The contribution of concentric electrode-evoked potentials and nociceptive withdrawal reflex to the routine neurophysiological assessment of neuropathic pain: cross-sectional study / A contribuição dos potenciais evocados por eletrodo concêntrico e reflexo de retirada nociceptiva para a avaliação neurofisiológica de rotina da dor neuropática: estudo observacional transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Conventional electrodiagnostic studies (EDX) are frequently used to support the diagnosis of peripheral neuropathic pain. However, routine EDX has poor diagnostic yield for identifying small fiber neuropathy, which may be cause of neuropathic pain in some patients. This study aimed to assess the gain in diagnostic yield brought by adding pain-related evoked potentials with concentric electrode (CN-PREP) and nociceptive withdrawal reflex (NWR) assessments to EDX. METHODS: Transversal observational accuracy study which included patients referred to routine EDX in a tertiary-care hospital who reported chronic neuropathic pain in their lower limbs. Besides routine EDX, subjects underwent CN-PREP and NWR assessments. Diagnostic yield and tolerability were examined and compared between test studies. RESULTS: The study enrolled 100 patients (54% female), with 57 ± 12 years. EDX was altered in 47% of all patients. The addition of CN-PREP alone, and NWR combined with CN-PREP increased diagnostic yield to 69% and 72%, respectively. CN-PREP proved to be well tolerable, while NWR was associated with higher test-related pain intensity and discontinuation rate (9% vs. 0%). Considering EDX as the reference test, CN-PREP sensitivity was 85.1% and specificity 58.5%. CONCLUSION: Combining CN-PREP with the routine EDX for patients with neuropathic pain is feasible and results in increased diagnostic yield. Conversely, the addition of NWR to the aforementioned tests provides little improvement to this yield and is less tolerable to the patient. Further studies are needed to determine the actual sensitivity and specificity of CN-PREP when compared to the gold-standard for small fiber neuropathy diagnosis, i.e. intraepidermal nerve fiber density assessment.

RESUMO JUSTIFICATIVA E OBJETIVOS: Estudos convencionais de eletrodiagnóstico (EDX) são frequentemente usados para apoiar o diagnóstico de dor neuropática periférica. No entanto, o EDX de rotina tem baixo rendimento diagnóstico para identificar neuropatia de pequenas fibras. O objetivo deste estudo foi avaliar o ganho no rendimento diagnóstico pela adição de avaliações de potenciais evocados relacionados à dor com eletrodo concêntrico (CN-PREP) e reflexo de retirada nociceptiva (NWR) ao EDX. MÉTODOS: Estudo de precisão observacional transversal que incluiu pacientes encaminhados para EDX de rotina com dor neuropática crônica em membros inferiores. Além do EDX de rotina, os indivíduos foram submetidos às avaliações CN-PREP e NWR. O rendimento diagnóstico e a tolerabilidade foram examinados e comparados entre os estudos de teste. RESULTADOS: O estudo envolveu 100 pacientes (54% mulheres), com 57 ± 12 anos. O EDX estava alterado em 47%. A adição de CN-PREP sozinho e NWR combinado com CN-PREP aumentou o rendimento diagnóstico para 69% e 72%, respectivamente. O CN-PREP provou ser bem tolerável, enquanto o NWR foi associado a maior intensidade de dor relacionada ao teste e taxa de descontinuação (9% vs. 0%). Considerando o EDX como teste de referência, a sensibilidade do CN-PREP foi de 85,1% e a especificidade de 58,5%. CONCLUSÃO: A combinação do CN-PREP com o EDX de rotina para pacientes com dor neuropática é viável e resulta em maior rendimento diagnóstico. Já a adição de NWR aos testes mencionados fornece pouca melhora nesse rendimento e é menos tolerável para o paciente. Mais estudos são necessários para determinar a real sensibilidade e especificidade do CN-PREP quando comparado ao padrão-ouro para diagnóstico de neuropatia de pequenas fibras, ou seja, a avaliação da densidade de fibras nervosas intraepidérmicas.

Research on feature classification of lower limb motion imagination based on electrical stimulation to enhance rehabilitation / 生物医学工程学杂志

Motor imaging therapy is of great significance to the rehabilitation of patients with stroke or motor dysfunction, but there are few studies on lower limb motor imagination. When electrical stimulation is applied to the posterior tibial nerve of the ankle, the steady-state somatosensory evoked potentials (SSSEP) can be induced at the electrical stimulation frequency. In order to better realize the classification of lower extremity motor imagination, improve the classification effect, and enrich the instruction set of lower extremity motor imagination, this paper designs two experimental paradigms: Motor imaging (MI) paradigm and Hybrid paradigm. The Hybrid paradigm contains electrical stimulation assistance. Ten healthy college students were recruited to complete the unilateral movement imagination task of left and right foot in two paradigms. Through time-frequency analysis and classification accuracy analysis, it is found that compared with MI paradigm, Hybrid paradigm could get obvious SSSEP and ERD features. The average classification accuracy of subjects in the Hybrid paradigm was 78.61%, which was obviously higher than the MI paradigm. It proves that electrical stimulation has a positive role in promoting the classification training of lower limb motor imagination.

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.

Estahlishment of a tethered cord syndrome model with neural axial stretch in pig / 第二军医大学学报

Objective To explore a method for establishment of tethered cord syndrome model with neural axial stretch in pig. Methods Eighteen adult pigs were randomized into three groups. Sham group: L1-5 spinal cords were exposed; control group: Li-r, bilateral pedicle screws were placed after exposure of L1-5 spinal cords; and experiment group: L1-5 spinal cords were exposed, then bilateral pedicle screws were placed, and finally L1-5 intervertebral spaces were extended axially, with six in each group. At different time points, the pigs in the three groups were subjected to X ray. hindlimb behaviors, urodynamics, somatosensory evoked potential, laser speckle imaging for blood flow and histopathology examination, and the examination results were compared and analyzed. Results In the sham group and control group, there was no obvious change in L1-5 intervertebral space height, hindlimb motor nerve function scores, urodynamics, somatosensory evoked potentials or laser speckle imaging for blood flow before and after operation; and the spinal cord and nerve structure were normal or nearly normal in the histopathology. In the experiment group, compared with before distraction, Liintervertebral height after distraction was significantly increased, hindlimb motor nerve function score was significantly decreased, latency of P-wave of sematosensory evoked potential was significantly extended and the amplitude was significantly decreased, and blood flow 011 the surface of spinal cord was significantly reduced (P

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.

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.

Monitoring of Motor and Somatosensory Evoked Potentials During Spine Surgery: Intraoperative Changes and Postoperative Outcomes

OBJECTIVE: To evaluate whether the combination of muscle motor evoked potentials (mMEPs) and somatosensory evoked potentials (SEPs) measured during spinal surgery can predict immediate and permanent postoperative motor deficits. METHODS: mMEP and SEP was monitored in patients undergoing spinal surgery between November 2012 and July 2014. mMEPs were elicited by a train of transcranial electrical stimulation over the motor cortex and recorded from the upper/lower limbs. SEPs were recorded by stimulating the tibial and median nerves. RESULTS: Combined mMEP/SEP recording was successfully achieved in 190 operations. In 117 of these, mMEPs and SEPs were stable and 73 showed significant changes. In 20 cases, motor deficits in the first 48 postoperative hours were observed and 6 patients manifested permanent neurological deficits. The two potentials were monitored in a number of spinal surgeries. For surgery on spinal deformities, the sensitivity and specificity of combined mMEP/SEP monitoring were 100% and 92.4%, respectively. In the case of spinal cord tumor surgeries, sensitivity was only 50% but SEP changes were observed preceding permanent motor deficits in some cases. CONCLUSION: Intraoperative monitoring is a useful tool in spinal surgery. For spinal deformity surgery, combined mMEP/SEP monitoring showed high sensitivity and specificity; in spinal tumor surgery, only SEP changes predicted permanent motor deficits. Therefore, mMEP, SEP, and joint monitoring may all be appropriate and beneficial for the intraoperative monitoring of spinal surgery.

Application of contact heat-evoked potentials in acute myelitis / 中华物理医学与康复杂志

Objective To study the characteristics of the central part of the nociceptive system in acute myelitis (AM) with contact heat evoked potentials (CHEPs) and to document the potentials in patients with AM.Methods Twenty patients with AM were recruited in this study as an experimental group,and twenty healthy subjects were chosen as a control group.A heat foil was used to elicit pain and CHEPs.Thermal stimuli were applied at 54.5 ℃ at five sites:the dorsum of the hand,the proximal volar surface of the forearm,the skin of the leg 5 cm proximal to the medial malleolus,and at the C7 and T12 acupuncture locations.The latency and waveform of the evoked potentials were recorded.The conduction velocity of the A8 fibers of the peripheral nerves and of the spinal part of the spinothalamic tract were analyzed.The somatosensory evoked potential (SEP) and sensory conduction velocity (SCV) of the limbs were also examined,and the results were compared with the CHEP results.The results were compared between the two groups.Results The N 550 latencies of the CHEP on the dorsum of the hand,the inside of the leg,and at C7 and T12 were prolonged significantly in the patients with AM compared to the healthy controls.There were no significant differences in the nerve conduction velocity of the Aδ fibers and the velocity or amplitude of sensory nerve conduction in the limbs between the groups.The conduction velocities of the spinothalamic tract were significantly reduced in the patients with AM compared to the control group,while the peak latencies of N13 and the interpeak latencies of N9-N13 and N13-N20 in the AM patients were significantly prolonged compared to the healthy persons.In the patients with AM,CHEP abnormality in the lower limbs (17/20,85％) was significantly higher than in the upper limbs,total CHEP abnormality and CHEP abnormality in the lower limbs were significantly greater than SEP abnormality.Conclusion Persons with AM have abnormalities in the central part of the nociceptive system.When used with MRI and other electrophysiological examinations,CHEP may contribute to diagnosing AM.It could be helpful in the differential diagnosis of AM from motor neuron diseases and peripheral nerve lesions.It is of great potential value in clinical practice.

Clinical Study of Application of Somatosensory Evoked Potentials in Tourette Syndrome / 中国康复理论与实践

@#Objective To explore the feasibility of somatosensory evoked potentials (SEP) evaluating Tourette syndrome, based on the theory of SEP evaluating sensory-motor cortical function. Methods 33 cases of Tourette syndrome in our hospital from March 2014 to April 2015 were as the experiment group and 30 healthy participants were as the normal control group. Both groups were evaluated with Yale Global Tic Severity Scale (YGTSS) and SEP. Results There was no significant difference in N20 leak latency and leak-leak amplitude of SEP between 2 groups (P>0.05). The P22 leak latency prolonged (t=2.356, P<0.05) and the leak-leak amplitude decreased (t=2.507, P<0.05) in the experiment group compared with the normal control group. The YGTSS score was higher in the experiment group than in the normal control group (t=3.012, P<0.01). The P22 leak latency was positively (r=0.402, P<0.001), and the P22 leak-leak amplitude was negatively (r=-0.180, P<0.001) correlated with YGTSS score. Conclusion Children with Tourette syndrome are disordered in inhibiting sensory or mo-tor impulse through cortex-striatum-thalamus-cortex regulation circuit. SEP is considered as the objective indicator of patients with Tourette syndrome.

Transcranial ultrasound can improve sensory functioning in children with cerebral palsy / 中华物理医学与康复杂志

Objective To explore the effects of transcranial ultrasound (TU) on the sensory functioning of children with cerebral palsy (CP).Methods Sixty-seven children with CP were randomly divided into a TU group (n =33) and a control group (n =34).All of the children were given conventional rehabilitative treatment, but the children in the TU group also received TU stimulation at 1.2 W/cm2 for 20 min daily, 5 times a week.All the treatments continued for 3 weeks in both groups.Before and after the intervention, the latencies and amplitudes of N20 and P37 were recorded and the escape reflex threshold was measured using the Von-Frey method.Results Before the treatment there were no significant differences between the two groups.After the 3 weeks of treatment, significant differences were observed in the N20 and P37 amplitudes, but not in the latencies in the control group.In TU group, however, the N20 and P37 latencies were significantly shorter and the amplitudes were significantly improved after the treatment.So significant inter-group differences were found in terms of N20 latency and both N20 and P37 amplitude after the treatment.The average escape reflex threshold in the TU group was significantly lower than before treatment, but not significantly different from the control group's average.Conclusions Transcranial ultrasound can effectively shorten the latencies and increase the amplitudes of somatosensory evoked potentials, suggesting that it can improve somatosensory functioning in children with CP.

Quantification of Deqi (arrival of qi) by Short-latency Somatosensory Evoked Potentials：A Randomized Crossover Controlled Trial Plan / 上海针灸杂志

Objective To explore the feasibility of using short-latency somatosensory evoked potentials (SLSEP) to quantitate Deqi.Methods A randomized crossover controlled trial was carried out. Healthy subjects were enrolled and allocated to treatment (thick needle, deep insertion and manipulation for Deqi) and control (thin needle, shallow insertion and no manipulation without Deqi) groups. Somatosensory evoked potentials were recorded before, during and after acupuncture. Deqi was assessed using the score scale in the subjets. The effects of Deqi and no Deqi at point Sanyinjiao (SP 6) on the potentials were observed.Results The preliminary exploration of the feasibility by the trial test showed that the effect of Deqi on short-latency somatosensory evoked potentials had certain regularity. It was worthy to be observed.Conclusion The plan is feasible. The formal test can be conducted.

The quantitative sensory testing is an efficient objective method for assessment of nerve injury / 대한악안면성형재건외과학회지

BACKGROUND: This study evaluated Somatosensory evoked potentials (SEP), Quantitative sensory testing (QST), and thermography as diagnostic methods for nerve injury. METHODS: From 2006 through 2011, 17 patients (mean age: 50.1 years) from OOOO Hospital who sought care for altered sensation after dental implant treatment were identified. The mean time of objective assessment was 15.2 months after onset. RESULTS: SEP of Inferior alveolar nerve(IAN) was 15.87 +/- 0.87 ms on the normal side and 16.18 +/- 0.73 ms on the abnormal side. There was delayed N20 latency on the abnormal side, but the difference was not statistically significant. In QST, the abnormal side showed significantly higher scores of the current perception threshold at 2 KHz, 250 Hz, and 5 Hz. The absolute temperature difference was 0.55degrees C without statistically significance. CONCLUSION: These results indicate that QST is valuable as an objective method for assessment of nerve injury.

Traumatic Atypical Tetraplegia Without Radiologic Abnormalities Including Magnetic Resonance Imaging in an Adult: A Case Report

Although spinal cord injury without radiographic abnormality (SCIWORA) literally refers to the specific type of spinal cord injury, however, some extents of spinal cord injuries can be detected by magnetic resonance imaging (MRI) in most of cases. We introduce an atypical case of spinal cord injury without radiologic abnormality. A 42-year-old male tetraplegic patient underwent MRI and computed tomography, and no specific lesions were found in any segments of the spinal cord. Moreover, the tetraplegic patient showed normal urodynamic function despite severe paralysis and absent somatosensory evoked potentials from the lower limbs.

Intra-operative monitoring of neuro-electrophysiology in spinal tuberculosis surgery / 中华物理医学与康复杂志

Objective To investigate the efficacy of combined monitoring of motor evoked potentials with transcranial electrical stimulation (TES-MEP),somatosensory evoked potentials (SEP) and spontaneous electromyo-graphy (s-EMG) in tuberculosis surgery involving the thoracic,lumbar and sacral vertebrae.Methods Twenty-seven patients with tuberculosis of the thoracic vertebrae (T2-L2) received intra-operative SEP and TES-MEP monito-ring.Combined SEP,TES-MEP and spontaneous EMG monitoring were employed in 11 patients with tuberculosis of the lumbar or/and sacral vertebrae (L3-S1).SEP and TES-MEP were used to precisely observe the status of the sen-sory and motor pathways; s-EMG responses were used to more accurately localize nerve root irritation.ResuIts (1) SEP monitoring was successful in all of the operations.TES-MEPs were successfully monitored in 35 of them (92.1％).Combined motor and sensory monitoring was successfully achieved in 35 cases (92.1％).Abnormal SEPs were observed in 3 cases (7.9％),while abnormal MEPs were observed in 11 cases (28.9％).Abnormality in both the SEP and TES-MEP occurred in 2 cases (5.3％).There were 9 cases (23.7％) where the SEPs were nor-mal and the TES-MEPs were abnormal.In only 1 case (2.6％) was the SEP normal and the MEP abnormal.The false negative rate was 0％ with combined SEP and TES-MEP monitoring,while the false positive rate was 5.3％.There were 2 cases complicated by post-operative neurological deficits.(2) Spontaneous EMG monitoring can accu-rately determine the functioning of lumbar nerve roots during lumbar or lumbosacral tuberculosis surgery.Among 5 cases where EMG responses were observed,4 cases occurred during the spinal canal and nerve root decompression,1 case occurred in the orthopedic reset phase.Conclusions (1) During tuberculosis surgery involving thoracic,lumbar or sacral vertebrae,combined monitoring of SEPs and TES-MEPs can reflect the physiological and pathological condition of the spinal cord after ruling out interfering factors.This can improve monitoring and help assure the safety of lumbar surgery.(2) Intra-operative s-EMG monitoring can accurately reveal nerve root function in real time,help-ing to avert nerve root injury in lumbar and lumbosacral tuberculosis surgery.

Effects of Desflurane and Sevoflurane on Somatosensory Evoked Potentials in Patients Undergoing Neurosurgery / 昆明医科大学学报

Objective To compare the effects of desflurane and sevoflurane on somatosensory evoked potentials (SEP) in patients undergoing spine neurosurgery. Methods Thirty patients with ASA grades I-Ⅱand undergoing spinal deformity orthopaedic surgery were selected and divided into two groups: desflurane group and sevoflurane group (n=30) . Bispectral index (BIS),the state of muscle relaxation, SEP and hemodynamics were monitored during operation. By maintaining the BIS in the range of 35-45,the state of muscle relaxation disappeared and hemodynamic became stable. Adjust the concentration of anesthetic step by step from 0 to 0.3, 0.6 and 0.9 maximum alveolar concentrations (MAC), then inhaled different concentrations of drugs. Record the incubation period and amplitude of SEP before inhaling anesthetics (based on the value), in the moment of achieving each inhaled concentration ( T1, T2 and T3) , and the moment that the inhaled anesthetics blows completely (regression value) . The percentages of T1, T2, T3, and the regression value compared with basic value were calculated.Results Compared with the basic value, T1, T2 and T3 of left arm, left leg and right leg in desflurane group, T2 and T3 of right arm in desflurane group, T2 and T3 of left arm, left leg and right arm in sevoflurane group,and T2 and T3 of right leg in sevoflurane group showed incubation period delaying ( <0.05) . And the incubation period extended along with the increase of inhaled anesthetics dosage. Compared with the basic value,T1,T2 and T1 of left arm and left leg in desflurane group,T1 of right arm in desflurane group, T1 and T2 of right leg in desflurane, T3 of left arm in sevoflurane group, T1 and T3 in left leg in sevoflurane group had decreased amplitude ( < 0.05), especially T1. Compared with desflurane, sevoflurane showed a weaker inhibition effect on the incubation period and amplitude of T1,T2,T3 of left arm and left leg,T2 and T3 of right arm and right leg, and the amplitude of T1 of right leg ( < 0.05) . Conclusion Both of desflurane and sevoflurane have inhibition effect on SEP. The inhibition effect gradually strengthens along with the increasing of dose. The inhibition effect of desflurane is stronger than sevoflurane.

Prediction of Outcome of Operation for Cervicalspondylotic Radiculopathy with Somatosensory Evoked Potentials / 中国康复理论与实践

@#Objective To evaluate the neurological function of cervicalspondylotic radiculopathy by somatosensory evoked potentials (SEP) and provide an objective basis for selecting the best operation occasion. Methods 60 patients with C6 and C7 radiculopathies were divided into 3 groups according to the results of SEP: normal group (n=22), mildly abnormal group (n=30) and severely abnormal group (n=8). All the patients underwent anterior cervical decompression and fusion. They were assessed with Neck Disability Index (NDI) before and after treatment. Results The postoperative NDI scores of all the groups improved significantly (P<0.001), especially in the normal group.Conclusion SEP, which can reflect the severity of cervicalspondylotic radiculopathy objectively and predict prognosis.

Changes of Functional Outcomes According to the Degree of Completeness of Spinal Cord Injury

OBJECTIVE: To evaluate whether an initial complete impairment of spinal cord injury (SCI) contributes to the functional outcome prediction, we analyzed the relationship between the degree of complete impairment according to the American Spinal Injury Association impairment scale (AIS), the posterior tibial nerve somatosensory evoked potential (PTSEP) and the changes of functional indices. METHODS: Sixty subjects with SCI were studied who received rehabilitative management for over 2 months. The degree of completeness on basis of the initial AIS and PTSEP were evaluated at the beginning of rehabilitation. Following treatment, several functional indices, such as walking index for spinal cord injury version II (WISCI II), spinal cord independence measure version III (SCIM III), Berg Balance Scale (BBS), and Modified Barthel Index (MBI), were evaluated until the index score reached a plateau value. RESULTS: The recovery efficiency of WISCI and BBS revealed a statistically significant difference between complete and incomplete impairments of initial AIS and PTSEP. The SCIM and MBI based analysis did not reveal any significant differences in terms of the degree of AIS and PTSEP completeness. CONCLUSION: AIS and PTSEP were highly effective to evaluate the prognosis in post-acute phase SCI patients. BBS and WISCI might be better parameters than other functional indices for activities of daily living to predict the recovery of the walking ability in post-acute SCI.

A New Measure for Monitoring Intraoperative Somatosensory Evoked Potentials

OBJECTIVE: To propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study. METHODS: The proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included. RESULTS: We found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery. CONCLUSION: Our results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.

Somatosensory Findings of Pusher Syndrome in Stroke Patients

OBJECTIVE: To investigate the somatosensory findings of pusher syndrome in stroke patients. METHODS: Twelve pusher patients and twelve non-pusher patients were enrolled in this study. Inclusion criteria were unilateral stroke, sufficient cognitive abilities to understand and follow instructions, and no visual problem. Patients were evaluated for pusher syndrome using a standardized scale for contraversive pushing. Somatosensory finding was assessed by the Cumulative Somatosensory Impairment Index (CSII) and somatosensory evoked potentials (SEPs) at 1 and 14 weeks after the stroke onset. Data of SEPs with median and tibial nerve stimulation were classified into the normal, abnormal, and no response group. RESULTS: In the baseline characteristics (sex, lesion character, and side) of both groups, significant differences were not found. The score of CSII decreased in both groups at 14 weeks (p<0.05), but there were no significant differences in the CSII scores between the two groups at 1 and 14 weeks. There were no significant differences in SEPs between the two groups at 1 and 14 weeks after the stroke onset. CONCLUSION: It appears that somatosensory input plays a relatively minor role in pusher syndrome. Further study will be required to reveal the mechanism of pusher syndrome.

The effect of elastic-taping on long-latency somatosensory evoked potentials (SEPs) / 体力科学

Taping is widely used by sports trainers to prevent injury and to protect affected sites post-injury. However, it is not clear whether taping affect the perception of somatosensory stimulation. We sought to clarify the effect of taping on somatosensory stimulation using somatosensory evoked potentials (SEPs). We recorded SEPs following transcutaneous electrical stimulation of the right medial forearm in ten healthy volunteers. SEPs were recorded from 9 electrodes on the scalp under control, elastic-taping and white-taping conditions. Subjects relaxed on a comfortable reclining seat without taping in the control condition, while they were subjected to taping along the muscle of forearm with tension (elastic-taping) and without tension (white-taping) in the taping conditions. Results showed that the peak amplitude of N140 did not differ significantly among the three conditions but the peak amplitude of P250 was significantly lower in the elastic-taping condition than control and white-taping conditions. Elastic-taping with tension along the muscles changes various afferent inputs from muscle spindle or skin, and this may affect the perception of somatosensory stimulation.