Spinal cord monitoring of the ventral funiculus function. Analysis of spinal field potentials after galvanic vestibular stimulation

Effects of postural-control training with different sensory reweightings in a patient with body lateropulsion: a single-subject design study

INTRODUCTION

Body lateropulsion (BL) is an active lateral tilt of the body during standing or walking that is thought to be affected by a lesion of the vestibulospinal tract (VST) and the subjective visual vertical (SVV) tilt. Interventions for BL have not been established.

OBJECTIVE

We examined the effects of postural-control training with different sensory reweighting on standing postural control in a patient with BL.

METHODS

The patient had BL to the left when standing or walking due to a left-side medullary and cerebellar infarct. This study was a single-subject A-B design with follow-up: Phase A was postural-control training with visual feedback; phase B provided reweighting plantar somatosensory information. Postural control, VST excitability, and SVV were measured.

RESULTS

At baseline and phase A, the patient could not stand with eyes-closed on a rubber mat, but became able to stand in phase B. The mediolateral center of pressure (COP) position did not change significantly, but the COP velocity decreased significantly during phase B and the follow-up on the firm surface. VST excitability was lower on the BL versus the non-BL side, and the SVV deviated to the right throughout the study.

CONCLUSION

Postural-control training with reweighting somatosensory information might improve postural control in a patient with BL.

Phase-dependent modulation of the vestibular-cerebellar network via combined alternating current stimulation influences human locomotion and posture

Background

Human locomotion induces rhythmic movements of the trunk and head. Vestibular signaling is relayed to multiple regions in the brainstem and cerebellum, and plays an essential role in maintaining head stability. However, how the vestibular-cerebellar network contributes to the rhythmic locomotor pattern in humans is unclear. Transcranial alternating current stimulation (tACS) has been used to investigate the effects of the task-related network between stimulation regions in a phase-dependent manner. Here, we investigated the relationship between the vestibular system and the cerebellum during walking imagery using combined tACS over the left cerebellum and alternating current galvanic vestibular stimulation (AC-GVS).

Methods

In Experiment 1, we tested the effects of AC-GVS alone at around individual gait stride frequencies. In Experiment 2, we then determined the phase-specificity of combined stimulation at the gait frequency. Combined stimulation was applied at in-phase (0° phase lag) or anti-phase (180° phase lag) between the left vestibular and left cerebellar stimulation, and the sham stimulation. We evaluated the AC-GVS-induced periodic postural response during walking imagery or no-imagery using the peak oscillatory power on the angular velocity signals of the head in both experiments. In Experiment 2, we also examined the phase-locking value (PLV) between the periodic postural responses and the left AC-GVS signals to estimate entrainment of the postural response by AC-GVS.

Results

AC-GVS alone induced the periodic postural response in the yaw and roll axes, but no interactions with imagery walking were observed in Experiment 1 (p > 0.05). By contrast, combined in-phase stimulation increased yaw motion (0.345 ± 0.23) compared with sham (-0.044 ± 0.19) and anti-phase stimulation (-0.066 ± 0.18) during imaginary walking (in-phase vs. other conditions, imagery: p < 0.05; no-imagery: p ≥ 0.125). Furthermore, there was a positive correlation between the yaw peak power of actual locomotion and in-phase stimulation in the imagery session (imagery: p = 0.041; no-imagery: p = 0.177). Meanwhile, we found no imagery-dependent effects in roll peak power or PLV, although in-phase stimulation enhanced roll motion and PLV in Experiment 2.

Conclusion

These findings suggest that combined stimulation can influence vestibular-cerebellar network activity, and modulate postural control and locomotion systems in a temporally sensitive manner. This novel combined tACS/AC-GVS stimulation approach may advance development of therapeutic applications.

Reliability and laterality of the soleus H-reflex following galvanic vestibular stimulation in healthy individuals

The vestibulospinal tract (VST) plays an important role in the control of the ipsilateral antigravity muscles, and the balance of left and right VST excitability is important in human postural control. A method for measuring VST excitability is the application of galvanic vestibular stimulation (GVS) before tibial nerve stimulation that evokes the soleus H-reflex; the change rate of the H-reflex amplitude is then evaluated. Assessments of VST excitability and the left and right balance could be useful when determining the pathology for interventions in postural control impairments. However, the reliability and laterality of this assessment have not been clarified, nor has its relationship to postural control. We investigated the reliability, laterality and standing postural control in relation to the degree of facilitation of the H-reflex following GVS in 15 healthy adults. The assessments were performed in two sessions, one each for the left- and right-sides, in random order. The inter-session reliability of the short-interval assessments of an increase in the H-reflex following GVS on both sides were sufficient. The degree of H-reflex facilitation by GVS showed no significant difference between the left- and right-sides in any session. There was a moderate positive correlation between the mediolateral position of the center of pressure in the eyes-closed standing on foam condition and the left/right ratio of the degree of increased H-reflex in the first-session. We concluded that this method for evaluating the increase in the soleus H-reflex following GVS has high inter-session reliability in the short-interval that did not differ between sides.

Posture influences on vestibulospinal tract excitability

The human vestibulospinal tract has important roles in postural control, but it has been unknown whether vestibulospinal tract excitability is influenced by the body's postures. We investigated whether postures influence the vestibulospinal tract excitability by a neurophysiological method, i.e., applying galvanic vestibular stimulation (GVS) 100 ms before tibial nerve stimulation evoking the soleus H-reflex. GVS is a percutaneous stimulation, and it has not been clarified how the cutaneous input from GVS influences the facilitation effect of cathodal GVS on the soleus H-reflex amplitude. In Experiment 1, we evaluated the effects of GVS on the soleus H-reflex amplitude of subjects in the prone, supine, and sitting positions in random order to clarify the differences in the GVS effects among these postures. In Experiment 2, to determine whether the effects of GVS in the supine and sitting positions are due solely to cutaneous input from GVS, we provided GVS and cutaneous stimulations as conditioning stimuli and compared the effects in both postures. Interaction effects between postures and stimulus conditions were observed in both experiments. The facilitation rate of the maximum H-reflex amplitude by GVS in the sitting position was significantly higher than those in the prone and supine positions (Experiment 1). The facilitation rate of GVS was significantly larger than the cutaneous stimulation only in the sitting position (Experiment 2). These results indicate that vestibulospinal tract excitability may be higher in the sitting position than in either lying position (prone and supine), due mainly to the increased need for postural control.

Cerebellar Repetitive Transcranial Magnetic Stimulation and Noisy Galvanic Vestibular Stimulation Change Vestibulospinal Function

Background

The cerebellum strongly contributes to vestibulospinal function, and the modulation of vestibulospinal function is important for rehabilitation. As transcranial magnetic stimulation (TMS) and electrical stimulation may induce functional changes in neural systems, we investigated whether cerebellar repetitive TMS (crTMS) and noisy galvanic vestibular stimulation (nGVS) could modulate vestibulospinal response excitability. We also sought to determine whether crTMS could influence the effect of nGVS.

Methods

Fifty-nine healthy adults were recruited; 28 were randomly allocated to a real-crTMS group and 31 to a sham-crTMS group. The crTMS was conducted using 900 pulses at 1 Hz, while the participants were in a static position. After the crTMS, each participant was allocated to either a real-nGVS group or sham-nGVS group, and nGVS was delivered (15 min., 1 mA; 0.1–640 Hz) while patients were in a static position. The H-reflex ratio (with/without bilateral bipolar square wave pulse GVS), which reflects vestibulospinal excitability, was measured at pre-crTMS, post-crTMS, and post-nGVS.

Results

We found that crTMS alone and nGVS alone have no effect on H-reflex ratio but that the effect of nGVS was obtained after crTMS.

Conclusion

crTMS and nGVS appear to act as neuromodulators of vestibulospinal function.

Electrophysiological analysis shows dizziness as the first symptom in human T cell lymphotropic virus type-associated myelopathy/tropical spastic paraparesis

Dizziness is a symptom in human T cell lymphotropic virus type-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and may occur due to vestibulospinal tract dysfunction. This tract can be assessed by an electrophysiological test called vestibular-evoked myogenic potential (VEMP). The aim was to correlate the result of VEMP generated by acoustic stimuli and dizziness in individuals with human T cell lymphotropic virus type 1 (HTLV-1)-asymptomatic infection and HAM/TSP. VEMP was recorded from the sternocleidomastoid muscle of 60 HTLV-1-negative adults (60±8 years) and 60 individuals infected with HTLV-1, 30 being asymptomatic (59±8 years) and 30 with HAM/TSP (59±8 years). In all groups, 90% of the participants were women. VEMP was generated by acoustic stimuli (short tone bursts), with an intensity of 118 dBHL and band-pass filter from 10 Hz to 1,500 Hz, and presented 200 stimuli at a frequency of 1,000 Hz with a record time of 60 ms. Of 60 HTLV-1-negative individuals, 14 (23%) reported dizziness; VEMP was normal in all. In the HTLV-1-asymptomatic group, 11(37%) complained of dizziness (p=0.31); VEMP was altered in four (40%) subjects with dizziness and in one (5%) without dizziness (p=0.00). In the group with HAM/TSP, dizziness was reported by 17 (57%) subjects (p=0.002); VEMP was altered in 11 (64%) with dizziness and in 5 (38%) without dizziness (p=0.15). Dizziness without an apparent etiology in HTLV-1-asymptomatic carriers deserves attention in terms of a possible subclinical spinal cord involvement that can be clarified through spinal electrophysiological tests. Damage of the vestibulospinal tract seems to occur in the early stages of HAM/TSP.

Vestibular evoked myogenic potential (VEMP) with galvanic stimulation in normal subjects

Introdução

O potencial evocado miogênico vestibular (VEMP) gerado por estimulação galvânica (GVS) reflete uma resposta vestíbulo-espinhal. A resposta obtida no músculo sóleo é bifásica, primeiro com componente de curta latência (CL), em torno de 60 ms, e depois com o de média latência (ML), em torno de 100 ms. O componente de CL associa-se à função otolítica (sáculo e utrículo), e o de ML, aos ductos semicirculares.

Objetivo

Descrever os valores de referência do VEMP com estimulação galvânica em indivíduos normais.

Casuística e método

Forma de estudo transversal; o VEMP foi gerado por GVS de 2 mA/400 ms, aplicada bilateralmente, sob frequência de 5–6 ms. Testou-se resposta no músculo sóleo de 13 sujeitos saudáveis, com idade média de 56 anos. Os sujeitos permaneceram de pé, com cabeça girada contralateral ao GVS aplicado na mastoide. Na configuração catodo direito, anodo esquerda, 30 GVS foi aplicado, seguidos de mais 30 com configuração inversa. Os componentes de CL e de ML da resposta vestibular foram analisados.

Resultado

Os componentes de CL e de ML foram semelhantes em ambas as pernas. O valor médio de CL foi 54 ms, e o de ML, 112 ms.

Conclusão

Os componentes de CL e de ML do VEMP solear foram replicáveis, sendo medidas úteis de função do trato vestíbulo-espinhal.

© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.

Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis

BACKGROUND AND PURPOSE

Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP.

METHODS

Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years).

RESULTS

The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves.

CONCLUSIONS

A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies.

Effects of galvanic vestibular stimulation on postural limb reflexes and neurons of spinal postural network

Quadrupeds maintain the dorsal side up body orientation due to the activity of the postural control system driven by limb mechanoreceptors. Binaural galvanic vestibular stimulation (GVS) causes a lateral body sway toward the anode. Previously, we have shown that this new position is actively stabilized, suggesting that GVS changes a set point in the reflex mechanisms controlling body posture. The aim of the present study was to reveal the underlying neuronal mechanisms. Experiments were performed on decerebrate rabbits. The vertebral column was rigidly fixed, whereas hindlimbs were positioned on a platform. Periodic lateral tilts of the platform caused postural limb reflexes (PLRs): activation of extensors in the loaded and flexing limb and a decrease in extensor activity in the opposite (unloaded and extending) limb. Putative spinal interneurons were recorded in segments L4-L5 during PLRs, with and without GVS. We have found that GVS enhanced PLRs on the cathode side and reduced them on the anode side. This asymmetry in PLRs can account for changes in the stabilized body orientation observed in normal rabbits subjected to continuous GVS. Responses to platform tilts (frequency modulation) were observed in 106 spinal neurons, suggesting that they can contribute to PLR generation. Two neuron groups were active in opposite phases of the tilt cycle of the ipsi-limb: F-neurons in the flexion phase, and E-neurons in the extension phase. Neurons were driven mainly by afferent input from the ipsi-limb. If one supposes that F- and E-neurons contribute, respectively, to excitation and inhibition of extensor motoneurons, one can expect that the pattern of response to GVS in F-neurons will be similar to that in extensor muscles, whereas E-neurons will have an opposite pattern. We have found that ~40% of all modulated neurons meet this condition, suggesting that they contribute to the generation of PLRs and to the GVS-caused changes in PLRs.

Use of galvanic vestibular feedback to control postural orientation in decerebrate rabbits

In quadrupeds, the dorsal-side-up body orientation during standing is maintained due to a postural system that is driven by feedback signals coming mainly from limb mechanoreceptors. In caudally decerebrated (postmammillary) rabbits, the efficacy of this system is considerably reduced. In this paper, we report that the efficacy of postural control in these animals can be restored with galvanic vestibular stimulation (GVS) applied transcutaneously to the labyrinths. In standing intact rabbits, GVS causes a lateral body sway towards the positive electrode. We used this GVS-caused sway to counteract the lateral body sway resulting from a mechanical perturbation of posture. Experiments were performed on postmammillary rabbits that stood on the tilting platform with their hindlimbs. To make the GVS value dependent on the postural perturbation (i.e., on the lateral body sway caused by tilt of the platform), an artificial feedback loop was formed in the following ways: 1) Information about the body sway was provided by a mechanical sensor; 2) The GVS current was applied when the sway exceeded a threshold value; the polarity of the current was determined by the sway direction. This simple algorithm allowed the "hybrid" postural system to maintain the dorsal-side-up orientation of the hindquarters when the platform was tilted by ± 20°. Thus, an important postural function, i.e., securing lateral stability during standing, can be restored in decerebrate rabbits with the GVS-based artificial feedback. We suggest that such a control system can compensate for the loss of lateral stability of various etiologies, and can be used for restoration of balance control in patients with impaired postural functions.

Properties and axonal trajectories of posterior semicircular canal nerve-activated vestibulospinal neurons

We studied the axonal projections of vestibulospinal neurons activated from the posterior semicircular canal. The axonal projection level, axonal pathway, and location of the vestibulospinal neurons originating from the PC were investigated in seven decerebrated cats. Selective electrical stimulation was applied to the PC nerve, and extracellular recordings in the vestibular nuclei were performed. The properties of the PC nerve-activated vestibulospinal neurons were then studied. To estimate the neural pathway in the spinal cord, floating electrodes were placed at the ipsilateral (i) and contralateral (c) lateral vestibulospinal tract (LVST) and medial vestibulospinal tract (MVST) at the C1/C2 junction. To elucidate the projection level, floating electrodes were placed at i-LVST and MVST at the C3, T1, and L3 segments in the spinal cord. Collision block test between orthodromic inputs from the PC nerve and antidromic inputs from the spinal cord verified the existence of the vestibulospinal neurons in the vestibular nuclei. Most (44/47) of the PC nerve-activated vestibulospinal neurons responded to orthodromic stimulation to the PC nerve with a short (<1.4 ms) latency, indicating that they were second-order vestibulospinal neurons. The rest (3/47) responded with a longer (>/=1.4 ms) latency, indicating the existence of polysynaptic connections. In 36/47 PC nerve-activated vestibulospinal neurons, the axonal pathway was histologically verified to lie in the spinal cord. The axons of 17/36 vestibulospinal neurons projected to the i-LVST, whereas 14 neurons projected to the MVST, and 5 to the c-LVST. The spinal segment levels of projection of these neurons elucidated that the axons of most (15/17) of vestibulospinal neurons passing through the i-LVST reached the L3 segment level; none (0/14) of the neurons passing through the MVST extended to the L3 segment level; most (13/14) of them did not descend lower than the C3 segment level. In relation to the latency and the pathway, 33/36 PC nerve-activated vestibulospinal neurons were second-order neurons, whereas the remaining three were polysynaptic neurons. Of these, 33 second-order vestibulospinal neurons, 16 passed through the i-LVST, while 13 and 4 descended through the MVST and c-LVST, respectively. The remaining three were polysynaptic neurons. Histological analysis showed that most of the PC nerve-activated vestibulospinal neurons were located within a specific area in the medial part of the lateral vestibular nucleus and the rostral part of the descending vestibular nucleus. In conclusion, it was suggested that PC nerve-activated vestibulospinal neurons that were located within a focal area of the vestibular nuclei have strong connections with the lower segments of the spinal cord and are related to postural stability that is maintained by the short latency vestibulospinal reflex.

Functional MRI of the cervical spinal cord on 1.5 T with fingertapping: to what extent is it feasible?

INTRODUCTION

Until recently, functional magnetic resonance imaging (fMRI) with blood oxygen level-dependent (BOLD) contrast, was mainly used to study brain physiology. The activation signal measured with fMRI is based upon the changes in the concentration of deoxyhaemoglobin that arise from an increase in blood flow in the vicinity of neuronal firing. Technical limitations have impeded such research in the human cervical spinal cord. The purpose of this investigation was to determine whether a reliable fMRI signal can be elicited from the cervical spinal cord during fingertapping, a complex motor activity. Furthermore, we wanted to determine whether the fMRI signal could be spatially localized to the particular neuroanatomical location specific for this task.

METHODS

A group of 12 right-handed healthy volunteers performed the complex motor task of fingertapping with their right hand. T2*-weighted gradient-echo echo-planar imaging on a 1.5-T clinical unit was used to image the cervical spinal cord. Motion correction was applied. Cord activation was measured in the transverse imaging plane, between the spinal cord levels C5 and T1.

RESULTS

In all subjects spinal cord responses were found, and in most of them on the left and the right side. The distribution of the activation response showed important variations between the subjects. While regions of activation were distributed throughout the spinal cord, concentrated activity was found at the anatomical location of expected motor innervation, namely nerve root C8, in 6 of the 12 subjects.

CONCLUSION

fMRI of the human cervical spinal cord on an 1.5-T unit detects neuronal activity related to a complex motor task. The location of the neuronal activation (spinal cord segment C5 through T1 with a peak on C8) corresponds to the craniocaudal anatomical location of the neurons that activate the muscles in use.

The vestibular control of balance after stroke

OBJECTIVES

To examine vestibular control of balance in those who recovered the ability to stand after middle cerebral artery (MCA) stroke.

METHODS

Sixteen patients with MCA stroke were compared with 10 age matched controls. Two additional patients were studied with isolated corticospinal tract lesions, one each at the level of the pons and medulla. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation (GVS) while patients stood with their eyes closed and head facing forwards, equally loading both legs. The GVS response was characterised by measuring the amplitude of the stimulus evoked lateral forces acting through each leg and the lateral displacement of the axial skeleton.

RESULTS

Lateral displacement and net lateral force following GVS were significantly larger after stroke. Unlike controls, the lateral forces in the stroke group were asymmetrical, being enhanced on the side of the non-paretic limb and small on the side of the paretic limb. The degree of GVS evoked asymmetry correlated with corticospinal damage assessed using transcranial magnetic stimulation. A similar asymmetrical response was seen in the patient with the pontine lesion but not the patient with the medullary lesion.

CONCLUSIONS

MCA stroke may disrupt corticobulbar projections to brainstem output pathways involved in vestibular control of balance. These projections are either collaterals of the corticospinal tract or lie close to that tract and terminate in the pons/upper medulla. This hypothesis accounts for the association between corticospinal tract damage and GVS response asymmetry, and the lack of GVS evoked asymmetry with corticospinal lesions below the rostral medulla.

Vestibulospinal influences on lower limb motoneurons

Galvanic vestibular stimulation (GVS) is a research tool used to activate the vestibular system in human subjects. When a low-intensity stimulus (1–4 mA) is delivered percutaneously to the vestibular nerve, a transient electromyographic response is observed a short time later in lower limb muscles. Typically, galvanically evoked responses are present when the test muscle is actively engaged in controlling standing balance. However, there is evidence to suggest that GVS may be able to modulate the activity of lower limb muscles when subjects are not in a free-standing situation. The purpose of this review is to examine 2 studies from our laboratory that examined the effects of GVS on the lower limb motoneuron pool. For instance, a monopolar monaural galvanic stimulus modified the amplitude of the ipsilateral soleus H-reflex. Furthermore, bipolar binaural GVS significantly altered the onset of activation and the initial firing frequency of gastrocnemius motor units. The following paper examines the effects of GVS on muscles that are not being used to maintain balance. We propose that GVS is modulating motor output by influencing the activity of presynaptic inhibitory mechanisms that act on the motoneuron pool.Key words: galvanic vestibular stimulation, h-reflex, motor unit, vestibulospinal, human.

Modulation of the soleus H-reflex in prone human subjects using galvanic vestibular stimulation

OBJECTIVES

To determine if vestibular-evoked modulation of the soleus H-reflex can be achieved in a muscle that is not being used for postural support.

METHODS

Ten healthy subjects lay prone while the right leg was supported. In this position soleus H-reflex amplitudes were measured with the head facing forward, coupled with ipsilateral monopolar monaural galvanic stimulation (anode or cathode). To evaluate the interval between the onset of the galvanic stimulus and tibial nerve stimulation, the timing was varied between 0 and 200 ms in 20 ms intervals. A two-way ANOVA and student's t-test was performed to compare the mean amplitudes of the test and conditioned H-reflexes.

RESULTS

Galvanic stimulation significantly modified the amplitude of the H-reflex in a prone lying subject (P<0.05). Furthermore, the peak inhibitory and facilitatory effect occurred when the galvanic vestibular stimulus was delivered 100 ms prior to the H-reflex stimulus.

CONCLUSIONS

The results of this study demonstrate that galvanic stimulation can modulate the excitability of the soleus motoneuron pool when the muscle is not being used posturally. This suggests that in certain situations, it may be possible to use this type of vestibular stimulation to examine the integrity of descending vestibulospinal pathways in prone human subjects.

Evaluation of motor function during thoracic and thoracolumbar spinal surgery based on motor-evoked potentials using train spinal stimulation

STUDY DESIGN

Using compound muscle action potentials after train spinal stimulation, intraoperative motor functional monitoring was performed during thoracic and thoracolumbar spinal surgery.

OBJECTIVES

This study was designed to clarify the clinical usefulness of train spinal stimulation and to determine the critical point of compound muscle action potential change at which neurologic injury during surgery occurs.

SUMMARY OF BACKGROUND DATA

In 1995 the authors reported that train spinal stimulation allows for the recording of compound muscle action potentials, even in animals and humans under general anesthesia. The facilitative effect of train stimulation overcomes the suppressive effects of anesthetics and allows potentials to pass through synapses, thereby enabling a reliable recording of lower extremity compound muscle action potential.

METHODS

Multisegmental recording of compound muscle action potentials after train spinal stimulation was conducted on 34 patients Undergoing surgical treatment for thoracic or thoracolumbar lesions. During surgery, train stimuli (5 pulse, Interstimular Interval: 1 ms) were administered using an epidural electrode introduced transcutaneously. Compound muscle action potentials were recorded from a total of 128 muscles. Anesthesia was maintained using fentanyl and propofol or nitrous oxide with or without isoflurane. Muscle relaxation was attained mainly by controlled infusion of vecuronium bromide. The percent occurrence of recordable compound muscle action potentials was determined, and the potential changes were correlated with changes in muscle strength.

RESULTS

Compound muscle action potentials could be recorded from at least one muscle in 94% of the patients, even in most patients with severe motor dysfunction. The compound muscle action potential changes before and after surgical maneuver were divided into four grades. All compound muscle action potential changes in deteriorated muscles belonged to Grade 2 (a 10% latency delay) or Grade 3 (disappearance).

CONCLUSIONS

The success rate in obtaining muscle potentials was greatly enhanced when all of the following methods were used: train spinal stimulation, anesthetic with weak suppressive effect, multiple muscle recording, and percutaneous introduction of epidural electrode. The critical point of compound muscle action potential change should be defined as a 10% latency delay or disappearance. Multisegmental muscle potential after train spinal stimulation is the most appropriate method for thoracic and thoracolumbar spinal surgery.