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 inClinical neurophysiology Vol. 162; pp. 2 - 8
Main Authors Wehab, Zaman, Lutz, Michael W., Bell, Emily P., Johnson, Holly E., AlGaeed, Mohanad, Husain, Aatif M.
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.06.2024
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Online AccessGet full text
ISSN1388-2457
1872-8952
1872-8952
DOI10.1016/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.
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.
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Keywords Myelopathy
Tetanic stimulation
Motor evoked potentials
Neuropathy
Enhancement
neuropathy
enhancement
tetanic stimulation
myelopathy
Language English
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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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https://www.clinicalkey.es/playcontent/1-s2.0-S1388245724000798
https://dx.doi.org/10.1016/j.clinph.2024.03.011
https://www.ncbi.nlm.nih.gov/pubmed/38547586
https://www.proquest.com/docview/3022572148
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