Facilitation of motor evoked potentials after tetanic peripheral nerve stimulation
•Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients.•Tetanic stimulation of peripheral nerves improves motor evoked potential amplitudes.•Tetanic stimulation can also be used in patient with myelopathy and peripheral neuropathy, with some cautions...
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Published in | Clinical neurophysiology Vol. 162; pp. 2 - 8 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.06.2024
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ISSN | 1388-2457 1872-8952 1872-8952 |
DOI | 10.1016/j.clinph.2024.03.011 |
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Abstract | •Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients.•Tetanic stimulation of peripheral nerves improves motor evoked potential amplitudes.•Tetanic stimulation can also be used in patient with myelopathy and peripheral neuropathy, with some cautions.
Tetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose of this study was to investigate the post-tetanic MEP (p-MEP) technique in improving MEP amplitudes.
Conventional TES MEPs (c-MEP) and p-MEPs with left upper limb stimulation (p-MEPUL) or left lower limb stimulation (p-MEPLL) were performed in 26 patients. Bilateral hand and foot MEP amplitudes obtained with each protocol were compared. Subgroup comparisons were performed for myelopathy and peripheral neuropathy patients. Within-subject amplitude differences between c-MEP and each p-MEP technique were compared using a Wilcoxon test.
The mean age of the patients was 52.7 years (range, 12–79 years). Overall, p-MEPUL resulted in MEP improvement in 25 of 26 (96%) patients, and p-MEPLL improved MEPs in 19 of 26 (73%) patients. The increase in MEP amplitudes were statistically significant in all muscle groups except left foot. Similar improvements were seen in the myelopathy group; in the neuropathy group, p-MEPUL produced similar results, but p-MEPLL did not.
The p-MEP technique can improve MEP amplitudes, including in patients with myelopathy. In patients with peripheral neuropathy, the results were mixed.
Tetanic stimulation can enhance intraoperative MEP amplitudes. |
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AbstractList | •Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients.•Tetanic stimulation of peripheral nerves improves motor evoked potential amplitudes.•Tetanic stimulation can also be used in patient with myelopathy and peripheral neuropathy, with some cautions.
Tetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose of this study was to investigate the post-tetanic MEP (p-MEP) technique in improving MEP amplitudes.
Conventional TES MEPs (c-MEP) and p-MEPs with left upper limb stimulation (p-MEPUL) or left lower limb stimulation (p-MEPLL) were performed in 26 patients. Bilateral hand and foot MEP amplitudes obtained with each protocol were compared. Subgroup comparisons were performed for myelopathy and peripheral neuropathy patients. Within-subject amplitude differences between c-MEP and each p-MEP technique were compared using a Wilcoxon test.
The mean age of the patients was 52.7 years (range, 12–79 years). Overall, p-MEPUL resulted in MEP improvement in 25 of 26 (96%) patients, and p-MEPLL improved MEPs in 19 of 26 (73%) patients. The increase in MEP amplitudes were statistically significant in all muscle groups except left foot. Similar improvements were seen in the myelopathy group; in the neuropathy group, p-MEPUL produced similar results, but p-MEPLL did not.
The p-MEP technique can improve MEP amplitudes, including in patients with myelopathy. In patients with peripheral neuropathy, the results were mixed.
Tetanic stimulation can enhance intraoperative MEP amplitudes. Highlights•Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients. •Tetanic stimulation of peripheral nerves improves motor evoked potential amplitudes. •Tetanic stimulation can also be used in patient with myelopathy and peripheral neuropathy, with some cautions. Tetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose of this study was to investigate the post-tetanic MEP (p-MEP) technique in improving MEP amplitudes. Conventional TES MEPs (c-MEP) and p-MEPs with left upper limb stimulation (p-MEP ) or left lower limb stimulation (p-MEP ) were performed in 26 patients. Bilateral hand and foot MEP amplitudes obtained with each protocol were compared. Subgroup comparisons were performed for myelopathy and peripheral neuropathy patients. Within-subject amplitude differences between c-MEP and each p-MEP technique were compared using a Wilcoxon test. The mean age of the patients was 52.7 years (range, 12-79 years). Overall, p-MEP resulted in MEP improvement in 25 of 26 (96%) patients, and p-MEP improved MEPs in 19 of 26 (73%) patients. The increase in MEP amplitudes were statistically significant in all muscle groups except left foot. Similar improvements were seen in the myelopathy group; in the neuropathy group, p-MEP produced similar results, but p-MEP did not. The p-MEP technique can improve MEP amplitudes, including in patients with myelopathy. In patients with peripheral neuropathy, the results were mixed. Tetanic stimulation can enhance intraoperative MEP amplitudes. Tetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose of this study was to investigate the post-tetanic MEP (p-MEP) technique in improving MEP amplitudes.OBJECTIVETetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose of this study was to investigate the post-tetanic MEP (p-MEP) technique in improving MEP amplitudes.Conventional TES MEPs (c-MEP) and p-MEPs with left upper limb stimulation (p-MEPUL) or left lower limb stimulation (p-MEPLL) were performed in 26 patients. Bilateral hand and foot MEP amplitudes obtained with each protocol were compared. Subgroup comparisons were performed for myelopathy and peripheral neuropathy patients. Within-subject amplitude differences between c-MEP and each p-MEP technique were compared using a Wilcoxon test.METHODSConventional TES MEPs (c-MEP) and p-MEPs with left upper limb stimulation (p-MEPUL) or left lower limb stimulation (p-MEPLL) were performed in 26 patients. Bilateral hand and foot MEP amplitudes obtained with each protocol were compared. Subgroup comparisons were performed for myelopathy and peripheral neuropathy patients. Within-subject amplitude differences between c-MEP and each p-MEP technique were compared using a Wilcoxon test.The mean age of the patients was 52.7 years (range, 12-79 years). Overall, p-MEPUL resulted in MEP improvement in 25 of 26 (96%) patients, and p-MEPLL improved MEPs in 19 of 26 (73%) patients. The increase in MEP amplitudes were statistically significant in all muscle groups except left foot. Similar improvements were seen in the myelopathy group; in the neuropathy group, p-MEPUL produced similar results, but p-MEPLL did not.RESULTSThe mean age of the patients was 52.7 years (range, 12-79 years). Overall, p-MEPUL resulted in MEP improvement in 25 of 26 (96%) patients, and p-MEPLL improved MEPs in 19 of 26 (73%) patients. The increase in MEP amplitudes were statistically significant in all muscle groups except left foot. Similar improvements were seen in the myelopathy group; in the neuropathy group, p-MEPUL produced similar results, but p-MEPLL did not.The p-MEP technique can improve MEP amplitudes, including in patients with myelopathy. In patients with peripheral neuropathy, the results were mixed.CONCLUSIONSThe p-MEP technique can improve MEP amplitudes, including in patients with myelopathy. In patients with peripheral neuropathy, the results were mixed.Tetanic stimulation can enhance intraoperative MEP amplitudes.SIGNIFICANCETetanic stimulation can enhance intraoperative MEP amplitudes. |
Author | Husain, Aatif M. Johnson, Holly E. Lutz, Michael W. Wehab, Zaman AlGaeed, Mohanad Bell, Emily P. |
Author_xml | – sequence: 1 givenname: Zaman surname: Wehab fullname: Wehab, Zaman organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA – sequence: 2 givenname: Michael W. surname: Lutz fullname: Lutz, Michael W. organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA – sequence: 3 givenname: Emily P. surname: Bell fullname: Bell, Emily P. organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA – sequence: 4 givenname: Holly E. surname: Johnson fullname: Johnson, Holly E. organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA – sequence: 5 givenname: Mohanad surname: AlGaeed fullname: AlGaeed, Mohanad organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA – sequence: 6 givenname: Aatif M. surname: Husain fullname: Husain, Aatif M. email: aatif.husain@duke.edu organization: Department of Neurology, Duke University Medical Center, Durham, NC, USA |
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Cites_doi | 10.1016/S1388-2457(02)00027-5 10.1016/j.spinee.2017.08.249 10.1097/WNP.0000000000000751 10.3340/jkns.2020.0111 10.1097/ANA.0b013e3181b9dd3a 10.1213/ane.0b013e3181617508 10.14245/kjs.2016.13.1.9 10.1007/s00540-008-0668-5 10.1097/WNP.0000000000000793 10.1097/BSD.0000000000001299 10.1007/s00540-008-0733-0 10.1007/s10877-020-00647-z 10.1111/j.2517-6161.1995.tb02031.x 10.1213/ane.0b013e318177082e 10.1097/BRS.0b013e318188adfc 10.1097/00000542-200504000-00007 10.1097/WNP.0000000000000338 10.1016/j.clinph.2016.01.018 10.2106/JBJS.H.01839 |
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Keywords | Myelopathy Tetanic stimulation Motor evoked potentials Neuropathy Enhancement neuropathy enhancement tetanic stimulation myelopathy |
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Snippet | •Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients.•Tetanic stimulation of peripheral nerves improves... Highlights•Motor evoked potential amplitudes may be small and difficult to monitor during surgery in some patients. •Tetanic stimulation of peripheral nerves... Tetanic stimulation of a peripheral nerve prior to transcranial electrical stimulation (TES) may enhance motor evoked potential (MEP) amplitudes. The purpose... |
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SubjectTerms | Adolescent Adult Aged Child Electric Stimulation - methods Enhancement Evoked Potentials, Motor - physiology Female Humans Male Middle Aged Motor evoked potentials Myelopathy Neurology Neuropathy Peripheral Nerves - physiology Peripheral Nerves - physiopathology Peripheral Nervous System Diseases - physiopathology Peripheral Nervous System Diseases - therapy Tetanic stimulation Transcranial Direct Current Stimulation - methods Young Adult |
Title | Facilitation of motor evoked potentials after tetanic peripheral nerve stimulation |
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