Centers. Patients Adult fecal incontinence and healthy subjects. Interventions Translumbar and transsacral magnetic stimulations performed bilaterally by applying a magnetic coil to the lumbar and sacral regions in 50 fecal incontinence (≥ 1 episode/week) and 20 healthy subjects. Both motor evoked potentials and pudendal nerve terminal motor latency were assessed in 30 fecal incontinence patients. Stimulation-induced motor evoked potentials were recorded simultaneously from rectum and anus with two pairs of bipolar ring electrodes. Main Outcome Measurements Latency and amplitude of motor evoked potentials after lumbosacral magnetic stimulation and agreement with pudendal nerve terminal motor latency. Results When compared to controls, one or more lumbo-anal, lumbo-rectal, sacro-anal, or sacro-rectal motor evoked potentials were significantly prolonged (p<0.01) and were abnormal in 44/50 (88%) fecal incontinence subjects. Positive agreement between abnormal motor evoked potentials and pudendal nerve terminal motor latency was 63% whereas negative agreement was 13%. motor evoked potentials were abnormal in more (p <0.05) fecal incontinence patients than pudendal nerve terminal motor latency, 26/30 (87%) versus 19/30 (63%) respectively, and in 24% of patients with normal pudendal nerve terminal motor latency. No adverse events. Limitations Anal electromyography was not performed. Conclusions Translumbar and transsacral magnetic stimulation–induced motor evoked potentials provide objective evidence for rectal or anal neuropathy in fecal incontinence patients and could be useful. Test was superior to pudendal nerve terminal motor latency and appears to be safe and well tolerated.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Translumbar and Transsacral Magnetic Neurostimulation for the Assessment of Neuropathy in Fecal Incontinence

Rao

Coss‐Adame

Tantiphlachiva

et al. 2014

Diseases of the Colon &Amp; Rectum

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“…57 In particular, sacral magnetic stimulation has advantages for measuring peripheral motor conduction time to the anal sphincter, because it is less painful and uncomfortable than intrarectal stimulation and allows for study of the anal/pudendal nerve along its entire length. 85,86,[133][134][135] Latency differences between sacral magnetic stimulation and intrarectal electrical stimulation range from 1.0 to 1.6 ms. 42,65,86,158 Results also depend on the type of recording electrodes. Surface recordings performed within the anal canal, using electrodes mounted on a glove, 42,56,57,158 a sponge, 86 a 12-F catheter, 73,135 or a plug, 46 provide shorter latencies than adhesive electrodes placed at the anal verge.…”

Section: Terminal Motor Latency Measurementmentioning

confidence: 99%

Neurophysiological testing in anorectal disorders

Lefaucheur

2005

Muscle and Nerve

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The neurophysiological techniques currently available to evaluate anorectal disorders include concentric needle electromyography (EMG) of the external anal sphincter, anal nerve terminal motor latency (TML) measurement in response to transrectal electrical stimulation or sacral magnetic stimulation, motor evoked potentials (MEPs) of the anal sphincter to transcranial magnetic cortical stimulation, cortical recording of somatosensory evoked potentials (SEPs) to anal nerve stimulation, quantification of electrical or thermal sensory thresholds (QSTs) within the anal canal, sacral anal reflex (SAR) latency measurement in response to pudendal nerve or perianal stimulation, and perianal recording of sympathetic skin responses (SSRs). In most cases, a comprehensive approach using several tests is helpful for diagnosis: needle EMG signs of sphincter denervation or prolonged TML give evidence for anal motor nerve lesion; SEP/QST or SSR abnormalities can suggest sensory or autonomic neuropathy; and in the absence of peripheral nerve disorder, MEPs, SEPs, SSRs, and SARs can assist in demonstrating and localizing spinal or supraspinal disease. Such techniques are complementary to other methods of investigation, such as pelvic floor imaging and anorectal manometry, to establish the diagnosis and guide therapeutic management of neurogenic anorectal disorders.

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“…The feasibility of magnetic and electric stimulation of the sacroanal motor pathway was evaluated by Morren et al [54]. These authors concluded that combined PNTML and sacral root terminal motor latency measurements may facilitate assessment of proximal and distal pudendal nerve motor function in patients with fecal incontinence.…”

Section: Magnetic and Electrical Stimulation Of Sacroanal Motor Pathwaysmentioning

confidence: 98%

Diagnostic testing in fecal incontinence

Kumar

Rao

2003

Curr Gastroenterol Rep

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Fecal incontinence is a common problem that disproportionately affects women and the elderly and has a significant impact on the quality of life. Incontinence is often multifactorial. Anorectal manometry, anal endosonography, magnetic resonance imaging, pudendal nerve latency, and electromyography provide morphologic and physiologic assessments of the internal and external anal sphincters, rectal motor and sensory function, rectal compliance, and rectoanal reflexes. This information, in concert, provides clues to the pathophysiology of fecal incontinence and may help to guide medical, surgical, or biofeedback therapy. These tests have also been used to assess the effectiveness of the therapeutic modalities. No data are available on the cost-effectiveness of diagnostic testing in fecal incontinence. Newer techniques, including electrophysiologic testing and morphologic imaging of the anorectum, are being pursued.

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Evaluation of the sacroanal motor pathway by magnetic and electric stimulation in patients with fecal incontinence

Cited by 18 publications

References 23 publications

Translumbar and Transsacral Magnetic Neurostimulation for the Assessment of Neuropathy in Fecal Incontinence

Translumbar and Transsacral Magnetic Neurostimulation for the Assessment of Neuropathy in Fecal Incontinence

Neurophysiological testing in anorectal disorders

Diagnostic testing in fecal incontinence

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