ABSTRACT
UNLABELLED: Transcranial motor stimulation with noninvasive cortical surface stimulation, using a high-intensity magnetic field referred to as transcranial magnetic stimulation generally, is considered a nonpainful technique. In contrast, transcranial electric stimulation of the motor tracts typically cannot be done in unanesthesized patients. Intraoperative monitoring of motor tract function with transcranial electric stimulation is considered a standard practice in many institutions for patients during surgical procedures in which there is potential risk of motor tract impairment so that the risk of paraplegia or paraparesis can be reduced. Because transcranial electric stimulation cannot be typically done in the outpatient setting, transcranial magnetic stimulation may be able to provide a well-tolerated method for evaluation of the corticospinal motor tracts before surgery. METHODS: One hundred fifty-five patients aged 5 to 20 years were evaluated preoperatively with single-stimulation nonrepetitive transcranial magnetic stimulation for preoperative assessment. RESULTS AND CONCLUSIONS: The presence of responses to transcranial magnetic stimulation reliably predicted the presence of responses to transcranial electric stimulation intraoperatively. No complications occurred during the testing, and findings were correlated to the clinical history and used in the setup of the surgical monitoring.
Subject(s)
Efferent Pathways/physiology , Evoked Potentials, Motor/physiology , Motor Cortex/physiology , Preoperative Care/methods , Transcranial Magnetic Stimulation/methods , Adolescent , Child , Child, Preschool , Electric Stimulation/methods , Electroencephalography , Female , Humans , Male , Monitoring, Intraoperative/methods , Preoperative Care/instrumentation , Preoperative Care/standards , Reproducibility of Results , Spinal Diseases/diagnosis , Spinal Diseases/physiopathology , Spinal Diseases/surgery , Transcranial Magnetic Stimulation/instrumentation , Transcranial Magnetic Stimulation/standardsABSTRACT
Concussion is a potentially serious injury for athletes. Recent statistics suggest that approximately 300,000 sports-related traumatic brain injuries occur annually in the United States. Soccer, rugby, football, and ice hockey are all considered high-risk team sports for concussion. Hockey-related concussions are of particular concern in Canada, where over 500,000 players compete annually in ice hockey. The United States is now registering similar numbers of players. Return to play issues are one of the most difficult issues for physicians caring for concussed athletes. The advent of computerized neuropsychological testing adds another tool to assist in this process. It also appears to enhance the education process for players, coaches, and parents on the potential seriousness of concussion for these young athletes.
