Transesophageal versus transcranial motor evoked potentials to monitor spinal cord ischemia

Tsuda, Kazumasa; Shiiya, Norihiko; Takahashi, Daisuke; Ohkura, Kazuhiro; Yamashita, Katsushi; Kando, Yumi; Arai, Yoshifumi

doi:10.1016/j.jtcvs.2015.08.120

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…In previous animal studies, histologic changes were generally observed 48 h after induction of cord infarction. Profound gray matter (GM) and white matter (WM) injuries accompanied by neuronal cell damage and a decline in cell numbers were observed, and the boundary between the two areas also became steadily unclear (24,25). The abnormal spinal cord conduction velocity findings may be primarily related to WM injuries accompanied by myelinated axonal damage, which is known to be eventually correlated with the extent of GM injuries (26,27).…”

Section: Discussionmentioning

confidence: 99%

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Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

et al. 2020

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Background: Spinal cord infarction (SCI) is a rare disease and its early diagnosis is challenging. Here, we described the clinical features and imaging findings of SCI, and assessed the results of evoked potential (EP) studies to elucidate their diagnostic role in the early stage of SCI. Methods: We retrospectively analyzed 14 patients who had spontaneous SCI. The demographic, neurological, and temporal profiles of the SCI patients were identified. We reviewed the imaging findings and assessed the changes in them over time. To review EP, central motor conduction time (CMCT) and somatosensory evoked potential (SEP) values were obtained. We also enrolled 15 patients with transverse myelitis (TM), and compared the clinical, radiological and electrophysiological features between SCI and TM patients. Results: The ages of the SCI patients ranged from 54 to 73 years. Nine patients (64.3%) showed nadir deficits within 6 h. The most common type of clinical visit was via the emergency center. Nine patients (64.3%) presented with peri-onset focal pain. The median initial modified Rankin scale score was 3. For 9 patients (64.3%), initial T2 imaging findings were negative, but subsequent diffusion weighed imaging (DWI) showed diffusion restriction. Vertebral body infarction was observed in 5 patients (35.7%). EP data were available for 10 SCI patients. All 8 patients who had their CMCT measured showed abnormalities. Among them, motor evoked potentials were not evoked in 6 patients at all. SEP was measured in 10 patients, and 9 of them showed abnormalities; one of them showed no SEP response. For 5 patients, the EP studies were done prior to DWI, and all the patients showed definite abnormalities. The abnormalities in the EP findings of the SCI patients were more profound than those of the TM patients, even though the duration from the onset to the start of the study was much shorter for SCI patients. Park et al. Spinal Cord Infarction Conclusion: SCI can be diagnosed based on typical clinical manifestations and appropriate imaging studies. Our study also indicates that immediate sensory and motor EP study can have an adjuvant diagnostic role in the hyperacute stage of SCI, and can improve the accuracy of diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…Experimental studies have also demonstrated that MEP responses to ischemia are sensitive and immediate. Tsuda et al (25) induced spinal infarction in dogs using aortic balloon occlusion and checked for changes in MEP. They discovered that transcranial MEP amplitude reduced by 50% in about 6 min, and completely disappeared in around 7 min.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

et al. 2020

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“…Anesthesia and instrumentation procedures were performed according to previously reported methods. 14 , 15 Briefly, the animals were anesthetized with intravenous infusion of propofol (12-24 mg/kg/h) and remifentanil (12-24 μg/kg/h) and were maintained on mechanical ventilation. For MEP recording, a Neuropak MEB-2200 system (Nihon Kohden, Tokyo, Japan) was used for data acquisition, processing, and analysis, with SEN-4100 equipment for electrical stimulation (Nihon Kohden, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

“…We have previously shown that transesophageal MEP (TE-MEP), which we call monopolar TE-MEP (monoTE-MEP) in this study, is feasible, safe, and superior to TC-MEP in terms of stability, response time to ischemia/reperfusion, and prognostic value in canine experiments. 14 , 15 We think that it is because supramaximal intensity stimulation can be applied safely and easily to the spinal cord. However, cervical cord stimulation results in the direct stimulation of the cervical alpha motor neurons with strenuous forelimb movement, which may be dangerous in clinical settings, and precludes forelimb potentials to be used as a real-time control.…”

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confidence: 99%

Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials

et al. 2020

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Objective: Although transesophageal motor-evoked potential elicited by monopolar cervical cord stimulation is more stable and rapid in response to ischemia than transcranial motor-evoked potential in canine experiments, direct cervical alpha motor neuron stimulation precludes clinical application. We evaluated a novel stimulation method using a bipolar esophageal electrode to enable thoracic cord stimulation.Methods: Twenty dogs were anesthetized. For bipolar transesophageal stimulation, the interelectric pole distance was set at 4 cm. Changes in amplitude in response to incremental stimulation intensity (100-600 V) were measured to evaluate stability. Spinal cord ischemia was induced by aortic balloon occlusion at the T8 to T10 level for 10 minutes to evaluate response time or at the T3 to T5 level for 25 minutes to evaluate prognostic value. Neurological function was evaluated using the Tarlov score at 24 and 48 hours postoperatively.Results: Bipolar transesophageal stimulation was successful in all animals and their forelimb waveforms were identical to those after transcranial stimulation. The minimum stimulation intensity to produce >90% of the maximum amplitude was significantly lower in both monopolar and bipolar transesophageal stimulation than in transcranial stimulation (n ¼ 5). Time to disappearance and recovery (>75%) of the hindlimb potentials were significantly shorter by both monopolar and bipolar transesophageal stimulation than by transcranial stimulation (n ¼ 5). Correlation with neurological outcomes was comparable among all stimulation methods (n ¼ 10).Conclusions: Motor-evoked potential can be elicited by bipolar transesophageal thoracic cord stimulation without direct cervical alpha motor neuron stimulation, and its stability and response time are comparable to those elicited by monopolar stimulation. (JTCVS Techniques 2020;4:28-35) Forelimb potentials by thoracic cord stimulation are evoked through synaptic transmission.

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“…These authors previously showed in canine experiments that measurement of monopolar transesophageal motor-evoked potentials (m-TE-MEP) is feasible, safe, and superior to TC-MEP in terms of stability, response time to ischemia/reperfusion, and prognostic value. 8 They induced SCI by aortic balloon occlusion at the thoracic level for 10 minutes and evaluated response time at the proximal thoracic cord after 25 minutes. Interestingly, bipolar transesophageal (bi-TE) stimulation was successful in all animals, and their forelimb waveforms were identical to those obtained with transcranial stimulation.…”

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confidence: 99%

Commentary: Going transesophageal will make your monitoring simpler!

2020

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Transesophageal versus transcranial motor evoked potentials to monitor spinal cord ischemia

Abstract: Transesophageal motor evoked potentials may be superior to transcranial motor evoked potentials in terms of quicker response to spinal cord ischemia and better prognostic value.

Cited by 7 publications

References 15 publications

Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

Bipolar transesophageal thoracic spinal cord stimulation: A novel clinically relevant method for motor-evoked potentials

Commentary: Going transesophageal will make your monitoring simpler!

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