Recommendations for the clinical use of motor evoked potentials in multiple sclerosis

Fernández, Victoria; Valls‐Solé, Josep; Relova, José Luis; Raguer, Nuria; Miralles, Frank; Dincă, Liviu; Taramundi, S.; Costa‐Frossard, Lucienne; Ferrándiz, María Encarnación Aguilar; Ramió-Torrentà, Ll; Villoslada, Pablo; Sáiz, Antonio; Calles, Carmen; Antigüedad, Alfredo Rodríguez; Álvarez‐Cermeño, José C.; Prieto, José M.; Izquierdo, Guillermo; Montalbán, Xavier; Fernández, Óscar

doi:10.1016/j.nrleng.2013.09.003

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…Latency is highly influenced by conduction properties and synaptic delays at central (cerebral and spinal) and peripheral divisions of the nervous system (Fernández et al 2013). Bergmann et al (Bergmann et al 2012) triggered spTMS over M1 during non-REM sleep according to the phase of spontaneous (> 1 Hz) neocortical slow oscillations (SO) to show that MEPs were larger and their latencies were shorter during SO up-states than during down-states, which revealed that MEP latency can be modulated by brain states.…”

Section: One Disadvantage Of Meps To Evaluate the Physiological Mechamentioning

confidence: 99%

Pre-stimulus theta power is correlated with variation of motor evoked potential latency: a single-pulse TMS study

et al. 2018

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There has been a growing interest in the role of pre-stimulus oscillations on cortical excitability in visual and motor systems. Prior studies focused on the relationship between pre-stimulus neuronal activity and TMS-evoked motor evoked potentials (MEPs) have reported heterogeneous results. We aimed to assess the role of pre-stimulus neural activity on the latency of MEPs, which might enhance our understanding of the variability of MEP signals, and potentially provide information on the role played by cortical activity fluctuations in the excitability of corticospinal pathways. Near-threshold single-pulse TMS (spTMS) was applied at random intervals over the primary motor cortex of 14 healthy participants while they sat passively, to trigger hand muscle contractions. Multichannel EEG was recorded during spTMS blocks. Spearman correlations between both the variation in MEP onset latencies and peak-to-peak MEP amplitudes, and the pre-stimulus power of EEG oscillations were calculated across participants. We found that the variation in MEP latency was positively correlated with pre-stimulus power in the theta range (4-7 Hz) in a broad time window (- 3.1 to - 1.9 s) preceding the spTMS generating the MEP. No correlation between pre-stimulus power in any frequency band and MEP amplitude was found. Our results show that pre-stimulus theta oscillations are correlated with the variation in MEP latency, an outcome measure determined by fiber conduction velocity and synaptic delays along the corticospinal tract. This finding could prove useful for clinicians using MEP latency-based information in pre- or intra-operative diagnostics of corticospinal impairment.

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Section: One Disadvantage Of Meps To Evaluate the Physiological Mechamentioning

confidence: 99%

Pre-stimulus theta power is correlated with variation of motor evoked potential latency: a single-pulse TMS study

et al. 2018

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“…MRI techniques have diminished their spectrum of use, although visual and motor EPs may have some utility as biomarkers of neurodegeneration [160]. Motor EPs are of special value in patients with MS presentation as a spinal cord syndrome [161]. Sensory EPs in combination with EDSS score could help in predicting short-term progression of disability in MS [162].…”

Section: Imaging Biomarkersmentioning

confidence: 99%

Biomarkers in Multiple Sclerosis: An Up-to-Date Overview

Katsavos

Anagnostouli

2013

Multiple Sclerosis International

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During the last decades, the effort of establishing satisfactory biomarkers for multiple sclerosis has been proven to be very difficult, due to the clinical and pathophysiological complexities of the disease. Recent knowledge acquired in the domains of genomics-immunogenetics and neuroimmunology, as well as the evolution in neuroimaging, has provided a whole new list of biomarkers. This variety, though, leads inevitably to confusion in the effort of decision making concerning strategic and individualized therapeutics. In this paper, our primary goal is to provide the reader with a list of the most important characteristics that a biomarker must possess in order to be considered as reliable. Additionally, up-to-date biomarkers are further divided into three subgroups, genetic-immunogenetic, laboratorial, and imaging. The most important representatives of each category are presented in the text and for the first time in a summarizing workable table, in a critical way, estimating their diagnostic potential and their efficacy to correlate with phenotypical expression, neuroinflammation, neurodegeneration, disability, and therapeutical response. Special attention is given to the “gold standards” of each category, like HLA-DRB1∗ polymorphisms, oligoclonal bands, vitamin D, and conventional and nonconventional imaging techniques. Moreover, not adequately established but quite promising, recently characterized biomarkers, like TOB-1 polymorphisms, are further discussed.

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“…According to recommendations from Fernández et al [ 36 ], MEP studies are considered the first choice in patients with symptoms that are compatible with the first episode of demyelinating diseases, in patients with a clinical diagnosis of MS, and normal or inconclusive results from a brain MRI. Further, since the functional pyramidal EDSS score was shown to be the most frequently associated with sustained disability progression, it might be relevant to report functional pyramidal EDSS scores together with the overall EDSS score.…”

Section: Discussion On Some Practical and Technical Guidelines For Im...mentioning

confidence: 99%

“…Recommendations for the clinical use of MEPs in MS are reported by Fernández et al [ 36 ], and mainly discuss the application of TMS with no navigation for the use of MEP assessment in pwMS. The majority of reported studies ( Table 1 ), assessing the MEP in pwMS, used TMS apparatus with no navigation.…”

Section: Assessment Of Meps In Multiple Sclerosismentioning

confidence: 99%

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Assessment of Motor Evoked Potentials in Multiple Sclerosis

Šoda

Pavelin

Vujović

et al. 2023

Sensors

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Transcranial magnetic stimulation (TMS) is a noninvasive technique mainly used for the assessment of corticospinal tract integrity and excitability of the primary motor cortices. Motor evoked potentials (MEPs) play a pivotal role in TMS studies. TMS clinical guidelines, concerning the use and interpretation of MEPs in diagnosing and monitoring corticospinal tract integrity in people with multiple sclerosis (pwMS), were established almost ten years ago and refer mainly to the use of TMS implementation; this comprises the magnetic stimulator connected to a standard EMG unit, with the positioning of the coil performed by using the external landmarks on the head. The aim of the present work was to conduct a narrative literature review on the MEP assessment and outcome measures in clinical and research settings, assessed by TMS Methodological characteristics of different TMS system implementations (TMS without navigation, line-navigated TMS and e-field-navigated TMS); these were discussed in the context of mapping the corticospinal tract integrity in MS. An MEP assessment of two case reports, by using an e-field-navigated TMS, was presented; the results of the correspondence between the e-field-navigated TMS with MRI, and the EDSS classifications were presented. Practical and technical guiding principles for the improvement of TMS studies in MEP assessment for MS are discussed, suggesting the use of e-field TMS assessment in the sense that it can improve the accuracy of corticospinal tract integrity testing by providing a more objective correspondence of the neurophysiological (e-field-navigated TMS) and clinical (Expanded Disability Status Scale—EDSS) classifications.

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Recommendations for the clinical use of motor evoked potentials in multiple sclerosis

Cited by 8 publications

References 27 publications

Pre-stimulus theta power is correlated with variation of motor evoked potential latency: a single-pulse TMS study

Pre-stimulus theta power is correlated with variation of motor evoked potential latency: a single-pulse TMS study

Biomarkers in Multiple Sclerosis: An Up-to-Date Overview

Assessment of Motor Evoked Potentials in Multiple Sclerosis

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