Water tank scale: a reliable method for assessing motor function after spinal cord injury in rats / 南方医科大学学报

OBJECTIVE@#To analyze the reliability of the Water Tank Scale for assessing recovery of motor function after spinal cord injury (SCI) in rats.@*METHODS@#Thirty-six adult female SD rats were randomly divided into SCI and sham-operated groups (n= 18). The recovery of the hind limb motor function was assessed using Water Tank scoring, BBB scoring, and motor-evoked potentials (MEP) at 1, 3, 5, 7, 14 and 21 days after SCI. MEP was used as the gold standard for analyzing and comparing differences between the two scoring methods.@*RESULTS@#The Water Tank scores of the rats were significantly higher than the BBB scores on day 3 (0.22±0.43 vs 0, P < 0.05) and also on days 5, 7 and 14 after SCI (0.67±0.49 vs 0.11±0.32, 4.33±1.19 vs 2.83±1.04, 8.61± 1.20 vs 7.06±1.0, P < 0.01). On day 21 after SCI, the scores of the Water Tank Scale of the rats did not significantly differ from the BBB scores (14.78±1.06 vs 14.50±1.47, P>0.05). Neurophysiological monitoring showed that both the Water Tank score and BBB score were significantly correlated with MEP latency, but the Water Tank score had a greater correlation coefficient with MEP latency (r=-0.90).@*CONCLUSION@#Compared with the BBB scale, Water Tank scoring allows more objective and accurate assessment of functional recovery of the spinal cord in early stages following SCI in rats, and can thus be used as a reliable method for assessing functional recovery of the hind limbs in rat models of acute SCI.

The effects of intermittent theta burst stimulation at different side of the cerebellar hemisphere on swallowing in healthy subjects / 中华物理医学与康复杂志

Objective:To observe any stimulatory effect of intermittent theta burst stimulation (iTBS) on the cerebral swallowing cortex and the cerebellar swallowing motor area and to explore the related mechanisms.Methods:Forty-four healthy right-handed subjects were divided at random into a dominant cerebellum group ( n=15), a non-dominant cerebellum group ( n=15) and a control group ( n=14). In the dominant cerebellum group, iTBS was administered to the cerebellum of the dominant hemisphere, and the other hemisphere was given sham stimulation. In the non-dominant cerebellum group, it was the opposite. The dominant cerebellum received the sham stimulation. In the control group both hemispheres received sham stimulation. Before and after the stimulation, single-pulse transcranial magnetic stimulation (TMS) was applied to the representative regions of suprahyoid muscles in bilateral brain and cerebellum to observe changes of the latency and amplitude of motor evoked potentials (MEPs). Results:After the intervention the MEP amplitude of the bilateral swallowing cortex and the stimulated cerebellum had increased in the non-dominant cerebellum group, with increased MEP amplitude only from the stimulated cerebellum of the dominant cerebellum group. Compared with the control group, the non-dominant cerebellum group showed the greatest improvement in MEP amplitude of the stimulated bilateral cerebral cortex and cerebellum. Improvement in the dominant cerebellum group was significantly smaller. However, there were no significant differences in MEP latency or the percentage change in MEP latency from baseline among the three groups.Conclusions:Applying iTBS to either the non-dominant or the dominant cerebellum excites the brain areas related to swallowing, but in different ways.

Stroke improvement with magnetic stimulation recapitulates ontogeny / Mejoría del ACV con estimulación magnética recapitula la ontogenia

Abstract A patient with chronic brainstem CVA sequelae received one cycle of magnetic stimulation to treat her dysphagia and serendipitously obtained a minimal improvement in her axial movement. Two additional cycles gave her improved postural control and then distal movement, preceded by a display of ipsilateral and contralateral motor evoked potentials, respectively. Magnetic stimulation at 10 Hertz produces cortical disinhibition and reopens the critical neurodevelop ment periods. The ontogenic pattern of hemiplegia recovery in this patient may be explained by an increased and rejuvenated brain plasticity due to critical period reopening through cortical disinhibition. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

Resumen Una paciente con secuelas crónicas de un ACV del tallo cerebral recibió un ciclo de estimulación magnética para el manejo de la disfagia y, por serendipia obtuvo mejoría leve del movimiento axial. Dos ciclos adicionales le permitieron mejoría del control postural y luego la aparición de movimiento distal, precedidos por la visualización de los potenciales evocados motores ipsilateral y contralateral, respectivamente. La estimulación magnética a 10 Hertz produce desinhibición cortical y reabre los periodos críticos del neurodesarrollo. Es posible, que el patrón ontogénico de recuperación de la hemiplejía en esta paciente se explique por el incremento y rejuvenecimiento de la plasticidad cerebral debido a la reapertura de los periodos críticos, por medio de la desinhibición cortical. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2253).

Transcranial magnetic stimulation can enhance the effectiveness of motor imagery therapy after a stroke / 中华物理医学与康复杂志

Objective:To observe any effect of combining motor imagery therapy (MIT) with repeated transcranial magnetic stimulation (rTMS) for improving upper limb motor functioning after a stroke.Methods:Ninety stroke survivors were randomly divided into a control group, an MIT group and a combination group, each of 30. All received conventional rehabilitation therapy, while the MIT group additionally received MIT and the combination group received the MIT along with 1Hz rTMS applied over the M1 region of the contralateral cortex. Before and after 4 weeks of treatment, everyone′s upper limb functioning was quantified using the Fugl-Meyer assessment scale (FMA) and the Hong Kong version of the hemiplegia upper limb function test (FTHUE-HK). Motor evoked potentials (MEPs), cortical latency (CL) and central motor conduction time (CMCT) were also recorded.Results:After the treatment the average FMA and FTHUE-HK scores of all three groups had improved significantly. The average CL and CMCT were significantly shortened. Compared with the control group, the average upper limb FMA score and FTHUE-HK scores of the treatment group were significantly higher. The combination group showed a significant improvement in its average MEP cortical latency and CMCT values.Conclusions:MIT therapy alone can improve the upper limb motor functioning of stroke survivors, but it is more effective in combination with rTMS.

Correlation between the characteristics of motor evoked potential and severity of spinal cord injury in patients with acute cervical hyperextension injury and central spinal cord syndrome / 中华创伤骨科杂志

Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.

The efficacy and mechanism of theta burst stimulation for the relief of dysphasia after a stroke / 中华物理医学与康复杂志

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the cerebellum on swallowing dysfunction after cerebellar infarction, and to explore its mechanism.Methods:Sixty-two cerebellar stroke survivors with dysphagia were randomly divided into an observation group and a control group, each of 29. In addition to the routine swallowing rehabilitation training, the observation group was treated with iTBS, while the control group was given sham iTBS. The incubation and amplitude of the bilateral suprahyoid muscle motor evoked potential (MEP) were recorded before and after 4 weeks of treatment. The exponential approximate entropy (ApEn) of different brain regions was compared between the two groups during reflex and autonomous swallowing. Swallowing function was evaluated using the penetration-aspiration scale (PAS).Results:MEP incubation in the bilateral suprahyoid muscles had decreased significantly after 4 weeks of treatment in the observation group, and the MEP amplitude in the bilateral suprahyoid muscles of the two groups had increased significantly. The average improvement in the amplitude and incubation in the observation group was significantly greater than in the control group. The average ApEn at C3, C4, P3, P4, T5 and T6 had increased significantly in both groups during both reflex and spontaneous swallowing, with the improvement in the observation group significantly greater. Swallowing function had improved significantly in both groups, but the average PAS grade of the observation group was again significantly better.Conclusions:iTBS can improve the swallowing function of dysphagic cerebellar stroke survivors. This may be due to iTBS improving the excitability of the cerebral cortex and improving motor control of the swallowing muscles.

Clinical Usefulness of Intraoperative Motor-Evoked Potential Monitoring during Temporal Lobe Epilepsy Surgery

BACKGROUND AND PURPOSE: We aimed to determine the effectiveness of intraoperative neurophysiological monitoring focused on the transcranial motor-evoked potential (MEP) in patients with medically refractory temporal lobe epilepsy (TLE). METHODS: We compared postoperative neurological deficits in patients who underwent TLE surgery with or without transcranial MEPs combined with somatosensory evoked potential (SSEP) monitoring between January 1995 and June 2018. Transcranial motor stimulation was performed using subdermal electrodes, and MEP responses were recorded in the four extremity muscles. A decrease of more than 50% in the MEP or the SSEP amplitudes compared with baseline was used as a warning criterion. RESULTS: In the TLE surgery group without MEP monitoring, postoperative permanent motor deficits newly developed in 7 of 613 patients. In contrast, no permanent motor deficit occurred in 279 patients who received transcranial MEP and SSEP monitoring. Ten patients who exhibited decreases of more than 50% in the MEP amplitude recovered completely, although two cases showed transient motor deficits that recovered within 3 months postoperatively. CONCLUSIONS: Intraoperative transcranial MEP monitoring during TLE surgery allowed the prompt detection and appropriate correction of injuries to the motor nervous system or ischemic stroke. Intraoperative transcranial MEP monitoring is a reliable modality for minimizing motor deficits in TLE surgery.

Biomarkers for assessing motor dysfunction after stroke / 中华物理医学与康复杂志

Objective@#To investigate whether diffusion tensor imaging (DTI) and motor evoked potentials (MEP) can be used as biomarkers to assess the degree of motor dysfunction of stroke survivors.@*Methods@#Sixty partially-paralyzed stroke survivors were given Fugl-Meyer assessments (FMAs) and MEP tests and assessed using DTI seeking any correlations among the results. The receiver operating characteristics curves (ROCs) were prepared to determine the tests′ efficacy in assessing severe motor dysfunction.@*Results@#① Asymmetry in the fractional anisotropy (aFA) of the peduncles cerebra as measured by DTI was negatively correlated with the FMA scores of the upper and lower limbs on the affected side. The aFA values of the posterior limb of the internal capsule (PLIC) were negatively correlated with the FMA scores of the affected upper limb, but not with the FMA scores of the affected lower limbs. The abnormalities in central motor conduction time and motor threshold, which are MEP parameters, were negatively correlated with the FMA scores of the affected limbs. ② The ROCs showed that the aFA value of the PLIC was the best indicator for assessing severe upper limb motor dysfunction, with a cut-off value of 0.167 giving the best discrimination. MEP waveform loss could also be used. It has high sensitivity but low specificity. ③ A combination of DTI and MEP can improve specificity in assessing severe motor dysfunction in the upper limbs.@*Conclusion@#DTI and MEP can both be used to evaluate motor dysfunction in stroke survivors. They have high clinical value for assessing severe motor dysfunction of the upper limbs.

Biomarkers for assessing motor dysfunction after stroke / 中华物理医学与康复杂志

Objective To investigate whether diffusion tensor imaging ( DTI) and motor evoked potentials (MEP) can be used as biomarkers to assess the degree of motor dysfunction of stroke survivors. Methods Sixty partially-paralyzed stroke survivors were given Fugl-Meyer assessments ( FMAs) and MEP tests and assessed using DTI seeking any correlations among the results. The receiver operating characteristics curves ( ROCs) were prepared to determine the tests' efficacy in assessing severe motor dysfunction. Results ① Asymmetry in the fractional ani-sotropy ( aFA) of the peduncles cerebra as measured by DTI was negatively correlated with the FMA scores of the up-per and lower limbs on the affected side. The aFA values of the posterior limb of the internal capsule ( PLIC) were negatively correlated with the FMA scores of the affected upper limb, but not with the FMA scores of the affected low-er limbs. The abnormalities in central motor conduction time and motor threshold, which are MEP parameters, were negatively correlated with the FMA scores of the affected limbs. ②The ROCs showed that the aFA value of the PLIC was the best indicator for assessing severe upper limb motor dysfunction, with a cut-off value of 0.167 giving the best discrimination. MEP waveform loss could also be used. It has high sensitivity but low specificity. ③A combination of DTI and MEP can improve specificity in assessing severe motor dysfunction in the upper limbs. Conclusion DTI and MEP can both be used to evaluate motor dysfunction in stroke survivors. They have high clinical value for assess-ing severe motor dysfunction of the upper limbs.

Effects of SEP and TES-MEP on the operation success rate and safety of patients with spinal surgery / 局解手术学杂志

Objective To investigate the success rate and safety of transcranial electrical stimulation motor evoked potentials (TES-MEP) and somatosensory evoked potential(SEP) in the monitor of the spinal operation.Methods A total of 98 patients with spinal surgery in our hospital from December 2015 to December 2016 were selected and divided into observation group and control group according to the intraoperative monitoring method,49 cases in each group.SEP conbined with TES-MEP were used in the observation group,and SEP monitoring was used in the control group.Intravenous anesthesia was used in all patients to observe and record the amplitude and latency of SEP and TES-MEP.The results of the two groups were compared with those of the postoperative spinal motor and sensory function and the complications.Results The successful detection rate of the observation group and the control group were respectively 100％ and 91.84％,and the difference was statistically significant(P ＜ 0.05).The sensitivity,specificity and Youden index of the spinal cord movement were significantly higher in the observation group than those in the control group,the difference was not significant(P ＞ 0.05).In addition,the sensitivity,specificity and Youden index of the sensory function were higher than those in the control group,and the differences were statistically significant (P ＜ 0.05).There was no significant difference in postoperation complication between the two groups (P ＞ 0.05).Conclusion SEP combined with TES-MEP in monitoring function changes of the spine during spinal surgery on sensitivity and specificity are higher than the SEP monitoring,which can accurately reflect the function of the spine in the operation state,and provide a good reference for surgery.

Intraoperative Monitoring of Hypoglossal Nerve Using Hypoglossal Motor Evoked Potential in Infratentorial Tumor Surgery: A Report of Two Cases

The hypoglossal nerve (CN XII) may be placed at risk during posterior fossa surgeries. The use of intraoperative monitoring (IOM), including the utilization of spontaneous and triggered electromyography (EMG), from tongue muscles innervated by CN XII has been used to reduce these risks. However, there were few reports regarding the intraoperative transcranial motor evoked potential (MEP) of hypoglossal nerve from the tongue muscles. For this reason, we report here two cases of intraoperative hypoglossal MEP monitoring in brain surgery as an indicator of hypoglossal deficits. Although the amplitude of the MEP was reduced in both patients, only in the case 1 whose MEP was disappeared demonstrated the neurological deficits of the hypoglossal nerve. Therefore, the disappearance of the hypoglossal MEP recorded from the tongue, could be considered a predictor of the postoperative hypoglossal nerve deficits.

Effects of different doses of dexmedetomidine used in SEP and MEP monitoring in patients undergoing neurosurgery / 实用医学杂志

Objective To investigate the effects of different doses of dexmedetomidine used in SEP and MEP monitoring in patients undergoing neurosurgery. Methods Eighty patients undergoing neurosurgery receiving SEP and MEP monitoring were randomly divided into 4 groups(n = 20 each):group C,group D1,group D2 and group D3. In groups D1 ,D2 and D3 ,dexmedetomidine 0.5 μg/kg was infused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.1,0.3 and 0.5μg/(kg·h)respectively toward the end of operation. Group C received the equal volume of normal saline. HR ,MAP and BIS were recorded at admission to the operating room(T1),skin incision(T2),when the muscle relaxants were stopped(T3)and 50 minutes later(T4). The current intensity and the time when first MEP was induced after muscle relaxant was stopped ,the amplitudes and latencies of SEP(N20-P25,N20)and MEP on thenar muscle at T4,the total consumption of propofol,and development of adverse affects were also recorded. Results Compared with groups C and D1,HR and MAP were decreased at T2-T4 in groups D2 and D3(P0.05). Conclusion Dexmedetomidine infused at 0.3 μg/(kg · h) after infusion of a loading dose of 0.5 μg/kg could improve monitoring quality of MEP through reducing the amount of propofol consumed ,have less inhibition on MEP than other groups,have no obvious effects on SEP,andmaintain hemodynamic stability.

Analysis of Abnormalities of Intraoperative Neurophysiological Monitoring in Spine and Spinal Cord Surgery under General Anesthesia / 中国康复理论与实践

@#Objective To analyze the factors related with intraoperative neurophysiological monitoring (IONM) in spine and spinal cord surgery under general anesthesia, in order to increase the effectiveness of IONM. Methods A retrospective study was performed on patients who received somatosensory-evoked potential (SEP) and motor-evoked potentials (MEP) in spine surgery under general anesthesia from Ju-ly, 2011 to January, 2016. Results Data from 104 patients were collected in which 18 cases had abnormal SEP and 17 cases had abnormal MEP. A single factor analysis indicated that abnormal SEP was related to concentration of inhalation anesthetic (CIA), hypothermia in peri-operative period (HTM), and type of anesthesia (χ2>6.219, P<0.05), whereas abnormal MEP was related to CIA, hypotension in periopera-tive period (HTN), and additional muscular relaxants (χ2>4.125, P<0.05). Logistic regression analysis indicated that abnormal SEP was relat-ed to CIA and HTM, whereas abnormal MEP was related to CIA and HTN (P<0.05). Conclusion CIA, HTM, and HTN were possible fac-tors related with IONM in spine surgery under general anesthesia.

Intensity-dependent effects of cycling exercise on corticospinal excitability in healthy humans: a pilot study

Abstract Aims the aim of this study was to verify the effects of different intensities of locomotor exercise on corticospinal excitability. Methods 18 healthy subjects (27.6 ± 6.5 years,) participated in a design study of three different exercise protocols on a cycle ergometer: (i) 10 min at 75% Wmax (high intensity); (ii) 15min at 60% Wmax (moderate intensity) or (iii) 30 min at 45% Wmax (low intensity). The protocols of lower body cycling were assigned in random order in separate sessions. A control session was done with subjects at rest. Corticospinal excitability was assessed before (baseline) and every 5 min for 15min after the end of exercise/rest (time: 0, 5, 10 and 15) by measurement of the motor evoked potential (MEP) elicited by transcranial magnetic stimulation in the relaxed first-dorsal interosseus muscle. Results Compared to the resting session, a significant decrease (64%) in the motor evoked potential amplitudes was found only in the session of exercise of high intensity. This result seems depend on the level of physical activity of subject. No change was found after rest, low and moderate exercises. Conclusions These findings suggest that changes in the corticospinal excitability depend on exercise intensity and level of physical activity of subjects.(AU)

Relationship Between Motor Evoked Potential Response and the Severity of Paralysis in Spinal Cord Injury Patients

OBJECTIVE: To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI). METHODS: We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups. RESULTS: MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above. CONCLUSION: Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.

Intraoperative Neurophysiological Monitoring for Spinal Cord Tumor Surgery: Comparison of Motor and Somatosensory Evoked Potentials According to Tumor Types

OBJECTIVE: To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type. METHODS: MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs. RESULTS: The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone. CONCLUSION: For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.

Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos normais / Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals

RESUMO Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos sem queixas auditivas e vestibulares. Métodos: Participaram da pesquisa 30 indivíduos sem queixa auditiva e com audição dentro dos padrões de normalidade. A coleta de dados foi realizada por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13 e N23 do potencial evocado miogênico vestibular cervical e para a latência da onda N10 do potencial evocado miogênico vestibular ocular. No gênero feminino não houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13, N23, N10, P15, interamplitude no potencial evocado miogênico vestibular cervical e interamplitude no potencial evocado miogênico vestibular ocular e para a latência das ondas P13, N23, N10 e P15. No gênero masculino houve diferença entre as orelhas direita e esquerda para a amplitude da onda P13. Conclusão: Os resultados do potencial evocado miogênico vestibular cervical e ocular combinado foram consistentes, uma vez que as respostas geradas pelos potenciais evocados miogênicos vestibulares apresentaram morfologia, latência e amplitude adequadas, o que permite a avaliação da via vestibular ipsilateral descendente e da via vestibular contralateral ascendente.

ABSTRACT Purpose: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. Methods: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. Results: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. Conclusion: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Advance in Neuro-electrophysiological Techniques in Functional Evaluation after Stroke (review) / 中国康复理论与实践

In recent years, neuro-electrophysiological techniques, as objective evaluation methods, have been gradually used in func-tional evaluation, guiding clinical rehabilitation programs and judging prognosis after stroke. They were proved to judge the integrity of cen-tral nervous system and conduction function and evaluate neuromuscular function. Nerve conduction, needle electromyography, H reflex, F wave, sympathetic skin response, motor-evoked potentials, somatosensory-evoked potentials, brain stem auditory-evoked potentials and sur-face electromyography were reviewed in this article.

Feasibility and safety of dexmedetomidine used in motor evoked potentials monitoring in patients under-going neurosurgery / 临床麻醉学杂志

Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomidine 0.5 μg/kg was in-fused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 · h-1 toward the end of operation.Group C received the equal volume of normal saline.HR,MAP and BIS were recorded at admission to the operating room (T0 ),skin incision (T1 ),when the muscle re-laxants were stopped (T2 )and 50 minutes later (T3 ).The current intensity and the time when first MEP was induced after muscle relaxant was stopped,the amplitudes and latencies of MEP on thenar muscle at T3 ,the total consumption of anesthetics,and development of adverse effects were also re-corded.Results Compared with T0 ,HR in group C at T1 ,T3 and MAP in group C at T1-T3 was in-creased,HR in group D was decreased at T2-T3 (P <0.05).Compared with group C,HR and MAP were decreased at T1-T3 in group D(P <0.05).The amount of propofol consumed and the current in-tensity inducing MEP were lower in group D than in group C (P <0.05).The amplitude of MEP at T3 was higher in group D than in group C (P <0.05).Compared with group C,the incidences of hy-pertension and tachycardia were decreased in group D,and the incidence of bradycardia was increased (P <0.05).Conclusion Dexmedetomidine used in MEP monitoring in patients undergoing neurosur-gery can meet the operation requirements,maintain hemodynamic stability,reduce the incidences of adverse reactions,and improve monitoring quality of MEP.It is a safe and feasible anesthesia method.

Application of motor evoked potential monitoring under threshold-level electrical stimulation using cranial peg- screw electrode during cerebral aneurysm keyhole approach surgery / 第二军医大学学报

Objective To explore the advantage of motor evoked potentials (MEPs) monitoring for postoperativemotor deficit evaluation under threshold-level electrical stimulation using cranial peg-screw electrode (CPSE) during cerebral aneurysm keyhole approach microsurgery. Methods A total of 31 patients who underwent anterior circulation aneurysm microsurgery through keyhole approach were selected in this study. MEPs monitoring of the operation side was conducted with threshold-level electrical stimulation using CPSE, and that of the non-operation side was conducted with transcranial electric stimulation using the same stimulation threshold. The change of minimum voltage required for MEPs monitoring was observed and recorded. The intraoperative MEPs monitoring results and postoperative neurological functions were analyzed by prospective observational study. Results MEPs of the operation side was successfully induced in 28 cases. No complications related to MEPs monitoring were observed. Intraoperative MEPs abnormalities were monitored in3 cases, and2 of them had postoperative transient hemiplegia, showing a sensitivity of 100% (2/2). No motor dysfunction was observed in the other 26 cases who were not presented with intraoperative MEPs abnormalities in 25 cases, showing a specificity of 96. 30% (26/27). Conclusion MEPs monitoring with threshold-level electrical stimulation using CPSE is a feasible and reliable method and t has satisfactory sensitivity and specificity for predicting motor dysfunction induced by cerebral ischemia, indicating that this method can be an alternative for routine MEPs monitoring with conventional transcranial electrical stimulation in cerebral aneurysm microsurgery.