The Use of Transcranial Magnetic Stimulation for Monitoring Descending Spinal Cord Motor Function
This report describes our initial clinical experience using transcranial magnetic stimulation for monitoring spinal cord motor function during surgical procedures. Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor respon...
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| Veröffentlicht in: | Clinical EEG and neuroscience 2002-01, Vol.33 (1), p.30-41 |
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| creator | Aglio, Linda S. Romero, Rafael Desai, Sukumar Ramirez, Marcela Gonzalez, Andres A. Gugino, Laverne D. |
| description | This report describes our initial clinical experience using transcranial magnetic stimulation for monitoring spinal cord motor function during surgical procedures. Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor responses (compound muscle action potentials – CMAPs) from the upper (N=1) or lower limbs (N=26). Wherever possible, cortical somatosensory responses (SEPs) were also monitored by electrically stimulating the left and right posterior tibial nerve (N=25) or the median nerve (N=1). The judicious choice of anesthetic regimens resulted in successfully obtaining motor evoked responses (MEPs) in 21 of 27 patients and SEPs in 26 of 27 patients. Single pulse TMS resulted in peripheral muscle responses having large variability, whereas, the variability of SEPs was much less. Criteria based on response variability for assessing clinically significant changes in both MEPs and SEPs resulted in two false negative predictions for SEPs and none for MEPs when evaluating postoperative motor function. We recommend monitoring both sensory and motor pathways during procedures where placing the spinal cord at risk of damage. |
| doi_str_mv | 10.1177/155005940203300106 |
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Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor responses (compound muscle action potentials – CMAPs) from the upper (N=1) or lower limbs (N=26). Wherever possible, cortical somatosensory responses (SEPs) were also monitored by electrically stimulating the left and right posterior tibial nerve (N=25) or the median nerve (N=1). The judicious choice of anesthetic regimens resulted in successfully obtaining motor evoked responses (MEPs) in 21 of 27 patients and SEPs in 26 of 27 patients. Single pulse TMS resulted in peripheral muscle responses having large variability, whereas, the variability of SEPs was much less. Criteria based on response variability for assessing clinically significant changes in both MEPs and SEPs resulted in two false negative predictions for SEPs and none for MEPs when evaluating postoperative motor function. 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Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor responses (compound muscle action potentials – CMAPs) from the upper (N=1) or lower limbs (N=26). Wherever possible, cortical somatosensory responses (SEPs) were also monitored by electrically stimulating the left and right posterior tibial nerve (N=25) or the median nerve (N=1). The judicious choice of anesthetic regimens resulted in successfully obtaining motor evoked responses (MEPs) in 21 of 27 patients and SEPs in 26 of 27 patients. Single pulse TMS resulted in peripheral muscle responses having large variability, whereas, the variability of SEPs was much less. Criteria based on response variability for assessing clinically significant changes in both MEPs and SEPs resulted in two false negative predictions for SEPs and none for MEPs when evaluating postoperative motor function. We recommend monitoring both sensory and motor pathways during procedures where placing the spinal cord at risk of damage.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Cortex</subject><subject>Evoked Potentials, Motor - physiology</subject><subject>Evoked Potentials, Somatosensory</subject><subject>Female</subject><subject>Fractures</subject><subject>Humans</subject><subject>Magnetic fields</subject><subject>Male</subject><subject>Median nerve</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative</subject><subject>Monitoring, Physiologic</subject><subject>Motor evoked potentials</subject><subject>Muscles</subject><subject>Neurosurgical Procedures</subject><subject>Patients</subject><subject>Pyramidal Tracts - physiology</subject><subject>Scalp</subject><subject>Scoliosis</subject><subject>Somatosensory evoked potentials</subject><subject>Spinal cord</subject><subject>Spinal Cord - physiology</subject><subject>Tibial nerve</subject><subject>Transcranial Magnetic Stimulation</subject><subject>Variability</subject><issn>0009-9155</issn><issn>1550-0594</issn><issn>2169-5202</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1LAzEQhoMotlT_gAcJCN5WZ7LZzeYo9RMqHqznJd1ka8o2qcnuwX9vSguK4iWTMM_7zmSGkDOEK0QhrrEoAArJgUGeAyCUB2TMsJRZwYAdkjEAyEwmbEROY1zB9i0SJ4_JKDnIhMkxUfN3Q9-iob6l86BcbNJhVUef1dKZ3jb0tbfroVO99Y62PtBn72zvg3VLemtiY5zeXl831iXV1AediJSn94NrtqITctSqLprTfZyQt_u7-fQxm708PE1vZlmTl6LPmC60UbpVuUaRflVyDmXLUXGldaFkUckSW80WxgiNHHHBBOcpX1VMMAH5hFzufDfBfwwm9vXapva6Tjnjh1gL5MCZwARe_AJXfgip-1ijrKpcYJHzRLEd1QQfYzBtvQl2rcJnjVBvN1D_3UASne-th8Xa6G_Jft4JuN4BUS3Nj7r_W34BaxWMVA</recordid><startdate>200201</startdate><enddate>200201</enddate><creator>Aglio, Linda S.</creator><creator>Romero, Rafael</creator><creator>Desai, Sukumar</creator><creator>Ramirez, Marcela</creator><creator>Gonzalez, Andres A.</creator><creator>Gugino, Laverne D.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200201</creationdate><title>The Use of Transcranial Magnetic Stimulation for Monitoring Descending Spinal Cord Motor Function</title><author>Aglio, Linda S. ; Romero, Rafael ; Desai, Sukumar ; Ramirez, Marcela ; Gonzalez, Andres A. ; Gugino, Laverne D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c367t-2d5deadfa3d1740264406f41a4add5a958961fd2bee7d1411b274441a88272703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Cortex</topic><topic>Evoked Potentials, Motor - physiology</topic><topic>Evoked Potentials, Somatosensory</topic><topic>Female</topic><topic>Fractures</topic><topic>Humans</topic><topic>Magnetic fields</topic><topic>Male</topic><topic>Median nerve</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative</topic><topic>Monitoring, Physiologic</topic><topic>Motor evoked potentials</topic><topic>Muscles</topic><topic>Neurosurgical Procedures</topic><topic>Patients</topic><topic>Pyramidal Tracts - physiology</topic><topic>Scalp</topic><topic>Scoliosis</topic><topic>Somatosensory evoked potentials</topic><topic>Spinal cord</topic><topic>Spinal Cord - physiology</topic><topic>Tibial nerve</topic><topic>Transcranial Magnetic Stimulation</topic><topic>Variability</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aglio, Linda S.</creatorcontrib><creatorcontrib>Romero, Rafael</creatorcontrib><creatorcontrib>Desai, Sukumar</creatorcontrib><creatorcontrib>Ramirez, Marcela</creatorcontrib><creatorcontrib>Gonzalez, Andres A.</creatorcontrib><creatorcontrib>Gugino, Laverne D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical EEG and neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aglio, Linda S.</au><au>Romero, Rafael</au><au>Desai, Sukumar</au><au>Ramirez, Marcela</au><au>Gonzalez, Andres A.</au><au>Gugino, Laverne D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Use of Transcranial Magnetic Stimulation for Monitoring Descending Spinal Cord Motor Function</atitle><jtitle>Clinical EEG and neuroscience</jtitle><addtitle>Clin Electroencephalogr</addtitle><date>2002-01</date><risdate>2002</risdate><volume>33</volume><issue>1</issue><spage>30</spage><epage>41</epage><pages>30-41</pages><issn>0009-9155</issn><issn>1550-0594</issn><eissn>2169-5202</eissn><abstract>This report describes our initial clinical experience using transcranial magnetic stimulation for monitoring spinal cord motor function during surgical procedures. Motor evoked potentials were elicited using a cap shaped coil placed on the scalp of 27 patients while recording peripheral motor responses (compound muscle action potentials – CMAPs) from the upper (N=1) or lower limbs (N=26). Wherever possible, cortical somatosensory responses (SEPs) were also monitored by electrically stimulating the left and right posterior tibial nerve (N=25) or the median nerve (N=1). The judicious choice of anesthetic regimens resulted in successfully obtaining motor evoked responses (MEPs) in 21 of 27 patients and SEPs in 26 of 27 patients. Single pulse TMS resulted in peripheral muscle responses having large variability, whereas, the variability of SEPs was much less. Criteria based on response variability for assessing clinically significant changes in both MEPs and SEPs resulted in two false negative predictions for SEPs and none for MEPs when evaluating postoperative motor function. We recommend monitoring both sensory and motor pathways during procedures where placing the spinal cord at risk of damage.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>11795209</pmid><doi>10.1177/155005940203300106</doi><tpages>12</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anesthesia Cortex Evoked Potentials, Motor - physiology Evoked Potentials, Somatosensory Female Fractures Humans Magnetic fields Male Median nerve Middle Aged Monitoring, Intraoperative Monitoring, Physiologic Motor evoked potentials Muscles Neurosurgical Procedures Patients Pyramidal Tracts - physiology Scalp Scoliosis Somatosensory evoked potentials Spinal cord Spinal Cord - physiology Tibial nerve Transcranial Magnetic Stimulation Variability |
| title | The Use of Transcranial Magnetic Stimulation for Monitoring Descending Spinal Cord Motor Function |
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