The ontogenetic model for CVA rehabilitation with transcranial stimulation

Currently, transcranial stimulation for CVA treatment is based on the interhemispheric rivalry model. This model has proven to have many anomalies, necessitating a new paradigm. Spontaneous recovery from post-CVA hemiplegia has an ontogenetic pattern. We reanalyzed the 2008 longitudinal London study and found that cortical disinhibition is the mechanism for ontogenetic CVA recovery. We propose that transcranial stimulation with 10 Hz rTMS or anode electrical microstimulation can produce CVA recovery similar to spontaneous recovery. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Actualmente la aplicación de la estimulación transcraneal para el tratamiento del ACV se realiza con base en el modelo de rivalidad interhemisférica. Este modelo ha mostrado muchas anomalías que hacen necesario un nuevo paradigma. La recuperación espontánea de la hemiplejia post-ACV tiene patrón ontogénico. Reanalizamos el estudio longitudinal de Londres 2008 y encontramos que su propuesta corresponde al mecanismo de recuperación ontogénica del ACV. Planteamos que la estimulación transcraneal, utilizando EMTr a 10 Hz o microestimulación eléctrica anódica, podría recuperar el ACV de manera similar a la recuperación espontánea. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2466).

Recording of motor and somatosensory evoked potential in an anaesthetised Wistar rat using digital polyrite system

Objectives: The aim of this article is to explain the detailed methodology to record Motor evoked potential (MEP) and somatosensory evoked potential (SSEP) in adult albino Wistar rat, male (200–250 g) which has not been defined previously. Materials and Methods: We have standardised recording of both MEP and SSEP in these rats under anaesthesia on ADI digital polyrite system. Results: Evoked potentials have been widely studied in spinal cord injured patients to estimate the degree of injury and to establish a predictive measure of functional recovery. MEPs and SSEPs, arising from the motor cortex or peripheral nerve and generated either by direct electrical stimulation or by transcranial magnetic stimulation, have been advocated as a reliable indicator of descending and ascending pathway integrity. In the rat brain, there is a physical overlap between the motor and somatosensory cortex. Hence, our objective was to identify the exact area for stimulation in the cortex where we could record maximum response with the application of minimum electrical stimulation. Conclusion: The recording of MEP and SSEP together provides a powerful neurological technique to monitor the tracts of the spinal cord.

Comparação das respostas do VEMP cervical e ocular em indivíduos com e sem doenças otoneurológicas / Comparison of cervical and ocular VEMP responses in individuals with and without otoneurological diseases / Comparación de respuestas VEMP cervicales y oculares en individuos con y sin enfermedades otoneurológicas

Introdução: a avaliação vestibular é realizada tradicionalmente por meio da prova calórica para avaliação do labirinto em indivíduos com tonturas, porém este exame não avalia toda a via vestibular. Os potenciais evocados miogênicos vestibulares (VEMP) consistem em um exame de rápida execução, considerado método de escolha para avaliação dos órgãos otolíticos e do nervo vestibular. Objetivo: analisar as respostas do exame VEMP cervical (cVEMP) e ocular (oVEMP) em indivíduos com doenças vestibulares e compará-las àquelas obtidas em indivíduos de mesma faixa etária e sexo sem queixas de tontura pregressas e atuais. Métodos: Estudo observacional, transversal e analítico. Os participantes foram divididos em dois grupos: grupo com tontura (GT), composto por indivíduos com diversas doenças vestibulares e o grupo sem queixa de tontura (GC). Ambos os grupos foram submetidos à meatoscopia, ao VEMP cervical e ocular. Resultados: A amostra foi composta por 45 indivíduos com a idade entre 23 e 68 anos, sendo 27 indivíduos do grupo GC e 18 do grupo GT. No exame cVEMP as latências, amplitudes, índice de assimetria e o índice de assimetria corrigido foram iguais no GT quando comparado com o GC. No exame oVEMP encontrou-se a amplitude esquerda maior e a latência N10 menor estatisticamente no grupo GT quando comparado ao grupo GC. Dentre as doenças do grupo GT os indivíduos com deiscência de canal superior tiveram valores maiores na amplitude esquerda, o que pode ter interferido nos resultados. Conclusão: Não foram evidenciadas diferenças nas respostas do cVEMP entre os grupos neste estudo. Encontrou-se aumento da amplitude esquerda e o valor menor da latência N10 direita no grupo com tontura na análise do exame oVEMP. Acredita-se que a heterogeneidade de doenças vestibulares no grupo com tontura e o reduzido número de participantes em ambos os grupos tenham contribuído para esse desfecho.

Introduction: The vestibular assessment is traditionally carried out with the caloric test to evaluate the labyrinth in individuals with dizziness. However, this examination does not evaluate the entire vestibular pathway. The vestibular evoked myogenic potentials (VEMP) are a quick test, considered a choice method to assess the otolith organs and the vestibular nerve. Purpose: To analyze the responses of the cervical (cVEMP) and ocular VEMP (oVEMP) examinations in individuals with vestibular diseases and compare them with the results obtained in individuals of the same age group and gender without previous and current complaints of dizziness. Methods: In this observational, cross-sectional, analytical study, the participants were divided into two groups: the dizziness group (DG), composed of individuals with several vestibular diseases, and the group without complaints of dizziness (CG). Both groups underwent meatoscopy, and cervical and ocular VEMP. Results: The sample comprised 45 individuals aged 23 to 68 years ­ 27 individuals in the CG and 18 in the DG. In the cVEMP exam, the latencies, amplitudes, asymmetry index, and the corrected asymmetry index were the same in the GT when compared to the GC. In the cVEMP examination, the latencies, amplitudes, asymmetry index, and corrected asymmetry index were equal in the DG when compared with the CG. In the oVEMP examination, the left amplitude was statistically greater and the N10 latency, smaller in the DG when compared with the CG. Of the diseases in the DG, individuals with superior canal dehiscence had higher left amplitude values, which may have interfered with the results.Conclusion: There were no differences in cVEMP responses between the groups in this study. An increase in the left amplitude and the lower value in the right N10 latency were found in the DG in the analysis of the oVEMP examination. It is believed that the heterogeneity of vestibular diseases in the DG and the small number of participants in both groups have contributed to this outcome.

Introducción: La evaluación vestibular se lleva a cabo tradicionalmente a través de la prueba calórica para evaluar el laberinto en individuos con mareos, sin embargo, este examen no evalúa toda la vía vestibular. Los potenciales miogénicos evocados vestibulares (VEMP) consisten en una prueba de funcionamiento rápido, considerada el método de elección para evaluar los órganos otolíticos y el nervio vestibular. Objetivo: Analizar las respuestas del examen VEMP cervical y ocular en individuos con enfermedades vestibulares y compararlas con las obtenidas en individuos del mismo grupo de edad y sexo sin quejas de mareos previas y actuales. Métodos:Estudio observacional, transversal y analítico. Los participantes se dividieron en dos grupos: grupo con mareos (GT), compuesto por individuos con varias enfermedades vestibulares y el grupo sin quejas de mareos (CG). Ambos grupos se sometieron a meatoscopia, VEMP cervical y ocular. Resultados: La muestra consistió en 45 individuos con edades comprendidas entre 23 y 68 años, 27 individuos del grupo GC y 18 del grupo GT. En el examen cVEMP, las latencias, amplitudes, índice de asimetría y el índice de asimetría corregido fueron los mismos en el GT en comparación con el CG. En el examen oVEMP, la amplitud izquierda fue mayor y la latencia N10 fue estadísticamente menor en el grupo GT en comparación con el grupo CG. Entre las enfermedades en el grupo GT, los individuos con dehiscencia del canal superior tenían valores más altos en la amplitud izquierda, lo que puede haber interferido con los resultados. Conclusión: No hubo diferencias en las respuestas de cVEMP entre los grupos en este estudio. Se encontró un aumento en la amplitud izquierda y un valor más bajo de la latencia N10 derecha en el grupo con mareos en el análisis del examen oVEMP. Se cree que la heterogeneidad de las enfermedades vestibulares en el grupo de mareos y el pequeño número de participantes en ambos grupos contribuyeron a este resultado.

Intraoperative Motor Evoked Potential Improvement in Cervical Spondylotic Myelopathy: Comparison of Cortical Stimulation Parameters

Motor Evoked Potentials in the Upper Extremities of Children with Spastic Hemiplegic Cerebral Palsy

The aim of this study was to evaluate and compare the reorganization of corticospinal pathways innervating upper extremity muscles in patients with spastic hemiplegic cerebral palsy (CP). Thirty-2 patients (17 male, 15 female) with spastic hemiplegic CP were enrolled. The average age (mean ± standard deviation) was 7.5 ± 4.6 (range: 2–17) years. Transcranial magnetic stimulation (TMS) was applied to the unaffected and affected motor cortices in turn, and bilateral electromyographic recordings were made from the first dorsal interossei (FDI), the biceps brachii (BB), and the deltoid muscles during rest. The onset latency, central motor conduction time, and peak-to-peak amplitude of motor evoked potentials (MEPs) were measured for each muscle bilaterally. Whilst TMS of both affected and unaffected hemispheres elicited contralateral MEPs in all muscles, the number of MEPs evoked from the affected hemisphere was less than from the unaffected hemisphere for FDI and BB. TMS responses to stimulation of the affected side showed prolonged latency and reduced amplitude. The amplitudes of MEPs increased with age whereas the latencies were relatively constant. These results suggest that the corticospinal pathways to the proximal and distal muscles of the upper extremity undergo sequential maturation and reorganization patterns.

Neuroprotective effects of Ghrelin on traumatic brain injury in mice / 中华行为医学与脑科学杂志

Objective@#To investigate the neuroprotective effect of Ghrelin on traumatic brain injury (TBI) in mice.@*Methods@#TBI model of C57BL / 6 mice was established by electronic cortical impact instrument (eCCI). According to the random figure table method, twenty-four mice were randomly divided into sham group(Sham group), TBI group and Ghrelin intervention group(Ghrelin group) with 8 mice in each group. The model of TBI was established in TBI group and Ghrelin group.The mice in Ghrelin group was injected intraperitoneally 0.5 g/kg before and 1 h after injury respectively. And the mice Sham group and TBI group were injected with the same amount of normal saline. The changes of cerebral blood perfusion (CBP) were monitored in real time by laser speckle contrast analysis(LSCI), the changes of neuroelectrophysiology were observed by monitoring motor evoked potential (MEP), and the status of neurological deficit was evaluated by modified neurological deficit score (mNSS).@*Results@#Compared with Sham group, the mice in TBI group had significantly lower cerebral blood perfusion(CBP) (t=-12.36, P<0.01), longer latency and lower amplitude of motor evoked potential (MEP) (t=5.03, -11.55, all P<0.01), and significantly higher mNSS scores (t=9.34, P<0.01). However, compared with the TBI group, the cerebral blood perfusion(CBP) of Ghrelin group increased significantly at 12 h after TBI((196.87±17.36) PU/mm2 vs (123.62±8.04)PU/mm2, t=10.45, P<0.01), while the latency of MEP decreased((5.30±0.33)ms vs (6.80±0.97)ms, t=-5.01, P<0.01), the amplitude of MEP increased((2.21±0.16)mV vs (1.27±0.27)mV, t=9.65, P<0.01). And compared with the TBI group, the neurological deficit score of Ghrelin group decreased significantly at 24 h after TBI((4.9±1.2) vs (8.4±2.6), t=-3.87, P<0.01).@*Conclusion@#Ghrelin exhibits a significant neuroprotective role by increasing cerebral blood flow perfusion, reducing the degree of neurological deficit and promoting motor function recovery in TBI mice.

Neuroprotective effects of Ghrelin on traumatic brain injury in mice / 中华行为医学与脑科学杂志

Objective To investigate the neuroprotective effect of Ghrelin on traumatic brain injury (TBI) in mice.Methods TBI model of C57BL/6 mice was established by electronic cortical impact instrument (eCCI).According to the random figure table method,twenty-four mice were randomly divided into sham group(Sham group),TBI group and Ghrelin intervention group(Ghrelin group) with 8 mice in each group.The model of TBI was established in TBI group and Ghrelin group.The mice in Ghrelin group was injected intraperitoneally 0.5 g/kg before and 1 h after injury respectively.And the mice Sham group and TBI group were injected with the same amount of normal saline.The changes of cerebral blood perfusion (CBP)were monitored in real time by laser speckle contrast analysis(LSCI),the changes of neuroelectrophysiology were observed by monitoring motor evoked potential (MEP),and the status of neurological deficit was evaluated by modified neurological deficit score (mNSS).Results Compared with Sham group,the mice in TBI group had significantly lower cerebral blood perfusion(CBP) (t=-12.36,P＜0.01),longer latency and lower amplitude of motor evoked potential (MEP) (t=5.03,-11.55,all P＜0.01),and significantly higher mNSS scores (t=9.34,P＜0.01).However,compared with the TBI group,the cerebral blood perfusion(CBP) of Ghrelin group increased significantly at 12 h after TBI((196.87± 17.36) PU/mm2 vs (123.62±8.04)PU/mm2,t=10.45,P＜0.01),while the latency of MEP decreased((5.30±0.33) ms vs (6.80±0.97) ms,t =-5.01,P＜0.01),the amplitude of MEP increased ((2.21 ± 0.16) mV vs (1.27± 0.27) mV,t =9.65,P＜0.01).And compared with the TBI group,the neurological deficit score of Ghrelin group decreased significantly at 24 h after TBI((4.9±1.2) vs (8.4±2.6),t=-3.87,P＜0.01).Conclusion Ghrelin exhibits a significant neuroprotective role by increasing cerebral blood flow perfusion,reducing the degree of neurological deficit and promoting motor function recovery in TBI mice.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease / Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière

Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. Objective: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. Methods: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. Results: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. Conclusion: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

Resumo Introdução: O potencial evocado miogênico vestibular é um potencial de média latência que avalia a resposta muscular decorrente de estimulação auditiva. Pode ser gerado a partir da contração do músculo esternocleidomastóideo e também a partir da contração de músculos extraoculares em resposta a sons de elevada intensidade. Este estudo apresenta uma técnica combinada ou simultânea de potencial evocado miogênico vestibular cervical e ocular em indivíduos com alterações no sistema vestibular para que possa ser usada no diagnóstico otoneurológico. Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière. Método: Participaram do estudo 120 indivíduos, 30 com hiporreflexia vestibular, 30 com doença de Ménière e 60 com audição dentro dos padrões de normalidade. A coleta de dados foi feita por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre o grupo de estudo (indivíduos com hiporreflexia vestibular e indivíduos com doença de Ménière) e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado. Para o potencial evocado miogênico vestibular cervical observou-se que o prolongamento da latência das ondas P13 e N23 foi a alteração mais encontrada no grupo de indivíduos com hiporreflexia vestibular e no grupo de indivíduos com doença de Ménière. Para o potencial evocado miogênico vestibular ocular o prolongamento da latência das ondas N10 e P15 foi a alteração mais encontrada no grupo de estudo. Conclusão: O potencial evocado miogênico vestibular cervical e ocular combinado apresentou resultados relevantes para os indivíduos com hiporreflexia vestibular e para os indivíduos com doença de Ménière. Houve diferença entre o grupo de estudo e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado.

Somatosensory evoked potential and motor evoked potential in detecting the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy / 临床麻醉学杂志

Objective To investigate the accurancy of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy (CEA).Methods Ninety patients (71 males, 19 females, aged 18-80 years, ASA physical status grade Ⅱ or Ⅲ) undergoing CEA using general anesthesia were studied.Bilateral SSEP and MEP were monitored during CEA and the intraoperative changes of SSEP and MEP amplitude and latency were analyzed before, during and after ICA cross-clamping until CEA ended.Neurological dysfunction was investigated within 5 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of neurological dysfunction.Results Fourteen cases (15.6%) were diagnosed as post-operative neurological dysfunction.The sensitivity, specificity of SSEP in detecting the occurrence of intraoperative brain ischemia were 79%, 92%, respectively.The sensitivity, specificity of MEP was 86%, 89% respectively.The sensitivity, specificity, of SSEP+MEP was 79%, 99% respectively.Conclusion During the carotid endarter ectomy,SSEP predicts the occurrence of cerebral ischemia with a high specificity.MEP has a high sensitivity.The combination monitoring of SSEP+MEP can improve the specificity, make up for the shortcomings of single monitoring.

Effects of different doses of cisatracurium on motor evoked potential of neurosurgery operation / 临床麻醉学杂志

Objective To determine the effects of different doses of cisatracurium on motor e-voked potential of neurosurgery operation.Methods Sixty patients,36 males and 24 females,aged 18 to 65 years,ASA physical status Ⅰ or Ⅱ,scheduled for spinal surgery with motor evoked potential monitoring,were included and randomly assigned to three groups.A single dose of cisatra-curium besilate for injection was given by intravenous injection in 5 s after the induction of general an-esthesia,respectively 0.1 mg/kg (group A),0.1 5 mg/kg (group B)and 0.2 mg/kg (group C).Cas-cade Elite 32 channel monitor was used to monitor MEPs,the electrode was stimulated for once two minutes after given the muscle relaxant,and the leading time of the wave of MEPs was recorded. Cooper’s score was used to evaluate the intubation conditions.Results The appearance time of the wave of motor evoked potentials was significantly longer in group C [(39.60±1.79)min]than that in groups A [(20.10 ± 1.89 )min]and B [(20.50 ± 1.93 )min](P < 0.05 ).The intubation conditions was significantly better in group B (100%)and C (100%)than that in group A (65%)(P<0.05).Conclusion The shortest time to elicit waveform of MEPs using the dose of cisatracurium is 0.1 5 mg/kg at induction of general anesthesia,which is better for tracheal intubation.The dose 0.1 5 mg/kg of cisatracurim is recommended as the initial dose on neurosurgery operation with motor e-voked potential monitoring.

Intraoperative Motor-Evoked Potential Disappearance versus Amplitude-Decrement Alarm Criteria During Cervical Spinal Surgery: A Long-Term Prognosis

BACKGROUND AND PURPOSE: We studied the clinical significance of amplitude-reduction and disappearance alarm criteria for transcranial electric muscle motor-evoked potentials (MEPs) during cervical spinal surgery according to different lesion locations [intramedullary (IM) vs. nonintramedullary (NIM)] by evaluating the long-term postoperative motor status. METHODS: In total, 723 patients were retrospectively dichotomized into the IM and NIM groups. Each limb was analyzed respectively. One hundred and sixteen limbs from 30 patients with IM tumors and 2,761 limbs from 693 patients without IM tumors were enrolled. Postoperative motor deficits were assessed up to 6 months after surgery. RESULTS: At the end of surgery, 61 limbs (2.2%) in the NIM group and 14 limbs (12.1%) in the IM group showed MEP amplitudes that had decreased to below 50% of baseline, with 13 of the NIM limbs (21.3%) and 2 of the IM limbs (14.3%) showing MEP disappearance. Thirteen NIM limbs (0.5%) and 5 IM limbs (4.3%) showed postoperative motor deficits. The criterion for disappearance showed a lower sensitivity for the immediate motor deficit than did the criterion for amplitude decrement in both the IM and NIM groups. However, the disappearance criterion showed the same sensitivity as the 70%-decrement criterion in IM (100%) and NIM (83%) surgeries for the motor deficit at 6 months after surgery. Moreover, it has the highest specificity for the motor deficits among diverse alarm criteria, from 24 hours to 6 months after surgery, in both the IM and NIM groups. CONCLUSIONS: The MEP disappearance alarm criterion had a high specificity in predicting the long-term prognosis after cervical spinal surgery. However, because it can have a low sensitivity in predicting an immediate postoperative deficit, combining different MEP alarm criteria according to the aim of specific instances of cervical spinal surgery is likely to be useful in practical intraoperative monitoring.

An Electrode Configuration for Recording Muscle Motor Evoked Potentials in the Upper Extremities during Intraoperative Neurophysiological Monitoring

OBJECTIVE: The main aim of the present study is to examine the electrode configurations used to record the muscle motor evoked potential (mMEP) in the upper extremities during surgery with the goal of producing a high and stable mMEP signal, in particular among the abductor pollicis brevis (APB), abductor digiti minimi (ADM), and across the APB-ADM muscles, which have been widely used for the mMEP in the upper extremities. METHODS: Thirty right-handed patients were recruited in this prospective study. No patients showed any adverse events in their mMEP signals of the upper extremities during surgery. The mMEPs were recorded independently from the signals for the APB and ADM and for those across the APB-ADM. RESULTS: The mMEP amplitude from across the APB-ADM was statistically higher than those recorded from the APB and ADM muscles. Moreover, the coefficient of variation of the mMEP amplitude from across the APB-ADM was smaller than those of mMEP amplitude recorded from the APB and ADM muscles. CONCLUSION: The mMEP from across the APB-ADM muscles showed a high yield with high stability compared to those in each case from the APB and ADM muscles. The configuration across the APB-ADM muscles would be best for mMEP recordings from the upper extremities for intraoperative neurophysiological monitoring purposes.

Perfusion of gastrodin in abdominal aorta for alleviating spinal cord ischemia reperfusion injury

OBJECTIVE@#To observe the effects of perfusion of the gastrodin in abdominal aorta for alleviating the spinal cord ischemia reperfusion injury (SCIRI).@*METHODS@#A total of 36 New Zealand white rabbits were divided randomly into sham-operated group (group S), control group (group C) and gastrodin group (group G), 12 rabbits for each group. Aorta abdominalis infrarenalis blocking method was applied to establish the SCIRI model. The changes of motor evoked potentials (MEPs) before the ischemia and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of the gastrodin were respectively recorded, and the neurologic function score before the ischemia, on the 6 h, 12 h and 24 h of the reperfusion of the gastrodin were assessed. And the changes of the concentration of serum neuron specific enolase (NSE), interleukin (IL)-lβ and IL-8 were measured before the ischemia, after 45 min of ischemia, and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of gastrodin. Then the levels of spinal cord nerve cells mitochondrial superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total antioxidant capacity (T-AOC) and mitochondrial swelling degree (MSD) were tested and the histopathologic changes in spinal cord tissues were observed.@*RESULTS@#The levels of the NSE, IL-lβ, IL-8, ROS, MDA and MSD of group C were all significantly elevated after the ischemia (P < 0.01); the levels of the spinal nerve cell mitochondria SOD, GSH-PX and T-AOC were all significantly reduced (P < 0.01), MEPs and spinal cord tissue pathology were damaged significantly (P < 0.01). The rate of motor neuron abnormalities and the damages of spinal cord tissue pathology of group G were significantly milder than those of group C (P < 0.01); the levels of NSE, IL-lβ, IL-8, ROS, MDA and MSD were significantly lower than those of group C (P < 0.01), but the levels of SOD, GSH-PX and T-AOC were all significantly higher than those of group C (P < 0.01), and the recovery of neurologic function score during the reperfusion of gastrodin was significantly faster than group C (P < 0.01).@*CONCLUSIONS@#Perfusion of the gastrodin in abdominal aorta can alleviate the spinal cord ischemia reperfusion injury by promoting the mitochondrial antioxidant capacity and inhibiting the inflammatory reaction.

Perfusion of gastrodin in abdominal aorta for alleviating spinal cord ischemia reperfusion injury

Objective To observe the effects of perfusion of the gastrodin in abdominal aorta for alleviating the spinal cord ischemia reperfusion injury (SCIRI). Methods A total of 36 New Zealand white rabbits were divided randomly into sham-operated group (group S), control group (group C) and gastrodin group (group G), 12 rabbits for each group. Aorta abdominalis infrarenalis blocking method was applied to establish the SCIRI model. The changes of motor evoked potentials (MEPs) before the ischemia and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of the gastrodin were respectively recorded, and the neurologic function score before the ischemia, on the 6 h, 12 h and 24 h of the reperfusion of the gastrodin were assessed. And the changes of the concentration of serum neuron specific enolase (NSE), interleukin (IL)-lβ and IL-8 were measured before the ischemia, after 45 min of ischemia, and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of gastrodin. Then the levels of spinal cord nerve cells mitochondrial superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total antioxidant capacity (T-AOC) and mitochondrial swelling degree (MSD) were tested and the histopathologic changes in spinal cord tissues were observed. Results The levels of the NSE, IL-lβ, IL-8, ROS, MDA and MSD of group C were all significantly elevated after the ischemia (P < 0.01); the levels of the spinal nerve cell mitochondria SOD, GSH-PX and T-AOC were all significantly reduced (P < 0.01), MEPs and spinal cord tissue pathology were damaged significantly (P < 0.01). The rate of motor neuron abnormalities and the damages of spinal cord tissue pathology of group G were significantly milder than those of group C (P < 0.01); the levels of NSE, IL-lβ, IL-8, ROS, MDA and MSD were significantly lower than those of group C (P < 0.01), but the levels of SOD, GSH-PX and T-AOC were all significantly higher than those of group C (P < 0.01), and the recovery of neurologic function score during the reperfusion of gastrodin was significantly faster than group C (P < 0.01). Conclusions Perfusion of the gastrodin in abdominal aorta can alleviate the spinal cord ischemia reperfusion injury by promoting the mitochondrial antioxidant capacity and inhibiting the inflammatory reaction.

The masseter motor-evoked potential after transcranial magnetic stimulation in patients with sleep bruxism / 实用口腔医学杂志

Objective:To study the masseter motor evoked potential(MEP)in patients with sleep bruxism(SB)and in healthy con-trols.Methods:30 subjects with SB and 30 healthy controls were included.MEPs were obtained by transcranial magnetic stimulation (TMS).Tests were done during daytime when the subjects were awake.The data were statistically analysed.Results:In the patients AMT was 55(52,55)%,latency of c-MEP (6.7 ±1.3)ms,the amplitude of c-MEP 0.19(0.15,0.29)mV,latency of r-MEP (2.3 ±0.4)ms,the central conduction time(CCT)4.4(3.3,5.2)ms.In the control subjects AMT was 52(52,55)%,latency of c-MEP (6.4 ±0.7)ms,the amplitude of c-MEP 0.23(0.17,0.28)mV,latency of r-MEP (2.4 ±0.4)ms,CCT 4.0 (3.4,4.4) ms.No significant difference was found between the 2 groups in the measurements evoked by TMS.Conclusion:The MEP after TMS in patients with SB is similar to that of healthy subjects,indicating that the excitability of the cortical motor system is not changed in bruxism subjects,at least when evaluated by TMS.

Comparison of the effects of total intravenous anesthesia or intravenous-inhalation combined anesthesia on intraoperative neurophysiological monitoring in spinal surgery / 临床麻醉学杂志

Objective To compare the effects of total intravenous anesthesia or Intravenous-in-halation combined anesthesia on intraoperative somatosensory evoked potential (SSEP)and motor evoked potential (MEP)in spinal surgery.Methods Sixty patients scheduled for spinal surgery under general anesthesia were divided randomly and equally into 2 groups.The anesthesia was maintained with TCI propofol (plasma target concentration 3.0-3.5 μg/ml)and 1% sevoflurane+propofol in group T or group I respectively.BIS was monitored and maintained at 40-50.SSEP and MEP was re-corded before induction of anaesthesia (T0 ),5 minutes after tracheal intubation (T1 ),during skin in-cision (T2 )and at the time of decompressing spinal canal (T3 ).Results The latency of P38 and N45 prolonged,and the amplitudes of P38 and N45 was significantly depressed at T1-T3 compared to those at T0 (P <0.05).No statistically significant differences in cortical SSEP amplitudes or latency was observed in each time point.There was no case who could not detect the wave of MEP intraoperative-ly in this study.Conclusion The data from these cases indicates that 1% sevoflurane can be used in conjunction with SSEP and MEP monitoring for some adult patients undergoing spinal surgery.

The effectiveness of low-frequency transcranial magnetic stimulation for restoring upper limb function after cerebral infarction / 中华物理医学与康复杂志

Objective To compare the effects of repetitive transcranial magnetic stimulation (rTMS) at various low frequencies on upper limb function after cerebral infarction.Methods Fifty patients were randomly assigned to a control group (10 cases),a sham rTMS group (10 cases) or an rTMS group which had three sub-groups treated at 0.25 Hz,0.5 Hz and 0.75 Hz with 10 cases in each.All of the patients were treated with conventional medical treatment and rehabilitation training.The sham and true rTMS groups received rTMS applied over the M1 area of the unaffected hemisphere,5 days per week for 4 weeks.Motor evoked potential (MEP) cortical latency,and central motor conduction time (CMCT) were measured and the Fugl-Meyer assessment (FMA),motricity index (MI) and a Hong Kong functional test for the hemiplegic upper extremity (FTHUE-HK) were evaluated beforehand and at Post 1 after 2 weeks of treatment and Post 2 after 4 weeks of treatment.Results The average CMCT and FMA scores of the control and sham rTMS groups both had improved significantly at Post 2.There was no significant difference in any of the indices between those 2 groups at any time point.At Post 1,the average MEP cortical latencies of the 0.25 Hz and 0.5 Hz subgroups had improved to be significantly better than those of the control and sham rTMS groups.The average CMCTs of the 0.25 Hz and 0.5 Hz rTMS subgroups were significantly shorter after treatment,and significantly better than those of the control and sham rTMS groups.At Post 2,the average MEP cortical latency of all groups except the control group showed significant improvement compared with pre-treatment.The 2 indices of the 0.25 Hz and 0.5 Hz subgroups were again significantly shorter than those of the control and sham rTMS groups,and the average CMCTs were significantly better than that of 0.75 Hz subgroup.At Post 1 the average FMA and MI scores of the rTMS subgroups had all improved significantly.In the 0.25 Hz and 0.5 Hz subgroups the average MI scores were significantly higher than those of the control and sham rTMS groups.The FTHUE-HK scores of those 2 subgroups had also improved significantly.At Post 2,the average FMA and MI scores of all groups and the FTHUE-HK scores of rTMS group had improved significantly.In the 0.25 Hz and 0.5 Hz subgroups,all of the indices were significantly better than in the control and sham rTMS groups.The average FTHUE-HK score of the 0.25 Hz subgroup was significantly superior to that of the 0.75 Hz subgroup.In the 0.75 Hz subgroup the average MI score was significantly higher than in the control and sham rTMS groups.Conclusions rTMS at either 0.25 Hz or 0.5 Hz applied to the unaffected hemisphere provides effective treatment for enhancing the excitability of the motor cortex and the motor function of a paretic upper limb after stroke.Compared with others,the total number of stimulus pulse in 0.25 Hz subgroup was the least,and priority consideration should be given to the frequency of 0.25 Hz when using rTMS in clinical treatment of cerebral infarction.

Usefulness of the Combined Motor Evoked and Somatosensory Evoked Potentials for the Predictive Index of Functional Recovery After Primary Pontine Hemorrhage

OBJECTIVE: To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. METHODS: Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. RESULTS: All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. CONCLUSION: The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.

Factors Affecting the Motor Evoked Potential Responsiveness and Parameters in Patients With Supratentorial Stroke

OBJECTIVE: To investigate the factors which affect the motor evoked potential (MEP) responsiveness and parameters and to find the correlation between the function of the upper extremities and the combined study of MEP with a diffusion tensor tractography (DTT) in patients with stroke. METHODS: A retrospective study design was used by analyzing medical records and neuroimaging data of 70 stroke patients who underwent a MEP test between June 2011 and March 2013. MEP parameters which were recorded from the abductor pollicis brevis muscle were the resting motor threshold, latency, amplitude, and their ratios. Functional variables, Brunnstrom stage of hand, upper extremity subscore of Fugl-Meyer assessment, Manual Function Test, and the Korean version of Modified Barthel Index (K-MBI) were collected together with the biographical and neurological data. The DTT parameters were fiber number, fractional anisotropy value and their ratios of affected corticospinal tract. The data were compared between two groups, built up according to the presence (MEP-P) or absence (MEP-N) of MEP on the affected hand. RESULTS: Functional and DTT variables were significantly different between MEP-P and MEP-N groups (p<0.001). Among the MEP-P group, the amplitude ratio (unaffected/affected) was significantly correlated with the Brunnstrom stage of hand (r=-0.427, p=0.013), K-MBI (r=-0.380, p=0.029) and the time post-onset (r=-0.401, p=0.021). The functional scores were significantly better when both MEP response and DTT were present and decreased if one or both of the two studies were absent. CONCLUSION: This study indicates MEP responsiveness and amplitude ratio are significantly associated with the upper extremity function and the activities of daily living performance, and the combined study of MEP and DTT provides useful information.

Medida da velocidade de condução nervosa motora em praticantes de três diferentes modalidades esportivas / Measurement of motor nerve conduction velocity in three different sports

INTRODUÇÃO: Estudos da condução nervosa têm sido focados para o público em geral, porém não para atletas, havendo carência de informações sobre medidas da velocidade de condução nervosa motora (VCNM) em indivíduos treinados, especialmente quando diferentes esportes são comparados. OBJETIVO: Medir a VCNM do nervo mediano e fibular comum, em três grupos de modalidades esportivas. Métodos: Foram analisados: um grupo de meio-fundistas (Gmf, n = 6), um grupo de velocistas (Gvel, n = 4) e um grupo de jogadores de handebol (Ghan, n = 5) e comparados com um grupo controle (Gcon, n = 9). Cada voluntário foi submetido a um único exame, no qual foram obtidos os dados para calcular a VCNM dos membros inferiores do Gmf e do Gvel, dos membros superiores do Ghan, e membros superiores e inferiores do Gcon. Os dados da pesquisa apresentaram distribuição normal e variâncias homogêneas, assim, utilizamos o teste t de Student para amostras independentes na comparação das médias da VCNM dos grupos de atletas com as do Gcon e as do Gvel com as do Gmf (comparações intergrupo). O teste t pareado foi usado para comparar as médias da VCNM entre membro dominante (Md) e membro não dominante (Mnd) (comparações intragrupo). RESULTADOS: Na análise intergrupo foram encontradas diferenças significativas nas comparações entre o Gvel e o Gcon e entre o Gmf e o Gcon (diferença apenas nas comparações entre os Md's). Por outro lado, a análise intragrupo, exibiu diferença significativa apenas nas comparações entre Md e Mnd do Ghan. CONCLUSÃO: O estudo sugere que a VCNM é beneficiada pelo esforço físico, principalmente em esportes com uso predominante dos membros inferiores, e que a maior utilização de um membro superior sobre outro pode levar a diferença significativa nos valores da VCNM do Md e Mnd.

INTRODUCTION: Electrodiagnostic tests such as nervous conduction studies are mainly aimed at the general public, not at athletes. Therefore, information about motor nervous conduction velocity (MNCV) is scarce for trained subjects, especially when different sports are compared. OBJECTIVE: to measure the MNCV of the median and common fibular nerves in three groups of sport modalities. Methods: A group of middle distance runners (M RG, n=6), a group of sprinter runners (S RG, n=4) and a group of handball players (H G, n=5) were analyzed and compared to a control group (C G, n=9). Each volunteer was submitted to a single examination where data necessary to measure MNCV from the lower limbs of M RG and of S RG; upper limbs of H G and both upper and lower limbs of C G were collected. Data analysis presented normal distribution and homogeneous variances in all cases; therefore, a Student's t test for independent samples was used to compare means of MNCV of the athlete groups and the C G, as well as in the mean comparison of S RG and M RG (intergroup comparison). The paired Student's t test was used to compare MNCV means of the dominant limb (DL) and non-dominant limb (NDL) (intragroup comparison). RESULTS: Significant differences were found in the comparison between S RG and CG and between M RG and CG, but only in the DL comparison in the last case. On the other hand, in the intragroup comparison, there was significant difference only in the comparison between D L and N DL of the H G. CONCLUSION: This study suggests that MNCV benefits from physical exercise, especially in those sports where lower limbs are predominantly used. It also suggests that greater use of one upper limb over the other could lead to significant differences in MNCV values of D L and N DL.