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Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162:129-140. [PMID: 38615499 DOI: 10.1016/j.clinph.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). METHODS Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA). RESULTS 83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD). CONCLUSIONS OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response. SIGNIFICANCE These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
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Affiliation(s)
- Nicolau Guanyabens
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Funakawa K, Kurihara M, Takahashi K, Higashihara M, Hara M, Mitsutake A, Ishiura H, Tokumaru AM, Sonoo M, Murayama S, Saito Y, Iwata A. Proximal sensory neuropathy and cerebellar ataxia as presenting symptoms of NOTCH2NLC-related neuronal intranuclear inclusion disease. J Neurol Sci 2024; 458:122915. [PMID: 38326182 DOI: 10.1016/j.jns.2024.122915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/21/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Kai Funakawa
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Kurihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Kensuke Takahashi
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mana Higashihara
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Manato Hara
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Akihiko Mitsutake
- Department of Neurology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Neurology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aya Midori Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeo Murayama
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders, Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Yuko Saito
- Department of Neuropathology (Brain Bank for Aging Research), Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Nagao K, Kadoya M, Shimizu Y, Murahara N, Fujii H, Takechi C, Aono S. Magnetic Resonance Imaging-negative Acute Inflammatory Myelopathy following Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Intern Med 2023; 62:2267-2272. [PMID: 37164679 PMCID: PMC10465296 DOI: 10.2169/internalmedicine.1344-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/23/2023] [Indexed: 05/12/2023] Open
Abstract
A 55-year-old woman was admitted to our hospital because of gait disturbance and urinary retention that acutely emerged 1 week after severe acute respiratory syndrome coronavirus 2 infection. Acute inflammatory myelopathy was clinically suspected, based on bilateral lower-limb weakness with an extensor plantar response and an elevated immunoglobulin G level in the cerebrospinal fluid. Whole-spine magnetic resonance imaging findings were normal. The central conduction time was extended, based on somatosensory evoked potentials. Her lower-limb weakness was partially ameliorated with immunosuppressive therapy. Postinfectious myelopathy is a rare neurological complication of coronavirus disease 2019 and can develop with normal radiological findings.
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Affiliation(s)
- Kaori Nagao
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Masato Kadoya
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Yukie Shimizu
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Nami Murahara
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Hiroko Fujii
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Chizuko Takechi
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Shigeaki Aono
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
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Matsukura K, Hokkoku K, Mukai T, Oishi C, Kanbayashi T, Takahashi T, Sonoo M. Tibial nerve SEPs in diagnosing lumbar spinal stenosis: The utility of segmental evaluation using P15 and N21. Clin Neurophysiol Pract 2023; 8:49-57. [PMID: 37008279 PMCID: PMC10064344 DOI: 10.1016/j.cnp.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Objective To establish the utility of the additional evaluation of the P15 potential generated at the greater sciatic foramen in the tibial nerve somatosensory evoked potentials (SEPs) in diagnosing lumbar spinal stenosis (LSS). Methods We retrospectively reviewed tibial nerve SEP findings in patients having MRI-confirmed LSS at the cauda equina or conus/epiconus region. P15 and N21 potentials were recorded and the following findings were defined as localizing abnormalities: 1) normal P15 latency either with prolonged P15-N21 interval or with absent N21; 2) decreased ratio of the N21 amplitude to P15 amplitude. As non-localizing abnormalities, N21 and P38 latencies were also evaluated. Tibial nerve F-wave findings were also investigated. Results According to the entry criteria, 18 patients were included, 15 with cauda equina lesions and 3 with conus/epiconus lesions. Localizing abnormalities in SEPs were found in 67% of patients, achieving significantly higher sensitivity than delayed P38 latency (28%), and higher sensitivity than N21 abnormalities (39%), though this was not significant. Localizing abnormalities were observed even in 6 out of 11 patients lacking both sensory symptoms and signs. Tibial nerve F-wave was abnormal in 36% of 14 patients with F-wave examinations, whereas the localizing abnormalities in SEPs were found in 64% of the same patient population. P15 amplitude was depressed in 4 patients (22%), which may indicate the involvement of the dorsal root ganglion in LSS, although its latency was normal even for these patients. Conclusions Tibial nerve SEPs with the recording of P15 and N21 potentials achieved sufficiently high sensitivity in diagnosing LSS. They have the advantage over F-wave in that they can localize the lesion at the cauda equina or conus/epiconus level. Significance Tibial nerve SEPs are promising in evaluating LSS, especially in documenting sensory tract involvement in cases lacking sensory symptoms/signs.
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Kanbayashi T, Ogawa G, Ito T, Hokkoku K, Oishi C, Hatanaka Y, Sonoo M. Utility of the tibial nerve somatosensory evoked potentials in differentiating between neuromyelitis optica spectrum disorders and multiple sclerosis. Mult Scler Relat Disord 2023; 70:104503. [PMID: 36610361 DOI: 10.1016/j.msard.2023.104503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/24/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Somatosensory evoked potentials (SEPs) are widely used for the diagnosis and evaluation of neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). However, whether the parameters of tibial nerve SEPs can help to distinguish NMOSD from MS remains unclear. Thus, the aim of this study was to investigate the utility of tibial nerve SEP parameters in differentiating patients with NMOSD and MS. METHODS The clinical data of patients with NMOSD or MS treated in our institution between 2005 and 2021 were retrospectively extracted from our electronic database. Additional inclusion criteria were presentation with sensory symptoms in the lower extremities with corresponding lesions in the magnetic resonance images as well as available data on anti-aquaporin-4 antibodies and tibial nerve SEPs. The Z-scores of the N21-P38 interval (central sensory conduction time), P38 latency, and P38 amplitude were compared between the patients with NMOSD and MS. The relationship of disease severity with the parameters of the tibial nerve SEPs was also evaluated. RESULTS Twenty patients with NMOSD and 13 patients with MS were enrolled. The Z-scores of the N21-P38 interval and P38 latency were significantly higher in the MS group than in the NMOSD group (p < 0.05 and p < 0.01, respectively), whereas there was no difference in the Z-scores of the P38 amplitude between the two groups. In the MS group, only the N21-P38 interval and P38 latency were significantly correlated with disease severity (p < 0.05 and p < 0.01, respectively). In contrast, none of the tibial nerve SEP parameters were significantly correlated with disease severity in the NMOSD group. CONCLUSION Evaluation of the N21-P38 interval and P38 latency in tibial nerve SEPs potentially helps in differentiating between NMOSD and MS.
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Affiliation(s)
- Takamichi Kanbayashi
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
| | - Go Ogawa
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
| | - Tatsuya Ito
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
| | - Chizuko Oishi
- Department of Neurology, Faculty of Medicine, Kyorin University, Tokyo, Japan.
| | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Tokyo 1738605, Japan.
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Imajo Y, Nishida N, Funaba M, Nagao Y, Suzuki H, Sakai T. The reference intervals of intraoperative posterior tibial nerve somatosensory evoked potentials. J Orthop Sci 2022; 27:774-779. [PMID: 34330609 DOI: 10.1016/j.jos.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND A reference interval exists for posterior tibial nerve somatosensory evoked potentials (PTN-SEPs) in awake. However, the reference interval for intraoperative- PTN-SEPs (I-PTN-SEPs) remains unclear. As a substitute for PTN-SEPs in awake, we considered I-PTN-SEPs can provide functional information about the dorsal somatosensory system. No report evaluated the physiologic and analytical issues in the measurement of I-PTN-SEPs. We investigated the sources of variation and reference intervals for I-PTN-SEPs. METHODS We studied 143 patients with unilateral radiculopathy and without neurologic deficit who underwent surgery. Stimulation was delivered to the PTN at the ankle. The scalp recording electrode was placed at the Cz with a reference electrode located on the forehead at the Fz. SEPs were recorded from patients during electrical stimulation of the I-PTN. RESULTS P1 and N1 latencies showed significant positive linear correlations with age (P1 latency = 36.52 + 0.0814 × age, P = 0.00003; N1 latency = 46.21 + 0.081 × age, P = 0.00022), and body height (P1 latency = 16.94 + 14.91 × body height, P = 0.00000; N1 latency = 25.42 + 15.64 × body height, P = 0.00002). In contrast, I-PTN-SEPs amplitude showed no correlation with age or body height. The 95% confidence interval for I-PTN-SEPs amplitude, or the reference interval, was determined as 0.31-5.91 μV. CONCLUSIONS The lower normal limit value was 0.31 μV, and this reference interval may be useful to evaluate function of the posterior funiculus, such that as during surgery for patients with intramedullary tumor.
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Affiliation(s)
- Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan.
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan
| | - Yuji Nagao
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan
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Takahashi K, Oishi C, Hamada Y, Nishiyama K, Sonoo M. The influence of right-left error in the placement of the Cc electrode in tibial nerve somatosensory evoked potentials (SEPs). Clin Neurophysiol Pract 2021; 6:215-218. [PMID: 34386647 PMCID: PMC8342850 DOI: 10.1016/j.cnp.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022] Open
Abstract
The Cz’–Cc lead in tibial nerve SEPs has a merit that it registers a stable P38 wave. Right-left error in the placement of the Cc electrode distorted SEP results. P38 disappeared by this error and a later component was misidentified as P38.
Objective At our laboratory, we routinely record tibial nerve somatosensory evoked potentials (SEPs) using 5 channels including the second cervical vertebra (C2S)-contralateral central area (Cc) and Cz’ (2 cm posterior to Cz)–Cc derivations. In a man with lumbar spondylotic myelopathy, symptoms improved after surgery, although the N21-P38 interval was markedly prolonged in comparison with that before surgery. We presumed that the Cc electrode was actually placed on the ipsilateral central area (Ci) at the second examination. Inspired by this episode, we investigated the influence of the right-left error in the placement of the Cc electrode. Methods Subjects were 20 healthy volunteers. Tibial nerve SEPs were recorded with 8 leads including Cz’–Cc, Cz’-Ci, C2S-Cc and C2S-Ci. Results For the Cz’-Ci lead, the P38 potential diminished in amplitude, was absent or became negative. For the C2S-Ci lead, a large negative potential corresponding to the phase reversal of P38 was frequently observed. Conclusions Tibial nerve SEPs using the Cz’–Cc or C2S-Cc lead are distorted if the Cc electrode is placed on the opposite side. Significance When a strange result is obtained in tibial nerve SEPs, we should check for a right-left error in the Cc electrode placement.
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Affiliation(s)
- Kazusa Takahashi
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738606, Japan.,Department of Neurology, Kitasato University School of Medicine, Kitazato 1-15-1, Minami-ku, Sagamihara, Kanagawa 2520375, Japan
| | - Chizuko Oishi
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738606, Japan.,Department of Neurology, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 1818611, Japan
| | - Yuichi Hamada
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738606, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Kitazato 1-15-1, Minami-ku, Sagamihara, Kanagawa 2520375, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo 1738606, Japan
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Yoon H, Park C, Park I, Kim K, Cha Y. A precision neurorehabilitation using SSEP for early detection of sensory deficit and restoration of the motor recovery in balance, gait and activities of daily living in acute stroke. Technol Health Care 2021; 29:377-383. [PMID: 33682775 PMCID: PMC8150643 DOI: 10.3233/thc-218036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND: Impaired sensory in acute stroke patients results in dynamic balance, gait and activities of daily living (ADL) impairment. OBJECTIVE: The aim of present study was to examine the correlation between somatosensory-evoked potential (SSEP) parameters and motor recovery in balance, gait and ADL performance in hemiparetic stroke survivors. METHODS: One hundred and one participants with hemiparetic stroke (43 males, 58 females; mean age, 6538 ± 1222 years; post-stroke duration, 199 ± 0.74 month) participated in this study. The Electro Synergy system (Viasys Healthcare; San Diego, CA, USA) was applied to measure SSEP measurement. The 101 stroke survivors were divided into three groups consistent with their SSEP results: sensory normal group; sensory impaired group; sensory absent group. All the subject participated the inpatient rehabilitation intervention for 4 weeks. Analyses of variance (ANOVA) were used to verify the group difference among the three groups after the treatment. RESULTS: ANOVA revealed the significant difference (p< 0.01). The Scheffe test demonstrated that the sensory normal group showed greater increasement in Modified Barthel Index (MBI), Fugl-Myer Assessment (FMA), Trunk Impairment Scale (TIS), Berg Balance Scale (BBS) and Functional Ambulation Category (FAC) scores than the sensory impaired and absent group (p< 0.05). CONCLUSIONS: Our research provides therapeutic evidence that correlation of somatosensory functions on motor recovery, balance, gait, and ADL in patients with hemiplegic stroke.
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Affiliation(s)
- Hyunsik Yoon
- Chungnam National University Hospital, Daejeon, Korea
| | - Chanhee Park
- Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Ilbong Park
- Department of Sports Rehabilitation, Busan University of Foreign Studies, Busan, Korea
| | - Kyoungtae Kim
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
| | - Youngjoo Cha
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
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Transcutaneous spinal direct current stimulation shows no effect on paired stimulation suppression of the somatosensory cortex. Sci Rep 2020; 10:22010. [PMID: 33319846 PMCID: PMC7738485 DOI: 10.1038/s41598-020-79131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is a safe and convenient method of neuromodulation. It has been proven to alter sensory processing at cervicomedullary level by amplitude changes of the P30 response of tibial nerve somatosensory evoked potentials (TN SEPs). With knowledge that tsDCS affects cortical circuits, we hypothesized that tsDCS may also affect intracortical excitability of the somatosensory cortex assessed by paired stimulation suppression (PSS). Fourteen healthy men were included in this prospective, single-blinded, placebo-controlled crossover study. Single (SS) and paired stimulation (PS) TN SEPs were recorded over the scalp before, immediately as well as 30 and 60 min after applying 15 min of tsDCS over the twelfth thoracic vertebra. Each volunteer underwent three independent and randomized sessions of either cathodal, anodal or sham stimulation. tsDCS showed no effect on peak-to-peak amplitudes or latencies of cortical P40-N50 response after SS. Furthermore, tsDCS failed to induce significant changes on amplitude ratios of PSS, thus showing no impact on intracortical excitability of the somatosensory cortex in healthy subjects. Further research is required to reveal the different mechanisms and to strengthen clinical use of this promising technique.
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Hernandez-Martin E, Arguelles E, Deshpande R, Sanger TD. Evoked Potentials During Peripheral Stimulation Confirm Electrode Location in Thalamic Subnuclei in Children With Secondary Dystonia. J Child Neurol 2020; 35:799-807. [PMID: 32567481 DOI: 10.1177/0883073820931970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Deep brain stimulation is an elective surgical intervention that improves the function and quality of life in children with dystonia and other movement disorders. Both basal ganglia and thalamic nuclei have been found to be relevant targets for treatment of dystonia in children, including the ventral intermediate nucleus of the thalamus, in which stimulation can control dystonic spasms. Electrophysiological confirmation of correct electrode location within the ventralis intermediate nucleus is thus important for the success of the surgical outcome. The present work shows the evoked potentials response during contralateral median-nerve stimulation at the wrist at low frequency (9 Hz) provides physiological evidence of the electrode's localization within the thalamus. We show the correlation between evoked potentials and magnetic resonance imaging (MRI) and computed tomography (CT) in 14 children undergoing implantation of deep brain stimulation electrodes for secondary dystonia. High fidelity and reproducibility of our results provides a new approach to ensure the electrode localization in the thalamic subnuclei.
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Affiliation(s)
- Estefania Hernandez-Martin
- Department of Electrical Engineering and Computer Science, 8788University of California, Irvine, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, 5116University of Southern California, Los Angeles, CA, USA
| | - Enrique Arguelles
- Department of Electrical Engineering and Computer Science, 8788University of California, Irvine, CA, USA
| | - Ruta Deshpande
- Department of Electrical Engineering and Computer Science, 8788University of California, Irvine, CA, USA
| | - Terence D Sanger
- Department of Electrical Engineering and Computer Science, 8788University of California, Irvine, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, 5116University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Shah SA, Brown P, Gimeno H, Lin JP, McClelland VM. Application of Machine Learning Using Decision Trees for Prognosis of Deep Brain Stimulation of Globus Pallidus Internus for Children With Dystonia. Front Neurol 2020; 11:825. [PMID: 32849251 PMCID: PMC7115974 DOI: 10.3389/fneur.2020.00825] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND While Deep Brain Stimulation (DBS) of the Globus pallidus internus is a well-established therapy for idiopathic/genetic dystonia, benefits for acquired dystonia are varied, ranging from modest improvement to deterioration. Predictive biomarkers to aid DBS prognosis for children are lacking, especially in acquired dystonias, such as dystonic Cerebral Palsy. We explored the potential role of machine learning techniques to identify parameters that could help predict DBS outcome. METHODS We conducted a retrospective study of 244 children attending King's College Hospital between September 2007 and June 2018 for neurophysiological tests as part of their assessment for possible DBS at Evelina London Children's Hospital. For the 133 individuals who underwent DBS and had 1-year outcome data available, we assessed the potential predictive value of six patient parameters: sex, etiology (including cerebral palsy), baseline severity (Burke-Fahn-Marsden Dystonia Rating Scale-motor score), cranial MRI and two neurophysiological tests, Central Motor Conduction Time (CMCT) and Somatosensory Evoked Potential (SEP). We applied machine learning analysis to determine the best combination of these features to aid DBS prognosis. We developed a classification algorithm based on Decision Trees (DTs) with k-fold cross validation for independent testing. We analyzed all possible combinations of the six features and focused on acquired dystonias. RESULTS Several trees resulted in better accuracy than the majority class classifier. However, the two features that consistently appeared in top 10 DTs were CMCT and baseline dystonia severity. A decision tree based on CMCT and baseline severity provided a range of sensitivity and specificity, depending on the threshold chosen for baseline dystonia severity. In situations where CMCT was not available, a DT using SEP alone provided better than the majority class classifier accuracy. CONCLUSION The results suggest that neurophysiological parameters can help predict DBS outcomes, and DTs provide a data-driven, highly interpretable decision support tool that lends itself to being used in clinical practice to help predict potential benefit of DBS in dystonic children. Our results encourage the introduction of neurophysiological parameters in assessment pathways, and data collection to facilitate multi-center evaluation and validation of these potential predictive markers and of the illustrative decision support tools presented here.
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Affiliation(s)
- Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Peter Brown
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Hortensia Gimeno
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Women and Children's Health Institute, King's College London, London, United Kingdom
| | - Jean-Pierre Lin
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Women and Children's Health Institute, King's College London, London, United Kingdom
| | - Verity M. McClelland
- Children's Neurosciences Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Kim M, Lee HH, Lee J. Does isolated somatosensory impairment affect the balance and ambulation of patients with supratentorial stroke after the acute phase? J Clin Neurosci 2020; 74:109-114. [PMID: 32051098 DOI: 10.1016/j.jocn.2020.01.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
Balance and ambulation are the result of a multicomponent control process through the interaction of the sensory and motor information. Despite the clinical relevance of the somatosensory system, its role has not drawn much attention from clinical researchers in that motor impairment is considered a major cause of dysfunction. There is little research on how somatosensory impairment alone affects functional disability after stroke. The purpose of this study was to investigate the effects of isolated somatosensory deficit on the balance and ambulation ability in patients with stroke. P38 latency of the SSEP was used to evaluate the integrity of the dorsal column-medial lemniscus pathway and the SSEP reference value was derived from the formula considering individual height and age. According to the SSEP latency, subjects were classified into 'normal', 'abnormal', and 'no response' group. A total of 110 supratentorial stroke patients with at least grade 4 of the Medical Research Council scale of lower extremity on the affected side were enrolled. Berg balance scale (BBS) and functional ambulatory categories (FAC) showed significant differences among the groups (P < 0.05). In post-hoc analysis, the BBS and FAC was significantly different between the 'normal' and 'abnormal SSEP' group (P = 0.013 for BBS, P = 0.004 for FAC) and the 'normal' and 'no response SSEP' group (P = 0.015 for BBS, P = 0.006 for FAC). We found that isolated somatosensory impairment has a negative effect on the balance and ambulation ability in patients with supratentorial stroke after the acute phase.
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Affiliation(s)
- Minsun Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea.
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea; Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
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MacDonald D, Dong C, Quatrale R, Sala F, Skinner S, Soto F, Szelényi A. Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clin Neurophysiol 2019; 130:161-179. [DOI: 10.1016/j.clinph.2018.10.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/27/2018] [Accepted: 10/21/2018] [Indexed: 11/25/2022]
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Yoon HS, Cha YJ, Sohn MK, You JSH. Effect of rehabilitation on the somatosensory evoked potentials and gait performance of hemiparetic stroke patients. Technol Health Care 2018; 26:145-150. [PMID: 29710747 PMCID: PMC6004975 DOI: 10.3233/thc-174432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Gait performance of stroke patients is affected by impaired sensory ability. The purpose of the present study was to determine the relationship between somatosensory-evoked potential (SSEP) parameters and gait performance in hemiparetic stroke patients. METHODS: A convenience sample of 17 hemiparetic stroke patients (mean age 60.11 ± 8.83 years; 10 women; right hemiplegia: 10, left hemiplegia: 7) were recruited for the present study. The Electro Synergy system (Viasys Healthcare; San Diego, CA, USA) was used for SSEP evaluation. The 17 patients were assigned to two groups according to their SSEP results as follows: 8 patients to the normal response group and 9 patients to the abnormal group. All the participants underwent the same rehabilitation exercise programs during 4 weeks, followed by clinical evaluation. A mixed-design analysis of a variance model was used to test for differences in timed up-and-go (TUG) test and 10-meter walking test (10MWT) scores between the two independent groups while the participants were subjected to repeated measures (pretest and posttest). RESULTS: Analysis of variance revealed the main time effect (p< 0.05) and group by time interaction effect (p< 0.05). The post hoc test result confirmed that the normal sensory group showed greater improvement in TUG test and 10MWT scores than the abnormal sensory group (p< 0.05). The TUG test and 10MWT scores in the posttest were greater in the normal sensory group than in the abnormal sensory group. CONCLUSIONS: The present study demonstrated the importance of the clinical contribution of the baseline sensory function of individuals with hemiparetic stroke to their gait performance and recovery after stroke rehabilitation. As anticipated, the individuals who had intact or spared sensory function showed greater improvements in gait speed and performance measures than those who had impaired sensory function.
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Affiliation(s)
- Hyun S Yoon
- Chungnam National University Hospital, Daejeon, Korea.,Sports ⋅ Movement Institue and Technology, Department of Physical Therapy Program, Yonsei University, Wonju, Korea
| | - Young J Cha
- Sports ⋅ Movement Institue and Technology, Department of Physical Therapy Program, Yonsei University, Wonju, Korea
| | - Min K Sohn
- Chungnam National University Hospital, Daejeon, Korea
| | - Joshua Sung H You
- Sports ⋅ Movement Institue and Technology, Department of Physical Therapy Program, Yonsei University, Wonju, Korea
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Dohzono S, Toyoda H, Tamura A, Hayashi K, Terai H, Nakamura H. Surgical Treatment of a Patient with Prolonged Exacerbation of Hirayama Disease. Spine Surg Relat Res 2018; 3:95-97. [PMID: 31435559 PMCID: PMC6690125 DOI: 10.22603/ssrr.2018-0037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akiko Tamura
- Department of Neurology, Sumitomo Hospital, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Somatosensory Evoked Potentials and Central Motor Conduction Times in children with dystonia and their correlation with outcomes from Deep Brain Stimulation of the Globus pallidus internus. Clin Neurophysiol 2017; 129:473-486. [PMID: 29254860 PMCID: PMC5786451 DOI: 10.1016/j.clinph.2017.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022]
Abstract
A high proportion (47%) of children with dystonia have evidence of abnormal sensory pathway function. Central motor conduction times (CMCTs) and somatosensory evoked potentials (SEPs) show a significant relationship with deep brain stimulation (DBS) outcome, independent of aetiology or cranial MRI. CMCTs and SEPs can guide patient selection and help counsel families about potential benefit of DBS.
Objectives To report Somatosensory Evoked Potentials (SEPs) and Central Motor Conduction Times (CMCT) in children with dystonia and to test the hypothesis that these parameters predict outcome from Deep Brain Stimulation (DBS). Methods 180 children with dystonia underwent assessment for Globus pallidus internus (GPi) DBS, mean age 10 years (range 2.5–19). CMCT to each limb was calculated using Transcranial Magnetic Stimulation. Median and posterior tibial nerve SEPs were recorded over contralateral and midline centro-parietal scalp. Structural abnormalities were assessed with cranial MRI. One-year outcome from DBS was assessed as percentage improvement in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m). Results Abnormal CMCTs and SEPs were found in 19% and 47% of children respectively and were observed more frequently in secondary than primary dystonia. Of children proceeding to DBS, better outcome was seen in those with normal (n = 78/89) versus abnormal CMCT (n = 11/89) (p = 0.002) and those with normal (n = 35/51) versus abnormal SEPs (n = 16/51) (p = 0.001). These relationships were independent of dystonia aetiology and cranial MRI findings. Conclusions CMCTs and SEPs provide objective evidence of motor and sensory pathway dysfunction in children with dystonia and relate to DBS outcome. Significance CMCTs and SEPs can contribute to patient selection and counselling of families about potential benefit from neuromodulation for dystonia.
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Demura Y, Kinoshita M, Fukuda O, Nose S, Nakano H, Juzu A, Murase N, Yamamoto K. Imbalance in multiple sclerosis and neuromyelitis optica: association with deep sensation disturbance. Neurol Sci 2016; 37:1961-1968. [PMID: 27576580 DOI: 10.1007/s10072-016-2697-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Abstract
Abnormality in balance is one of the most important causes of gait disturbance which has a direct impact to disability and medical cost in multiple sclerosis (MS) and neuromyelitis optica (NMO). However, characteristics of imbalance in these two diseases have not been fully elucidated. The aim of this study was to evaluate the degree and features of imbalance using stabilography, the degree of deep sensation disturbance using tibial nerve somatosensory evoked potentials (SEP), and their association with clinical impairment, in patients with MS and NMO. Seven NMO patients and seven MS patients with balance disturbance were examined. The relationship among stabilography measurements representing the degree and features of imbalance, height-adjusted P38 peak latency of SEP, and neurological functional disability, were analyzed. Stabilography evaluation showed a significantly severer degree of imbalance in NMO than in MS. Romberg quotient of the patients with brainstem lesions was significantly larger than those without them. In all patients, length of excursion per second significantly correlated positively with anterio-posterior-axis power spectra at intermediate frequency band. In all patients and in NMO, P38 peak latency adjusted by height significantly correlated positively with anterio-posterior-axis power spectra at intermediate frequency band. These findings suggest that the degree of imbalance of MS and NMO possibly correlate with deep sensation disturbance, which could be evaluated by anterio-posterior-axis power spectra at intermediate frequency band by stabilography. Severer imbalance in NMO than MS may be associated with the severe longitudinally extensive spinal cord lesions.
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Affiliation(s)
- Yutaka Demura
- Department of Clinical Laboratory, Utano National Hospital, National Hospital Organization, Kyoto, Japan
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masako Kinoshita
- Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto, 616-8255, Japan.
| | - Osamu Fukuda
- Department of Clinical Laboratory, Utano National Hospital, National Hospital Organization, Kyoto, Japan
| | - Shouzou Nose
- Department of Clinical Laboratory, Utano National Hospital, National Hospital Organization, Kyoto, Japan
| | - Hitoshi Nakano
- Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto, 616-8255, Japan
| | - Akira Juzu
- Department of Clinical Laboratory, Utano National Hospital, National Hospital Organization, Kyoto, Japan
| | - Nagako Murase
- Department of Neurology, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
| | - Kenji Yamamoto
- Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto, 616-8255, Japan
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Hanson C, Lolis AM, Beric A. SEP Montage Variability Comparison during Intraoperative Neurophysiologic Monitoring. Front Neurol 2016; 7:105. [PMID: 27445969 PMCID: PMC4927628 DOI: 10.3389/fneur.2016.00105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/20/2016] [Indexed: 11/13/2022] Open
Abstract
Intraoperative monitoring is performed to provide real-time assessment of the neural structures that can be at risk during spinal surgery. Somatosensory evoked potentials (SEPs) are the most commonly used modality for intraoperative monitoring. SEP stability can be affected by many factors during the surgery. This study is a prospective review of SEP recordings obtained during intraoperative monitoring of instrumented spinal surgeries that were performed for chronic underlying neurologic and neuromuscular conditions, such as scoliosis, myelopathy, and spinal stenosis. We analyzed multiple montages at the baseline, and then followed their development throughout the procedure. Our intention was to examine the stability of the SEP recordings throughout the surgical procedure on multiple montages of cortical SEP recordings, with the goal of identifying the appropriate combination of the least number of montages that gives the highest yield of monitorable surgeries. Our study shows that it is necessary to have multiple montages for SEP recordings, as it reduces the number of non-monitorable cases, improves IOM reliability, and therefore could reduce false positives warnings to the surgeons. Out of all the typical montages available for use, our study has shown that the recording montage Cz-C4/Cz-C3 (Cz-Cc) is the most reliable and stable throughout the procedure and should be the preferred montage followed throughout the surgery.
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Affiliation(s)
- Christine Hanson
- Department of Neurology, Division of Clinical Neurophysiology, New York University School of Medicine , New York, NY , USA
| | - Athena Maria Lolis
- Department of Neurology, Division of Clinical Neurophysiology, New York University School of Medicine , New York, NY , USA
| | - Aleksandar Beric
- Department of Neurology, Division of Clinical Neurophysiology, New York University School of Medicine , New York, NY , USA
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Hwang P, Sohn MK, Kim CS, Jee S. Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke. J Clin Neurosci 2016; 26:122-5. [PMID: 26778357 DOI: 10.1016/j.jocn.2015.05.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/25/2015] [Accepted: 05/30/2015] [Indexed: 11/16/2022]
Abstract
Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80 years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (P<0.001). Post hoc analysis showed a significant difference between normal and absent response in Berg balance scale (P<0.001) and FAC (P<0.001), and between abnormal and absent response in Berg balance scale (P=0.012) and FAC (P=0.019). Functional outcomes of the normal response group were better than the abnormal response group, but there was no statistical significance. These findings suggest that initial tibial nerve SSEP may be a useful biomarker for prognosticating functional outcomes in hemiplegic patients.
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Affiliation(s)
- Pyoungsik Hwang
- Daejeon Chungcheong Regional Rehabilitation Center, Chungnam National University Hospital, Republic of Korea
| | - Min Kyun Sohn
- Daejeon Chungcheong Regional Rehabilitation Center, Chungnam National University Hospital, Republic of Korea
| | - Cuk-Seong Kim
- Department of Physiology, School of Medicine, Chungnam National University, Munhwa-dong, Jung-gu, Daejeon 301-130, Republic of Korea
| | - Sungju Jee
- Daejeon Chungcheong Regional Rehabilitation Center, Chungnam National University Hospital, Republic of Korea.
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Mochizuki H, Yagi K, Tsuruta K, Taniguchi A, Ishii N, Shiomi K, Nakazato M. Prolonged central sensory conduction time in patients with chronic arsenic exposure. J Neurol Sci 2015; 361:39-42. [PMID: 26810514 DOI: 10.1016/j.jns.2015.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/07/2015] [Accepted: 12/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many patients from Toroku, Japan, who have chronic arsenic exposure demonstrate whole-body sensory disturbance that is slightly more pronounced in the extremities. Although previous research in this population showed a mild peripheral neuropathy, it is unknown whether these patients have central nervous system impairment. To investigate the lesion sites underlying sensory disturbance related to chronic arsenic poisoning, we analyzed somatosensory evoked potentials (SEP). METHODS Clinical features, nerve conduction study results, and median and/or tibial SEP were analyzed in patients with chronic arsenic exposure (total, 13 patients; median & tibial, 4; median, 5; tibial, 4) retrospectively. The SEP findings in patients were compared with those in normal controls. RESULTS The median SEP results indicated a conduction delay between the proximal brachial plexus and the primary sensory cortex, and tibial SEP findings indicated a delay between the dorsal gray matter of the lumbosacral cord and the primary sensory cortex. CONCLUSION This is the first study to identify an impairment of the central somatosensory pathway in patients with chronic arsenic exposure. Sensory disturbance in these patients is related not only to peripheral neuropathy but also to impairment of the central nervous system.
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Affiliation(s)
- Hitoshi Mochizuki
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan.
| | - Kazuhiro Yagi
- Brain and Nerve Center, Junwakai Memorial Hospital, Japan
| | | | - Akitoshi Taniguchi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Nobuyuki Ishii
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Kazutaka Shiomi
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Masamitsu Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
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Zhao C, Valentini E, Hu L. Functional features of crossmodal mismatch responses. Exp Brain Res 2014; 233:617-29. [DOI: 10.1007/s00221-014-4141-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/02/2014] [Indexed: 11/25/2022]
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Koutlidis R, Ayrignac X, Pradat PF, Le Forestier N, Léger JM, Salachas F, Maisonobe T, Fournier E, Viala K. Segmental somatosensory-evoked potentials as a diagnostic tool in chronic inflammatory demyelinating polyneuropathies, and other sensory neuropathies. Neurophysiol Clin 2014; 44:267-80. [DOI: 10.1016/j.neucli.2014.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022] Open
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Early and late activity in somatosensory cortex reflects changes in bodily self-consciousness: An evoked potential study. Neuroscience 2012; 216:110-22. [DOI: 10.1016/j.neuroscience.2012.04.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 11/17/2022]
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Hokkoku K, Sonoo M, Murashima H, Iwanami T, Nishiyama K, Kawamura Y, Arai Y, Tsukamoto H, Hatanaka Y, Shimizu T. [Clinical features of predominantly sensory stroke due to brainstem infarction]. Rinsho Shinkeigaku 2011; 51:248-54. [PMID: 21595293 DOI: 10.5692/clinicalneurol.51.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report 13 patients presenting with predominantly sensory strokes due to brainstem infarction, without any other brainstem symptoms such as hemiparesis, dysarthria or vertigo. All of them had lacunar infarctions localized at the medial lemniscus and/or spinothalamic tract, at the pontine (12 patients) or midbrain (1 patient) tegmentum. The presenting symptom was dysesthesia with a variety of distributions for all cases, and a thalamic-pain-like unpleasant dysesthesia persisted in 4 patients. The lesion on brain MRI was usually very small, and was sometimes overlooked by radiological evaluation, which led to a long delay in the correct diagnosis of a stroke in two cases. Median nerve somatosensory evoked potentials showed a depressed N20 amplitude or a loss of the P15 potential unilaterally with preserved P13/14 potential in 7 out of 10 cases examined, and was useful in localizing the lesion intracranially. During the 4-year study period, 10 patients with brainstem infarctions were admitted to our department as acute sensory stroke cases (2.1% of all acute strokes), whereas 11 patients with thalamic infarctions (2.3%) were admitted due to similar symptoms. Cases with brainstem infarctions had sensory symptoms localized below the neck more frequently (5/10) than cases with thalamic infarctions (1/11), thus would be more likely to be confused with cervical or peripheral nerve disorders. The relative frequency of brainstem infarction as compared to thalamic infarction was higher than that in previous reports, implying that some cases with brainstem infarction might have been overlooked due to difficulty in obtaining the correct diagnosis. One should always keep this syndrome in mind when assessing patients with acute-onset sensory symptoms.
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Affiliation(s)
- Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine
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Murakami T, Fukai Y, Rikimaru M, Henmi S, Ohsawa Y, Sunada Y. Hereditary sensory ataxic neuropathy associated with proximal muscle weakness in the lower extremities. J Neurol Sci 2010; 291:121-3. [DOI: 10.1016/j.jns.2009.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 11/20/2009] [Accepted: 12/11/2009] [Indexed: 01/11/2023]
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Bebawy JF, Gupta DK, Cotton MA, Gil KS, Fohrman EB, Mirkovic S, Koht A. Alternative anterior reference sites for measuring posterior tibial nerve somatosensory evoked potentials. J Clin Monit Comput 2010; 24:107-11. [PMID: 20063048 DOI: 10.1007/s10877-009-9216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 12/20/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the utility and feasibility of using alternative anterior reference leads when measuring left posterior tibial nerve somatosensory evoked potentials (SEPs). METHODS With IRB approval, 12 patients were monitored using both traditional (FPz and C4') and alternative anterior (F3 and F4) reference leads during routine spine surgery with SEP monitoring. Recordings from the routine and novel electrode pairs were collected and analyzed. RESULTS All of the SEP amplitudes measured were of similar magnitude except for that of F3-F4, which was significantly lower (P < 0.001) than all of the other five lead combinations which were assessed (Cz'-FPz, C3'-C4', C3'-F4, Cz'-F3, and Cz'-F4). The latencies of the novel lead combinations (C3'-F4, Cz'-F3, Cz'-F4, and F3-F4) were similar to those of the "gold standards" (Cz'-FPz and C3'-C4') (pooled median, 45.6 ms with 25-75th percentiles, 44.0-47.8 ms, P = 0.308). The coefficients of variation (CV %) of the amplitudes were not statistically significantly different (P = 0.341). CONCLUSIONS The use of alternative frontal reference leads (F3 and F4) for left posterior tibial nerve SEP monitoring yields signals of equal quality and reproducibility compared to signals with standard (FPz and C4') referencing. These alternative leads may substitute for traditional referencing when placement of FPz or C4' is precluded by the location of surgery.
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Affiliation(s)
- John F Bebawy
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tsukamoto H, Sonoo M, Shimizu T. Segmental evaluation of the peripheral nerve using tibial nerve SEPs for the diagnosis of CIDP. Clin Neurophysiol 2010; 121:77-84. [DOI: 10.1016/j.clinph.2009.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 08/21/2009] [Accepted: 09/17/2009] [Indexed: 11/28/2022]
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Abstract
STUDY DESIGN Magnetic lumbar stimulation was used to detect spinal nerve degeneration in patients with lumbar spinal stenosis (LSS). OBJECTIVE To evaluate delays in the motor conduction time in the cauda equina of patients with LSS. SUMMARY OF BACKGROUND DATA Previous studies suggested a bilateral slowing of motor conduction in the cauda equina in LSS. Among several methods, only magnetic stimulation is sufficiently sensitive for detecting potential degeneration in LSS. A recent study demonstrated the direct calculation of the cauda equina motor conduction time using magnetic stimulation at proximal and distal sites of the cauda equina. We used this technique to determine potential degeneration in patients with LSS. METHODS Twenty adult subjects and 15 patients with LSS were investigated. Lumbosacral roots were stimulated at intervertebral levels L1-L2 and L5-S1 by magnetic coil stimulation. The muscle responses to stimulation were recorded from the gastrocnemius-soleus, and anterior tibialis muscles on both sides with bipolar surface electrodes. The response latency from stimulations at the L5 spine level were subtracted from those at the L1 level on the same side. This value represented the conduction time from the proximal to distal ends of the cauda equina. RESULTS The mean conduction time along the cauda equina was significantly prolonged in patients with LSS compared with controls. The mean cauda equina motor conduction time was 1.97 +/- 0.67 milliseconds in controls and 3.57 +/- 2.22 milliseconds in patients with LSS (P = 0.00). CONCLUSION Determining the motor conduction time along the cauda equina using L1 and L5 magnetic stimulation provides an effective alternative method for evaluating the lumbar motor roots in patients with LSS.
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van de Wassenberg W, Kruizinga W, van der Hoeven J, Leenders K, Maurits N. Multichannel recording of tibial-nerve somatosensory evoked potentials. Neurophysiol Clin 2008; 38:277-88. [DOI: 10.1016/j.neucli.2008.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 05/30/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022] Open
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Nakai SI, Sonoo M, Shimizu T. Somatosensory evoked potentials (SEPs) for the evaluation of cervical spondylotic myelopathy: Utility of the onset-latency parameters. Clin Neurophysiol 2008; 119:2396-404. [DOI: 10.1016/j.clinph.2008.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/14/2008] [Accepted: 07/20/2008] [Indexed: 11/15/2022]
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Fukuda H, Sonoo M, Ishibashi M. Muscle afferent contributions to tibial nerve somatosensory evoked potentials investigated using knee stimulations. Clin Neurophysiol 2007; 118:2104-11. [PMID: 17646132 DOI: 10.1016/j.clinph.2007.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2005] [Revised: 05/21/2007] [Accepted: 06/19/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the contribution of muscle afferents to tibial nerve somatosensory evoked potentials (SEPs). METHODS The left tibial nerve was stimulated at the knee and ankle in eight normal subjects. We tried to selectively stimulate Ia fibers from the calf muscles at the popliteal fossa by subtly changing the stimulation site while monitoring the H-waves of the calf muscles and sensory events. RESULTS Selective or predominant Ia stimulation at the knee was achieved in seven subjects, and evoked a significantly smaller first cortical component (labeled as P38 for both ankle and knee stimulations) than that evoked by ankle stimulation or by mixed stimulation of the foot branch and muscle afferents at the knee. The P38 following mixed stimulation at the knee was smaller than that following ankle stimulation in six out of eight subjects, which must be due to a partial gating mechanism and also indicates that calf Ia afferent SEPs are not extremely large. CONCLUSIONS Physiologically important muscle afferents from the large calf muscles evoked rather small cortical components. SIGNIFICANCE It seems reasonable to infer that the contribution of muscle afferents from the small intrinsic foot muscles to routine tibial nerve SEPs following ankle stimulation is even smaller.
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Affiliation(s)
- Hiroyuki Fukuda
- Department of Internal Medicine, University Hospital, Mizonokuchi, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Kawasaki, Japan
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Polácek H, Kozák J, Vrba I, Vrána J, Stancák A. Effects of spinal cord stimulation on the cortical somatosensory evoked potentials in failed back surgery syndrome patients. Clin Neurophysiol 2007; 118:1291-302. [PMID: 17452003 DOI: 10.1016/j.clinph.2007.02.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 02/21/2007] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the functional activation of the somatosensory cortical regions in neuropathic pain patients during therapeutic spinal cord stimulation (SCS). METHODS In nine failed back surgery syndrome patients, the left tibial and the left sural nerves were stimulated in two sessions with intensities at motor and pain thresholds, respectively. The cortical somatosensory evoked potentials were analyzed using source dipole analysis based on 111 EEG signals. RESULTS The short-latency components of the source located in the right primary somatosensory cortex (SI: 43, 54 and 65ms) after tibial nerve stimulation, the mid-latency SI component (87ms) after sural nerve stimulation, and the mid-latency components in the right (approximately 161ms) and left (approximately 168ms) secondary somatosensory cortices (SII) were smaller in the presence of SCS than in absence of SCS. The long-latency source component arising from the mid-cingulate cortex (approximately 313ms) was smaller for tibial and larger for sural nerve stimuli during SCS periods compared to periods without SCS. CONCLUSIONS SCS attenuates the somatosensory processing in the SI and SII. In the mid-cingulate cortex, the effect of SCS depends on the type of stimulation and nerve fibers involved. SIGNIFICANCE Results suggest that the effects of SCS on cortical somatosensory processing may contribute to a reduction of allodynia during SCS.
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Affiliation(s)
- Hubert Polácek
- Charles University Prague, Department of Normal, Pathological and Clinical Physiology, Third Faculty of Medicine, Ke Karlovu 4, Prague 2, Czech Republic.
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Egli D, Hausmann O, Schmid M, Boos N, Dietz V, Curt A. Lumbar spinal stenosis: Assessment of cauda equina involvement by electrophysiological recordings. J Neurol 2007; 254:741-50. [PMID: 17426910 DOI: 10.1007/s00415-006-0427-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 09/20/2006] [Accepted: 09/28/2006] [Indexed: 11/29/2022]
Abstract
UNLABELLED The objective of this study was to investigate the relationship between electrophysiological recordings and clinical as well as radiological findings in patients suggestive to suffer from a lumbar spinal stenosis (LSS). We hypothesise that the electrophysiological recordings, especially SSEP, indicate a lumbar nerve involvement that is complementary to the neurological examination and can provide confirmatory information in less obvious clinical cases. In a prospective cohort study, 54 patients scheduled for surgery due to LSS were enrolled in an unmasked, uncontrolled trial. All patients were assessed by neurological examination, electrophysiological recordings, and magnetic resonance imaging (MRI) of the lumbar spine. The electrophysiological recordings focused on spinal lumbar nerve involvement. RESULTS About 88% suffered from a multisegmental LSS and 91% of patients respectively complained of chronic lower back pain and/or leg pain for more than 3 months, combined with a restriction in walking distance. The neurological examination revealed only a few patients with sensory and/or motor deficits while 87% of patients showed pathological electrophysiological recordings (abnormal tibial SSEP in 78% of patients, abnormal H-reflex in 52% of patients). CONCLUSIONS Whereas the clinical examination, even in severe LSS, showed no specific sensory-motor deficit, the electrophysiological recordings indicated that the majority of patients had a neurogenic disorder within the lumbar spine. By the pattern of bilateral pathological tibial SSEP and pathological reflexes associated with normal peripheral nerve conduction, LSS can be separated from a demyelinating polyneuropathy and mono-radiculopathy. The applied electrophysiological recordings, especially SSEP, can confirm a neurogenic claudication due to cauda equina involvement and help to differentiate neurogenic from vascular claudication or musculo-skeletal disorders of the lower limbs. Therefore, electro-physiological recordings provide additional information to the neurological examination when the clinical relevance of a radiologically-suspected LSS needs to be confirmed.
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Affiliation(s)
- D Egli
- Spinal Cord Injury Center, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
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Tierra-Criollo CJ, Infantosi AFC. Low-frequency oscillations in human tibial somatosensory evoked potentials. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:402-6. [PMID: 16917609 DOI: 10.1590/s0004-282x2006000300010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Accepted: 02/08/2006] [Indexed: 11/22/2022]
Abstract
Oscillatory cerebral electric activity has been related to sensorial and perceptual-cognitive functions. The aim of this work is to investigate low frequency oscillations (<300 Hz), particularly within the gamma band (30-110 Hz), during tibial stimulation. Twenty-one volunteers were subjected to 5 Hz stimulation by current pulses of 0.2 ms duration and the minimum intensity to provoke involuntary twitch. EEG signals without (spontaneously) and during stimulation were recorded at primary somatosensory area. A time-frequency analysis indicated the effect of the stimulus artifact in the somatosensory evoked potential (SEP) frequencies up to 5 ms after the stimulus. The oscillations up to 100 Hz presented the highest relative power contribution (approximately 99%) for the SEP and showed difference (p<0.01) from the frequencies of the spontaneously EEG average. Moreover, the range 30-58 Hz was identified as the band with the highest contribution for the tibial SEP morphology (p<0.0001).
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Affiliation(s)
- Carlos Julio Tierra-Criollo
- Biomedical Engineering Group, Electrical Department, Federal University of Minas Gerais, Av. Antônio Carlos 6627, 31270-010 Belo Horizonte MG, Brazil.
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Kallmann BA, Fackelmann S, Toyka KV, Rieckmann P, Reiners K. Early abnormalities of evoked potentials and future disability in patients with multiple sclerosis. Mult Scler 2006; 12:58-65. [PMID: 16459720 DOI: 10.1191/135248506ms1244oa] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Evoked potentials (EP) have a role in making the diagnosis of multiple sclerosis (MS) but their implication for predicting the future disease course in MS is under debate. EP data of 94 MS patients examined at first presentation, and after five and ten years were retrospectively analysed. Patients were divided into two groups in relation to the prior duration of disease at the time point of first examination: group 1 patients (n=44) were first examined within two years after disease onset, and group 2 patients (n=50) at later time points. As primary measures sum scores were calculated for abnormalities of single and combined EP (visual (VEP), somatosensory (SEP), magnetic motor evoked potentials (MEP)). In patients examined early after disease onset (group 1), a significant predictive value for abnormal EP was found with MEP and SEP sum scores at first presentation correlating significantly with Expanded Disability Status Scale (EDSS) values after five years, while the VEP sum score was not. The cumulative number of abnormal MEP, SEP and VEP results also indicated higher degrees of disability (EDSS > or = 3.5) after five years. Combined pathological SEP and MEP findings at first presentation best predicted clinical disability (EDSS > or = 3.5) after five years (odds ratio 11.0). EP data and EDSS at first presentation were not significantly linked suggesting that EP abnormalities at least in part represented clinically silent lesions not mirrored by EDSS. For patients in later disease phases (group 2), no significant associations between EP data at first presentation and EDSS at five and ten years were detected. Together with clinical findings and MR imaging, combined EP data may help to identify patients at high risk of long-term clinical deterioration and guide decisions as to immunomodulatory treatment.
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Affiliation(s)
- B A Kallmann
- Department of Neurology, Universitätsklinikum der Bayerischen Julius-Maximilians-Universität, 97080 Würzburg, Germany.
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Sonoo M. Chapter 16 Generators of subcortical components of SEPs and their clinical applications. ACTA ACUST UNITED AC 2006; 59:113-20. [PMID: 16893101 DOI: 10.1016/s1567-424x(09)70020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan.
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MacDonald DB, Al Zayed Z, Stigsby B. Tibial somatosensory evoked potential intraoperative monitoring: recommendations based on signal to noise ratio analysis of popliteal fossa, optimized P37, standard P37, and P31 potentials. Clin Neurophysiol 2005; 116:1858-69. [PMID: 16005261 DOI: 10.1016/j.clinph.2005.04.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 04/08/2005] [Accepted: 04/27/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the intraoperative signal-to-noise ratio (SNR), reproducibility and rapidity of popliteal fossa (PF), optimized P37, standard P37 and P31 potentials. METHODS Raw sweeps and 11 averages doubling sweep number from 2 to 2048 were compared in 37 patients undergoing scoliosis surgery. Optimized (highest amplitude or SNR) P37 derivations were Cz-CPc (22), CPz-CPc (27), Pz-CPc (7), iCPi-CPc (8), CPi-CPc (1), Cz-Pz (2) or Pz-FPz (3), and in two patients with non-decussation, Cz-CPi (1) or CPz-CPi (3). Standard P37 and P31 derivations were CPz-FPz and FPz-C5S. Signal amplitude was measured in 2048-sweep averages; peak noise was measured in raw sweeps and +/- averages; SNR was amplitude/noise. Visual superimposability and < 20-30% amplitude variation determined reproducibility. Sweeps to reproducibility determined rapidity. RESULTS The SNR order was PF >> optimized P37 > standard P37 > P31. Mean optimized P37 SNR advantages over the standard P37 and P31 were 2.1:1 and 4.9:1. SNR had powerful non-linear correlations to reproducibility and rapidity. Median sweeps to reproducibility were PF: 2, optimized P37: 128, standard P37: 512 and P31: 1024. EEG noise was greatest in FPz derivations. Burst-suppression increased scalp potential SNR and rapidity. CONCLUSIONS Optimized P37 and PF recordings are most rapidly reproducible due to superior SNRs and are recommended. FPz should be avoided. Burst-suppression may be desirable. SIGNIFICANCE CPz-FPz and FPz-C5S should no longer be standard.
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Affiliation(s)
- D B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center, MBC 76, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
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MacDonald DB, Stigsby B, Al Zayed Z. A comparison between derivation optimization and Cz′–FPz for posterior tibial P37 somatosensory evoked potential intraoperative monitoring. Clin Neurophysiol 2004; 115:1925-30. [PMID: 15261872 DOI: 10.1016/j.clinph.2004.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare P37 derivation optimization to Cz'-FPz. METHODS After induction in 120 patients, monitoring derivations optimized by mapping FPz, Cz, Cz', Pz, C4', C2', C1' and C3'-mastoid to determine the P37 and N37 maximums for use as inputs 1 and 2 were compared to Cz'-FPz. This was repeated later in 35 surgeries. RESULTS Eleven optimal derivations occurred and usually differed between sides. Input 1 was Cz', Pz, Cz, iCi', or Ci' and input 2 was Cc', FPz, Ci' or Pz. Even the most frequent Cz'-Cc' derivation was optimal for both sides of an individual in only 17% and this was true for Cz'-FPz in only 4%. Optimization produced higher amplitudes than Cz'-FPz (P<0.001). The ratio was [squareroot of 2] : 1 in 61% of patients and > or =2:1 in 28%, approximately halving or quartering averaging times. Optimization assessed decussation, disclosing non-decussation in one patient while Cz'-FPz did not. Alterations of P37 topography that reduced initially optimal derivation amplitude and made a different derivation optimal were demonstrated by repeat optimization in 13 of 35 patients, preventing misinterpretation in one. While also affected, Cz'-FPz neither detected nor adjusted for potentially misleading topographic changes. CONCLUSIONS Higher amplitudes, decussation assessment and topographic adjustment make P37 derivation optimization superior to Cz'-FPz for monitoring this highly variable potential.
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Affiliation(s)
- D B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center MBC 76, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
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