Correlation of upper extremity somatosensory evoked potentials with sensory and motor functions in stroke patients in different stages / 中国康复理论与实践

ObjectiveTo investigate the correlation between somatosensory evoked potentials (SEP) of upper limbs, and sensory and motor functions in stroke patients in different stages. MethodsFrom June, 2021 to October, 2023, 177 stroke patients in Shijiazhuang People's Hospital were diveded into acute stage group (within 14 days, n = 25), early recovery group (14 days to one month, n = 110) and middle to late recovery group (one to six months, n = 42) according to the duration of the disease. General information of the patients was recorded; SEP examination was performed, and N20 lantency and amplitude were recorded. Monofilament touch and two-point discrimination sensation of the patient's hands were tested using the monofilament and two-point discrimination tools, respectively; and motor function was assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE). The correlation between SEP, and the sensory and motor scores in each group was analyzed. ResultsThere was no significant difference in the monofilament tactile and two-point discrimination scores among the three groups (P > 0.05). SEP was not correlated with sensory and motor functions in the acute stage group (P > 0.05); in the early recovery group, N20 latency was negatively correlated with monofilament tactile sensation (r = -0.267, P = 0.005) and positively correlated with two-point discrimination sensation (r = 0.220, P = 0.021), and N20 amplitude was positively correlated with monofilament tactile sensation (r = 0.328, P < 0.001) and FMA-UE score (r = 0.418, P < 0.001), and negatively correlated with two-point discrimination (r = -0.405, P < 0.001); in the middle to late recovery group, the N20 latency was negatively correlated with FMA-UE score (r = -0.313, P = 0.044), and N20 amplitude was positively correlated with monofilament tactile sensation (r = 0.598, P < 0.001) and FMA-UE score (r = 0.393, P = 0.010), and negatively correlated with two-point discrimination (r = -0.591, P < 0.001). Multiple linear regression analyses showed that the score of monofilament tactile sensation was negatively correlated with N20 latency (β = -0.510, P = 0.046), and the FMA-UE score was positively correlated with N20 amplitude (β = 0.313, P = 0.026) in the middle to late recovery group; in the early recovery group, the two-point discriminative sensation score was negatively correlated with N20 amplitude (β = -0.270, P = 0.039). ConclusionThe correlation between SEP and sensory and motor functions becomes more significant with the prolongation of disease.

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.

The neurophysiological evaluation in 60 patients with Kennedy disease / 中华神经科杂志

Objective:To study the neurophysiological features of Kennedy disease (KD) and to figure out the function of the nervous system.Methods:Subjects were recruited from the outpatient and the ward of Peking University Third Hospital from November 2010 to November 2022. Sixty patients with KD (29 patients with KD alone, 31 KD cases with the complication of diabetes mellitus) and 60 patients with diabetic polyneuropathy (DPN) were included in this study. Electrophysiological tests were performed in all subjects, including electromyogram, nerve conduction study, somaosensory evoked potential (SEP), contact heat evoked potential (CHEP) and triple stimulation technique (TST). Student′s t-tests were conducted to compare differences intra or inter groups of nerve conduction velocity and action potential of nerve conduction study, latency and interphase of SEP, initial peak latency of CHEP and other parameters. Results:Compared with the normative value, the amplitude of the sensory nerve action potential (SNAP) declined by 30%-80% in KD patients [median nerve (0.7±0.4) μV, ulnar nerve (0.8±0.3) μV, sural nerve (1.8±0.1) μV], the amplitude of the median and ulnar nerves was lower than the sural nerves ( t=2.43, P=0.010; t=2.40, P=0.010). The conduction time of peripheral segments of SEP and CHEP was prolonged by 115%-130%, while that of the central segments was prolonged by 104%-115% in SEP. TST test/TST control declined by 40%-60% in 17 patients with KD. The amplitude of SNAP declined by 30%-50% in patients with DPN [median nerve (2.9±0.5) μV, ulnar nerve (2.6±0.6) μV, sural nerve (1.6±0.2) μV], the amplitude of the sural nerves was lower than the median and ulnar nerves ( t=2.52, P=0.006; t=2.47, P=0.007). The conduction time of peripheral segments of SEP and CHEP was prolonged by 75%-112%, while that of the central segments was normal in both SEP and CHEP in DPN patients. Compared with DPN patients, the upper limb SNAP amplitude was lower in KD patients with the complication of diabetes mellitus [median nerve (0.7±0.3) μV, t=3.18, P=0.001; ulnar nerve (0.8±0.4) μV, t=3.20, P=0.001]. Conclusions:Sensory nerve is involved in patients with KD, including the large fiber and the small one. The central segments was abnormal in the deep sensory pathway, and the pyramid tract may be involved besides the anterior horn cell.

A novel spinal cord classification system: predict Intraoperative Neuromonitoring Event during correction of congenital kyphosis / 中华骨科杂志

Objective:To propose a novel classification system based on the morphology and relative position of spinal cord in the spinal canal at sagittal T2-MRI, and to investigate the incidence and risk factors of the intraoperative neuromonitoring event (IONME) across these classifications.Methods:From January 2016 to December 2021, a consecutive cohort of 85 patients who underwent surgical correction of congenital kyphosis with pedicle screw/rod constructs were retrospectively reviewed, including 43 males and 42 females, aged 14.6±6.1 years old. According to the morphology and relative location of spinal cord at the apex of the curve on the sagittal-T2 MRI, patients were divided into three groups. Type A (5 cases) is characterized by the spinal cord centrally positioned within the spinal canal, surrounded by discernible cerebrospinal fluid (CSF). Type B (33 cases) depicts the spinal cord abutting the spinal canal's anterior wall, maintaining its intrinsic morphology. In Type C (47 patients), the spinal cord is contorted by the apical vertebral body, devoid of interposing CSF. The global kyphosis (GK) and sagittal deformity ratio (SDAR) of patients were measured before surgery. The incidence of IONME were recorded. All patients included in the study were further divided into the IONME group and the non-IONME group. Potential risk factors were identified using univariate testing. Binary Logistic Regression was used to analyze the independent risk factors for IONM.Results:All of 85 patients were reviewed: 5 (5.9%) Type A; 33 (38.8%) Type B; and 47 (55.3%) Type C spinal cords. Intraoperatively, 27 (31.8%) instances presented with lost trans-cranial motor-evoked potentials (MEPs) and/or somatosensory evoked potentials (SSEPs). Of these, 2 (7.4%) were Type B, and 25 (92.6%) were Type C, reflecting a statistically significant variance in IONME occurrences across types (χ 2=27.15, P<0.001). Notable differences were observed between IONME and non-IONME groups concerning GK, SDAR, and apex location ( t=5.41, P<0.001; t=3.65, P<0.001; χ 2=7.71, P=0.005). Univariate analysis showed that potential risk factors of IONME included Type C spinal cord ( OR=20.46, P<0.001), higher GK ( OR=1.07, P<0.001), SDAR ( OR=1.15, P=0.002) and apical vertebrae located at middle thoracic( OR=4.30, P=0.008). Independent predictors identified on binary Logistics regression modeling included higher GK ( OR=1.05, P=0.015), Type C spinal cord ( OR=6.22, P=0.042) and apex located at middle thoracic ( OR=6.43, P=0.021). Specifically, within Type C, 79% of cases where the apical vertebra was mid-thoracic experienced IONME, contrasting the 42% incidence observed in those with a lower thoracic apex positioning, signifying a notably elevated IONME likelihood for the mid-thoracic region (χ 2=5.16, P=0.023). Conclusion:Risk factors of IONME included Type C spinal cord, higher GK and apex located at middle thoracic during correction of congenital kyphosis. Preoperative MRI spinal cord typing showed great predictive value for IONME.

Functional and prognostic assessment of children with severe disorders of consciousness using convalescent somatosensory evoked potentials / 中华物理医学与康复杂志

Objective:To explore the value of convalescent somatosensory evoked potentials (SEPs) in formulating a prognosis for children with severe disorders of consciousness (DOC) caused by brain trauma, infection or hypoxia.Methods:This was a retrospective cohort study of 286 children with DOC children treated between 2013 and 2021. They were divided into a trauma group ( n=103), an intracranial infection group ( n=101), a hypoxia group ( n=42) and an other-causes group ( n=40). Their consciousness status and functional recovery were obtained in follow-up appointments, and their functional condition 1 year after discharge was assessed using the modified Glasgow Outcome scale (GOS). Results:During 8-year follow-up, 16 had died, with 4 deaths within 1 year. Among the 191 cases followed up to 1 year, children with a bilateral N20 SEP had significantly better functional outcomes than those with unilateral or bilateral N20 absence. For the trauma group, the presence of a bilateral N20 signal was a strong indicator of good functional outcome at the 1-year follow-up, with a specificity of 90.9%, sensitivity of 55.6%, positive predictive value (PPV) of 92.6%, negative predictive value (NPV) of 50% and a positive likelihood rate (PLR) of 6.111. However, for the intracranial infection group, the presence of N20 had a low specificity for predicting good outcomes, though the absence of an N20 potential predicted poor functional outcome at 1 year with a specificity of 82.4%, sensitivity of 62.1%, PPV of 75%, and PLR of 3.517. For the hypoxic group, bilateral N20 could not predict a good prognosis, though its absence meant a poor outcome, with a specificity of 87.5%, sensitivity of 63.6%, PPV of 93.3%, and PLR of 5.818.Conclusion:SEPs during the recovery period can help to formulate a prognosis for children with severe DOC. Traumatic brain injury and the presence of bilateral N20 potentials can be used as a good prognostic indicator. For intracranial infection and hypoxic-ischemic brain injury, the absence of an N20 potential indicates a poor prognosis.

Siringomielia: revisión a propósito de un caso / Syringomyelia: review, case and report

La siringomielia supone un desafío diagnóstico, ya que es una entidad poco reconocida si no se tiene conciencia de su existencia. Al ser un cuadro progresivo, cuya clínica puede presentarse de forma larvada y ser coincidente con otras patologías neurológicas tales como la esclerosis múltiple, su detección suele realizarse en etapas tardías sobre todo en población adulta y más aún cuando se presenta de forma adquirida. Por lo que el estudio imagenológico con Resonancia Magnética adquiere especial relevancia, permitiendo identificar y clasificar la enfermedad, lo que brindará la base para decidir terapía.

Syringomyelia is a diagnostic challenge, since it is a poorly recognized disease, especially if its existence remains unknown. Being a progressive disease, whose clinic can present in a latent way and be coincident with other neurological pathologies such as multiple sclerosis, its detection is usually conducted in late stages, especially in the adult population and even more when it presents in an acquired way. Therefore, the imaging study with Magnetic Resonance acquires special relevance, allowing to be identified and classified, which will provide the basis for deciding on therapy

Changes in somatosensory perception induced by trigeminal injury after Maxillofacial Surgical Procedures / Cambios en la percepción somatosensorial inducidos por lesiones trigeminales causadas por procedimientos quirúrgicos maxilofaciales

Abstract Evidence has been reported that shows that somatosensory perception can be altered by a trigeminal injury resulting from maxillofacial surgical procedures. However, the surgical procedures that most frequently cause trigeminal lesions and the risk factors are unknown. In the same way, there is little information on what has been determined in preclinical models of trigeminal injury. This article integrates relevant information on trigeminal injury from both clinical findings and primary basic science studies. This review shows that the age and complexity of surgical procedures are essential to induce orofacial sensory alterations.

Resumen Se han reportado evidencias que demuestran que la percepción somatosensorial puede ser alterada por la lesión trigeminal producto de procedimientos quirúrgicos maxilofaciales. Sin embargo, se desconoce cuáles son los procedimientos quirúrgicos que más frecuentemente producen lesiones trigeminales, y los factores de riesgo. De la misma forma hay poca información sobre lo que se ha determinado en modelos preclínicos de lesión trigeminal. El objetivo de este artículo es integrar información relevante sobre la lesión trigeminal desde los hallazgos clínicos como los principales estudios de ciencia básica. Esta revisión demuestra que la edad y el tipo de procedimiento son fundamentales para inducir alteraciones sensoriales orofaciales, así como los procesos neurobiológicos que subyacen a estos padecimientos.

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.

Seventy years since the invention of the averaging technique in Neurophysiology: Tribute to George Duncan Dawson / 70 anos da invenção da técnica de promediação na Neurofisiologia: Tributo a George Duncan Dawson

ABSTRACT In 1951, the physiologist George Duncan Dawson presented his work with the averaging of the signal in the evoked potentials (EPs), opening a new stage in the development of clinical neurophysiology. The authors present aspects of Professor Dawson's biography and a review of his work on the EPs and, mainly, the article reveals the new technique in detail that would allow the growth of the clinical application of the visual, auditory, and somatosensory EPs.

RESUMO Em 1951 o fisiologista George Duncan Dawson apresentou seu trabalho com a promediação de sinal nos potenciais evocados, abrindo uma nova etapa no desenvolvimento da neurofisiologia clínica. Os autores apresentam aspectos da biografia do professor Dawson e uma revisão de seus trabalhos sobre os potenciais evocados, principalmente do artigo que mostrava a nova técnica, que viria a permitir o crescimento da aplicação clínica dos potenciais evocados visual, auditivo e somatossensitivo.

Effects of Suspension Exercise Therapy Combined with Soft Tissue Manipulation on Upper Limb Sensory Function in Patients with Radicular Cervical Spondylosis / 医用生物力学

bjective To observe the changes of upper extremity sensory function in patients with radicular cervical spondylosis and evaluate the treatment effect, by using the method of suspension exercise therapy (SET) and soft tissue manipulation. Methods A total of 72 patients with cervical spondylosis were divided into observation group (treated by SET combined with manipulation)and control group (treated by purely cervical traction) by simple random method. Both groups received 4-week continuous treatment for 6 times per week. The somatosensory evoked potential(SEP), current perception threshold (CPT) before and after the treatment in two groups were separatedly tested, and changes in visual analogue scale (VAS) pain scores of the affected limbs were examined, so as to determine the effective rate of treatment. Results After treatment, the latency of SEP was shortened mainly in brachial plexus potential N9 and cervical spinal potential N13 in two groups (P<0.05). The CPT levels and the VAS pain scores of the affected limbs were reduced in two groups (P<0.01), and the treatment effect in observation group was better that in control group (P<0.01)．Conclusion SET combined with soft tissue manipulation can effectively promote the repair of nerve sense function of cervical spondylotic radiculopathy.

Effect of somatosensory motor combined with neuromuscular acupoint electrical stimulation on motor function and blood glucose amongpatients with type 2 diabetes mellitus / 预防医学

Objective@#To evaluate the effect of high-intensity interval somatosensory training combined with neuromuscular acupoint electrical stimulation on blood glucose and motor function among patients with type 2 diabetes mellitus (T2DM), so as to provide insights into prevention of daily life disability among T2DM patients.@*Methods@#T2DM patients treated in Zhejiang Hospital during the period from January 2019 to October 2021 were enrolled and randomly assigned into four groups. Patients in the K group received Kinect somatosensory interaction technology-assisted high-intensity interval training, patients in the N group received neuromuscular acupoint electrical stimulation, and patients in the KN group received high-intensity interval somatosensory training combined with neuromuscular acupoint electrical stimulation, while patients in the C group were given no interventions. The 2 h postprandial plasma glucose and glycated haemoglobin (HbA1c) levels were measured prior to interventions and 4 and 12 weeks post-interventions, and seven physical fitness tests were performed. The blood glucose levels and motor activity were compared among four groups using generalized estimating equations to evaluate the effectiveness of interventions.@*Results@#Totally 199 T2DM patients were enrolled, including 51 patients in the KN group, 49 patients in the K group, 52 patients in the N group and 47 patients in the C group. There were no significant differences in gender, age, course of disease, duration of daily exercises, waist-to-hip ratio, vital capacity or maximal oxygen uptake among the four groups prior to interventions (all P>0.05). There were time-group interaction effects in blood glucose and exercise parameters among the four groups post-interventions (all P>0.05), with the largest changes seen in the KN group. The HbA1c, 2 h postprandial plasma glucose, 2.4 m standing and detour test and back scratch test results reduced by 17.06%, 27.01%, 36.52% and 20.94% 12 weeks post-interventions as compared to those prior to interventions, while 2 min stepping test, 30 s sit-ups, 30 s loading and elbow flexion test, 6 min walking test and sit and reach test results increased by 18.85%, 34.69%, 15.41%, 7.22% and 112.37%, respectively.@*Conclusion@#High-intensity interval somatosensory training combined with neuromuscular acupoint electrical stimulation may improve the blood glucose and motor activity among patients with T2DM.

Effect of sling exercise therapy combined with Tuina on nerve conduction of upper extremities after radicular cervical spondylosis / 中国康复理论与实践

@#Objective To observe the effect sling exercise therapy (SET) and Tuina on radicular cervical spondylosis. Methods From August, 2015 to December, 2016, 72 patients with radicular cervical spondylosis were randomly divided into control group (n = 36) and trial group (n = 36), who accepted traction and SET+Tuina, respectively, for four weeks. They were measured F-wave conduction velocity with electromyogram from median nerve and ulnar nerve, somatosensory evoked potential (SEP), and current perception threshold (CPT) before and after treatment. The clinical ratio of improvement was calculated. Results The ratio of improvement was 83.33% in the trial group more than 58.33% in the control group (Z = 2.093, P < 0.05). F-wave conduction velocity increased in both groups after treatment (t > 12.059, P < 0.001), and increased more in the trial group than in the control group (t > 3.266, P < 0.01); while the latency of SEP decreased in N9 and N13 in both groups (t > 7.061, P < 0.001), and decreased more in the trial group than in the control group (t > 8.033, P < 0.001); the grade of CPT decreased in both groups (t > 8.895, P < 0.001), and decreased more in the trial group than in the control group (t = 8.913, P < 0.001). Conclusion The combination of SET and Tuina can promote the repair of nerve conduction of cervical spondylotic radiculopathy.

Diagnostic properties of sensitivity changes in patients with maxillofacial fractures: a systematic review

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient's report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient's peripheral nervous situation

Somatosensory evoked potentials in clinical practice: a review / Potenciais evocados somatossensitivos na prática clínica: uma revisão

Abstract The authors present a review of the current use of somatosensory evoked potentials (SSEPs) in neurological practice as a non-invasive neurophysiological technique. For this purpose we have reviewed articles published in English or Portuguese in the PubMed and LILACS databases. In this review, we address the role of SSEPs in neurological diseases that affect the central nervous system and the peripheral nervous system, especially in demyelinating diseases, for monitoring coma, trauma and the functioning of sensory pathways during surgical procedures. The latter, along with new areas of research, has become one of the most important applications of SSEPs.

Resumo Os autores apresentam uma revisão do uso atual do potencial evocado somatossensitivo (PESS) na prática neurológica como uma técnica neurofisiológica não invasiva. Revisamos artigos publicados em Inglês ou Português nas bases de dados PubMed e LILACS. Nesta revisão abordamos o papel do PESS nas doenças neurológicas que atingem o sistema nervoso central e o sistema nervoso periférico, especialmente, nas doenças desmielinizantes, no monitoramento do coma, do trauma e da função das vias sensitivas durante os procedimentos cirúrgicos, que se tornou uma de suas aplicações mais importantes, assim como novas áreas de pesquisa.

Application of multi-mode electrophysiological monitoring in highly selective posterior rhizotomy for patients with spastic cerebral palsy / 西安交通大学学报(医学版)

【Objective】 To explore the application of multi-mode electrophysiological monitoring technology in highly selective posterior rhizotomy (SPR) of patients with spastic cerebral palsy. 【Methods】 We retrospectively collected data on patients with systolic cerebral palsy who underwent SPR in our hospital from January 2019 to December 2019. Bispectral index (BIS), somatosensory evoked potentials (SEP) and electromyography during surgery of all the patients were measured. We used EMG to monitor the depth of the anus, spinal cord function, and the stimulation response of multiple muscle groups, and recorded and summarized abnormal intraoperative electrophysiological monitoring, surgical treatment and complications during displacement and discharge, and relief and exercise functional recovery six months after the surgery. 【Results】 The intraoperative BIS parameters of 18 patients were 60-75, the EMG amplitude was abnormal in 1 case (5.6%), and the SEP amplitude decreased in 1 case (5.6%). The preoperative muscle tension of both lower extremities was 3.6 on average, and the postoperative muscle tension was 1.4, with a decrease by 2.2 grades. There were 16 cases (88.9%) in long-term follow-up, among which 12 cases (75%) had complete relief of spasm, 4 cases (25%) had significant improvement, gait function improvement rate was 100%, and no complications occurred. 【Conclusion】 Multi-mode electrophysiological monitoring technology is an effective method for SPR to increase the success rate of surgery. It can increase the accuracy of the ratio of posterior root resection of spinal nerves, reduce the risk of spinal cord damage, and improve the poor prognosis.

Application of multimodal intraoperative neurophysiological monitoring in cervical spine surgery / 西安交通大学学报(医学版)

【Objective】 To explore the application of multi-mode electrophysiological monitoring technology in cervical spine surgery. 【Methods】 We retrospectively collected data of patients who received cervical spine surgery in Department of Neurosurgery of our hospital in January 2018 to December 2019. All patients were guided by the bispectral index (BIS) to control the depth of anesthesia. High cervical spine lesions were treated with somatosensory evoked potentials (SEP), motor evoked potentials (MEP), brainstem auditory evoked potentials(BAEP)and electromyography (EMG) monitoring. We selected SEP, MEP and EMG combined monitoring for low cervical nerve and spinal cord injury, recorded and summarized the abnormalities of intraoperative electrophysiological monitoring, surgical efficacy and complications at the time of discharge and 6 months after surgery. 【Results】 The intraoperative BIS parameters of 112 patients were 45-60, the MEP amplitude decreased in 9 cases (8.0%), the SEP amplitude decreased in 4 cases (3.6%), the EMG amplitude was abnormal in 5 cases (4.5%), and the BAEP amplitude decreased in 4 cases (3.6%); no operation was terminated due to significant abnormalities in monitoring. Compared with 44 cases (39.3%) before operation, 112 patients had little change in SEP and MEP amplitudes, 35 cases (31.3%) had a slight increase in SEP amplitude, 2 cases (1.8%) had a slight decrease, 24 cases (21.4%) had slightly increased MEP amplitude, while 7 cases (6.3%) had slightly decreased one. There were no new neurological disorders at the time of postoperative discharge and 6 months after surgery. 【Conclusion】 Multi-mode electrophysiological monitoring shows the recovery of damaged nerve electrophysiological activity immediately after the operation, which provides an objective basis for the recovery of nerve function, and can effectively prevent and reduce iatrogenic spinal cord and nerve function damage, and improve the efficacy of surgery.

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.

Effect of Acupuncture Stimulation on the Long Latency Reflex / 全日本鍼灸学会雑誌

[Objectives] In this study, we examined the effects of acupuncture stimulation on short latency reflexes (SLR) and long latency reflexes (LLR) to determine the site of acupuncture stimulation in modulating motor reflexes. Further, we investigated the relationship between changes in LLR and changes in the N20 somatosensory evoked potential (SEP) component induced by acupuncture stimulation and examined changes in central motor conduction time (CMCT).[Subjects and Methods] Sixteen healthy and right-handed adults (11 males and 5 females; 28.9 ± 6.6 years old; upper limb length 54.9 ± 3.2 cm) participated in this study. The experiments were performed under three conditions: (1) control (no acupuncture stimulation), (2) acupuncture stimulation of right-sided Hegu (LI4), and (3) acupuncture stimulation of left-sided LI4. An acupuncture needle (0.18 mm in diameter) was inserted up to a depth of 10 mm at the right- or left-sided LI4. Electrical stimulation was delivered to the median nerve in the right hand joint at a 120% intensity compared with the threshold to produce an M-wave. SLR and LLR were recorded from the opponens pollicis muscle of the right hand. The frequency and amplitude ratio of SLR (latency, approximately 20-30 ms) and LLR (latency, approximately 40-70 ms) were analyzed. SEP was produced by electrical stimulation delivered to the median nerve. The amplitude from baseline and mean latency of N20 waves were measured. F-wave in the evoked electromyography was evoked by electrical stimulation of the median nerve of the right hand at supramaximal intensity to elicit an M-wave and recorded from the opponens pollicis muscle of the same hand. We analyzed the mean latency and calculated the CMCT using the mean latencies of LLR, N20, F-wave, and M-wave.[Results] The frequency and amplitude ratio of SLR were reduced by acupuncture stimulation of left- and right-sided LI4, respectively. LLR frequency and amplitude ratio were reduced by acupuncture stimulations on either side. A correlation was observed between changes in the LLR amplitude ratio and changes in the N20 SEP amplitude ratio induced by acupuncture stimulation. No effect of acupuncture stimulation was observed on CMCT. [Discussion and Conclusion] SLR is the reflex potential of the spinal cord, and LLR is the motor reflex of the central nervous system via supraspinal pathways. These findings suggest that acupuncture stimulation inhibits motor nerve reflexes via both spinal and supraspinal modulation systems.

Utilização de monofilamentos para avaliação sensorial em pacientes com sequela de Acidente Vascular Encefálico (AVE) - uma revisão sistemática / Use of monofilaments for sensory evaluation in patients with sequelae of stroke - a systematic review

FUNDAMENTO: A estesiometria é um teste quantitativo para avaliar o desempenho tátil sensorial, verificar o grau de sensibilidade cutânea por meio dos monofilamentos de nylon ao toque leve e à pressão. OBJETIVO: Verificar a utilização dos monofilamentos como instrumento de avaliação da sensibilidade de pacientes com sequela de AVE na literatura. MÉTODO: Estudo de revisão sistemática, realizado com artigos indexados na base de dados PubMed, Lilacs e Scielo, sem limitação por data de publicação, sendo a busca realizada no mês de outubro de 2018. RESULTADOS: Foram elencados dezessete estudos, após análise destes, nove foram excluídos por não preencherem os critérios de inclusão, e oito foram lidos na íntegra. Após leitura dos artigos, foram obtidos os dados referentes a: número da amostra, instrumentos de avaliação, se houve ou não intervenção, e a conclusão do estudo. CONCLUSÃO: Por mais promissor que seja o uso dos monofilamentos para avaliação sensorial, esta revisão mostrou que existem poucos estudos avaliando os pacientes com sequela de AVE com este método de avaliação, principalmente estudos clínicos.

BACKGROUND:The esthesiometry is a quantitative test to evaluate the tactile sensory performance, to verify the degree of cutaneous sensitivity through nylon monofilaments to light touch and pressure. OBJECTIVE: To verify the use of monofilaments as a tool to assess the sensitivity of patients with a sequel to stroke in the literature. METHOD: A systematic review study was carried out with articles indexed in the PubMed, Lilacs and Scielo database, without limitation by date of publication. The search was carried out in October 2018. RESULTS: Seventeen studies were analyzed, after analyzing nine were excluded because they did not meet the inclusion criteria, and eight were read in full. After reading the articles, data were obtained regarding: sample number, evaluation instruments, whether or not there was intervention, and the conclusion of the study. CONCLUSION: As promising as it may be the use of monofilaments for sensory evaluation, this review showed that there are few studies evaluating patients with sequelae of stroke with this method of evaluation, mainly clinical studies.

From anatomy to function: the role of the somatosensory cortex in emotional regulation

Since the pioneering work of Penfield and his colleagues in the 1930s, the somatosensory cortex, which is located on the postcentral gyrus, has been known for its central role in processing sensory information from various parts of the body. More recently, a converging body of literature has shown that the somatosensory cortex also plays an important role in each stage of emotional processing, including identification of emotional significance in a stimulus, generation of emotional states, and regulation of emotion. Importantly, studies conducted in individuals suffering from mental disorders associated with abnormal emotional regulation, such as major depression, bipolar disorder, schizophrenia, post-traumatic stress disorder, anxiety and panic disorders, specific phobia, obesity, and obsessive-compulsive disorder, have found structural and functional changes in the somatosensory cortex. Common observations in the somatosensory cortices of individuals with mood disorders include alterations in gray matter volume, cortical thickness, abnormal functional connectivity with other brain regions, and changes in metabolic rates. These findings support the hypothesis that the somatosensory cortex may be a treatment target for certain mental disorders. In this review, we discuss the anatomy, connectivity, and functions of the somatosensory cortex, with a focus on its role in emotional regulation.