The effects of propofol on rat transcranial magnetic motor evoked potentials

Temporary Occlusion of Common Carotid Arteries Does Not Evoke Total Inhibition in the Activity of Corticospinal Tract Neurons in Experimental Conditions

Temporary occlusion of the common cervical artery is the reason for ischemic stroke in 25% of patients. Little data is provided on its effects, especially regarding neurophysiological studies verifying the neural efferent transmission within fibers of the corticospinal tract in experimental conditions. Studies were performed on 42 male Wistar rats. In 10 rats, ischemic stroke was evoked by permanent occlusion of the right carotid artery (group A); in 11 rats, by its permanent bilateral occlusion (B); in 10 rats, by unilateral occlusion and releasing after 5 min (C); and in 11 rats, by bilateral occlusion and releasing after 5 min (D). Efferent transmission of the corticospinal tract was verified by motor evoked potential (MEP) recordings from the sciatic nerve after transcranial magnetic stimulation. MEPs amplitude and latency parameters, oral measurements of temperature, and verification of ischemic effects in brain slides stained with hematoxylin and eosin staining (H + E) were analyzed. In all groups of animals, the results showed that five minutes of uni- or bilateral occlusion of the common carotid artery led to alterations in brain blood circulation and evoked changes in MEP amplitude (by 23.2% on average) and latency parameters (by 0.7 ms on average), reflecting the partial inability of tract fibers to transmit neural impulses. These abnormalities were associated with a significant drop in the body temperature by 1.5 °C on average. Ten minutes occlusion in animals from groups A and B resulted in an MEP amplitude decrease by 41.6%, latency increase by 0.9 ms, and temperature decrease by 2.9 °C of the initial value. In animals from groups C and D, five minutes of recovery of arterial blood flow evoked stabilization of the MEP amplitude by 23.4%, latency by 0.5 ms, and temperature by 0.8 °C of the initial value. In histological studies, the results showed that ischemia was most prominent bilaterally in sensory and motor areas, mainly for the forelimb, rather than the hindlimb, innervation of the cortex, putamen and caudate nuclei, globulus pallidus, and areas adjacent to the fornix of the third ventricle. We found that the MEP amplitude parameter is more sensitive than the latency and temperature variability in monitoring the ischemia effects course following common carotid artery infarction, although all parameters are correlated with each other. Temporary five-minute lasting occlusion of common carotid arteries does not evoke total and permanent inhibition in the activity of corticospinal tract neurons in experimental conditions. The symptoms of rat brain infarction are much more optimistic than those described in patients after stroke, and require further comparison with the clinical observations.

A motor evoked potential trending system may discriminate outcome: retrospective application with three cases

This report presents a method for tracking Motor Evoked Potential (MEP) amplitudes over the course of a case using a moving least squares linear regression (LSMAs). During a case, newly obtained MEP amplitudes are compared to those predicted by a just previous linear regression (least squares moving average or LSMA). When detected by this comparison, a set criterion amplitude loss will then trigger linear regression of ensuing MEP amplitudes on an expanding step function which tracks the persistence of the amplitude loss for the remainder of the case. Three cases are presented. One in which the patient woke up with a newly acquired weakness in the left tibialis anterior and another in which MEP amplitudes were suddenly lost from the right foot, but after intervention, they were restored again. In a third case the patient again woke up with a new post-operative deficit, but MEP trial sampling had been more limited and variable than in the first two cases. When the linear trending method was applied to the affected myotome in the first case, the expanding step function regression was triggered after the moment of MEP loss and remained at a high level until the end of case. In the second case, the expanding step function regression was also triggered in the relevant myotome at the time of the reported MEP change, but diminished by end of case. In the third case the tracking method again successfully triggered a predictive R-Square despite the limited number of pre-event trials. The R-Square value of the expanding step function regression appears to have discriminative capability with regard to new post-op deficit. Given the importance of the intra-operative MEP for monitoring motor functioning and the high degree of variability that can affect it, the development of new quantitative, statistical methods to detect real from apparent MEP change will be necessary.

Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery

Objective

Motor evoked potentials (MEPs) changes might be caused to the non-surgically induced factors during cervical spinal surgery. Therefore, control MEPs recorded cranially to the exit of the C5 root are highly recommendable in cervical spinal surgery. We studied whether corticobulbar MEPs (C-MEPs) from tongue muscle could be used as a control MEPs in cervical spinal surgery.

Methods

Twenty-five consecutive cervical spinal surgeries were analyzed. Stimulation of motor area for tongue was done by subcutaneous electrodes placed at C3/C4 (10-20 EEG System), and recording was done from both sides of tongue.

Results

C-MEPs were recorded successfully 24 out of the 25 (96%) tested patients. Forty-six out of fifty MEPs (92%) from tongue muscles were monitorable from the baseline. In two patients, we could obtain only unilateral C-MEPs. Mean MEPs latencies obtained from the left and right side of the tongue were 11.5 ± 1 ms and 11.5 ± 0.8 ms, respectively.

Conclusions

Monitoring C-MEPs from tongue muscles might be useful control in cervical spinal surgery. They were easily elicited and relatively free from phenomenon of peripheral stimulation of the hypoglossal nerves.

Significance

This is first study to identify the usefulness of C-MEPs as a control of cervical spinal surgery.

Repetitive Transcranial Magnetic Stimulation to the Unilateral Hemisphere of Rat Brain

Previous rodent models of repetitive transcranial magnetic stimulation (rTMS) adopted whole-brain stimulation instead of unilateral hemispheric rTMS, which is unlike the protocols used for human subjects. We report a successful application of rTMS to the unilateral hemisphere of rat brain. The rTMS was delivered with a low-frequency (1 Hz), high-frequency (20 Hz), or sham stimulation protocol to one side of the brain by using a small 25-mm figure-8 coil. We placed the center of the coil 1 cm lateral to the vertex on the biauricular line and angulated the coil 45° to the ground to minimize a potential direct effect of rTMS on the contralateral cortex. We also used an in-house water cooling system to enable repetitive magnetic stimulation for more than 20 min, even at a 20-Hz stimulation frequency. Increases in the transcriptions of immediate early genes (Arc, Junb, and Egr2) were greater after rTMS than after sham stimulation. After 5 consecutive days of 20-min 1-Hz rTMS, bdnf mRNA expression was significantly higher in stimulated cortex than in contralateral side. The model presented herein will elucidate the molecular mechanisms of rTMS by allowing analysis of the inter-hemispheric difference in its effect.

Interdisciplinary approaches of transcranial magnetic stimulation applied to a respiratory neuronal circuitry model

Respiratory related diseases associated with the neuronal control of breathing represent life-threatening issues and to date, no effective therapeutics are available to enhance the impaired function. The aim of this study was to determine whether a preclinical respiratory model could be used for further studies to develop a non-invasive therapeutic tool applied to rat diaphragmatic neuronal circuitry. Transcranial magnetic stimulation (TMS) was performed on adult male Sprague-Dawley rats using a human figure-of-eight coil. The largest diaphragmatic motor evoked potentials (MEPdia) were recorded when the center of the coil was positioned 6 mm caudal from Bregma, involving a stimulation of respiratory supraspinal pathways. Magnetic shielding of the coil with mu metal reduced magnetic field intensities and improved focality with increased motor threshold and lower amplitude recruitment curve. Moreover, transynaptic neuroanatomical tracing with pseudorabies virus (applied to the diaphragm) suggest that connections exist between the motor cortex, the periaqueductal grey cell regions, several brainstem neurons and spinal phrenic motoneurons (distributed in the C3-4 spinal cord). These results reveal the anatomical substrate through which supraspinal stimulation can convey descending action potential volleys to the spinal motoneurons (directly or indirectly). We conclude that MEPdia following a single pulse of TMS can be successfully recorded in the rat and may be used in the assessment of respiratory supraspinal plasticity. Supraspinal non-invasive stimulations aimed to neuromodulate respiratory circuitry will enable new avenues of research into neuroplasticity and the development of therapies for respiratory dysfunction associated with neural injury and disease (e.g. spinal cord injury, amyotrophic lateral sclerosis).

Correlation between electrophysiological properties, morphological maturation, and olig gene changes during postnatal motor tract development

This study investigated electrophysiological and histological changes as well as alterations of myelin relevant proteins of descending motor tracts in rat pups. Motor-evoked potentials (MEPs) represent descending conducting responses following stimulation of the motor cortex to responses being elicited from the lower extremities. MEP responses were recorded biweekly from postnatal (PN) week 1 to week 9 (adult). MEP latencies in PN week 1 rats averaged 23.7 ms and became shorter during early maturation, stabilizing at 6.6 ms at PN week 4. During maturation, the conduction velocity (CV) increased from 2.8 ± 0.2 at PN week 1 to 35.2 ± 3.1 mm/ms at PN week 8. Histology of the spinal cord and sciatic nerves revealed progressive axonal myelination. Expression of the oligodendrocyte precursor markers PDGFRα and NG2 were downregulated in spinal cords, and myelin-relevant proteins such as GalC, CNP, and MBP increased during maturation. Oligodendrocyte-lineage markers Olig2 and MOG, expressed in myelinated oligodendrocytes, peaked at PN week 3 and were downregulated thereafter. A similar expression pattern was observed in neurofilament M/H subunits that were extensively phosphorylated in adult spinal cords but not in neonatal spinal cords, suggesting an increase in axon diameter and myelin formation. Ultrastructural morphology in the ventrolateral funiculus (VLF) showed axon myelination of the VLF axons (99.3%) at PN week 2, while 44.6% were sheathed at PN week 1. Increased axon diameter and myelin thickness in the VLF and sciatic nerves were highly correlated to the CV (rs > 0.95). This suggests that MEPs could be a predicator of morphological maturity of myelinated axons in descending motor tracts.

Translational neuromodulation: approximating human transcranial magnetic stimulation protocols in rats

OBJECTIVE

Transcranial magnetic stimulation (TMS) is a well-established clinical protocol with numerous potential therapeutic and diagnostic applications. Yet, much work remains in the elucidation of TMS mechanisms, optimization of protocols, and in development of novel therapeutic applications. As with many technologies, the key to these issues lies in the proper experimentation and translation of TMS methods to animal models, among which rat models have proven popular. A significant increase in the number of rat TMS publications has necessitated analysis of their relevance to human work. We therefore review the essential principles for the approximation of human TMS protocols in rats as well as specific methods that addressed these issues in published studies.

MATERIALS AND METHODS

We performed an English language literature search combined with our own experience and data. We address issues that we see as important in the translation of human TMS methods to rat models and provide a summary of key accomplishments in these areas.

RESULTS

  An extensive literature review illustrated the growth of rodent TMS studies in recent years. Current advances in the translation of single, paired-pulse, and repetitive stimulation paradigms to rodent models are presented. The importance of TMS in the generation of data for preclinical trials is also highlighted.

CONCLUSIONS

Rat TMS has several limitations when considering parallels between animal and human stimulation. However, it has proven to be a useful tool in the field of translational brain stimulation and will likely continue to aid in the design and implementation of stimulation protocols for therapeutic and diagnostic applications.

Significance of intraoperative motor function monitoring using transcranial electrical motor evoked potentials (MEP) in patients with spinal and cranial lesions near the motor pathways

Intraoperative motor evoked potential (MEP) monitoring in patients with spinal and cranial lesions is thought to be a valuable tool for prevention of postoperative motor deficits. Aim of this study was to investigate its diagnostic value in a spinal and a cranial patient group. Ninety-six patients, 31 with spinal and 65 with intracranial lesions, were studied. Transcranial stimulation was performed with a high-frequency electrical train stimulation using two subdermal needle electrodes. MEPs were recorded from the pathology-related muscles. Decreasing amplitudes of 50% or more, increasing stimulus intensities of 20% or more or increased latencies were taken as warning criteria. MEP recording was possible in 90% of the spinal and 98% of the cranial group. With two further exclusions, 28 patients of the spinal and 62 of the cranial group were analyzed. We saw a temporary maximum amplitude reduction of 50% or more and an increase in stimulation intensity of 20% or more in 8 spinal and 29 cranial patients. Five of the spinal and nine of the cranial patients deteriorated in motor function postoperatively. One patient with normal MEP monitoring showed a temporary motor weakness postoperatively. Latencies were normal in all patients. Given both warning criteria, intraoperative MEP changes had a sensitivity of 83%/ 100% and a specificity of 86%/ 62% (spinal/ cranial group). The positive predictive value of MEP changes for postoperative motor function deterioration was 63%/ 31%, and the negative predictive value was 95%/ 100%. Transcranial electrical monitoring of MEP is a practicable and safe method. However, there are many events, which can cause amplitude changes of MEP independent from surgical manipulations. Although sensitivity is high for both groups, this results in a moderate specificity for the cranial group and a low positive predictive value for both groups.

Use of magnetic stimulation to elicit motor evoked potentials, somatosensory evoked potentials, and H-reflexes in non-sedated rodents

Assessment of locomotor function of rodents may be supplemented using electrophysiological tests which monitor the integrity of ascending and descending tracts as well as the focal circuitry of the spinal cord in non-sedated rodents. Magnetically induced SSEPs (M-SSEPs) were elicited in rats by activating the hindpaw using magnetic stimulation (MS). M-SSEP response latencies were slightly longer than those elicited by electrical stimulation. M-SSEPs were eliminated following selective dorsal column lacerations of the spinal cord, indicating that they were transmitted via this tract. Magnetically induced motor evoked potentials (M-MEPs) were elicited in mice following transcranial MS and recorded from the gastrocnemius muscles. M-MEPs performed on myelin deficient mice demonstrated longer onset latencies and smaller amplitudes than in wild-type mice. Magnetically induced H-reflexes (MH-reflexes) which assess local circuitry in the lumbosacral area of the spinal cord were performed in rats. This response disappeared following an L3 contusion spinal cord injury, however, kainic acid (KA) injection at L3, known to selectively destroy interneurons, caused a shorter latency and an increase in the amplitude of the MH-reflex. M-SSEPs and MH-reflexes in rats and M-MEPs in mice compliment locomotor evaluation in assessing the functional integrity of the spinal cord under normal and pathological conditions in the non-sedated animal.

Rat Models of Traumatic Spinal Cord Injury to Assess Motor Recovery

Devastating motor, sensory, and autonomic dysfunctions render long-term personal hardships to the survivors of traumatic spinal cord injury (SCI). The suffering also extends to the survivors' families and friends, who endure emotional, physical, and financial burdens in providing for necessary surgeries, care, and rehabilitation. After the primary mechanical SCI, there is a complex secondary injury cascade that leads to the progressive death of otherwise potentially viable axons and cells and that impairs endogenous recovery processes. Investigations of possible cures and of ways to alleviate the hardships of traumatic SCI include those of interventions that attenuate or overcome the secondary injury cascade, enhance the endogenous repair mechanisms, regenerate axons, replace lost cells, and rehabilitate. These investigations have led to the creation of laboratory animal models of the different types of traumatic human SCI and components of the secondary injury cascade. However, no particular model completely addresses all aspects of traumatic SCI. In this article, we describe adult rat SCI models and the motor, and in some cases sensory and autonomic, deficits that each produces. Importantly, as researchers in this area move toward clinical trials to alleviate the hardships of traumatic SCI, there is a need for standardized small and large animal SCI models as well as quantitative behavioral and electrophysiological assessments of their outcomes so that investigators testing various interventions can directly compare their results and correlate them with the molecular, biochemical, and histological alterations.

Functional abnormalities of the motor tract in the rat after portocaval anastomosis and after carbon tetrachloride induction of cirrhosis

INTRODUCTION

Hepatic encephalopathy is a neurologic syndrome secondary to liver failure that causes cognitive and motor abnormalities. Impairment in the function of the first neuron of the motor tract (corticospinal tract) has been demonstrated in patients with cirrhosis and minimal hepatic encephalopathy.

AIM

Investigate the function of the first neuron of the motor tract in experimental models of minimal hepatic encephalopathy.

MATERIAL AND METHODS

Rats with portocaval anastomosis (n = 8) and rats with carbon tetrachloride induced cirrhosis (n = 11) underwent neurophysiological recording under light anesthesia with propofol. Motor evoked potentials were elicited applying a transcranial electric pulse and were recorded in the tibialis anterior muscle. The effect of the dose of anesthesia was assessed in a group of normal rats (n = 10).

RESULTS

Rats with portocaval anastomosis exhibited a decrease in motor evoked potentials amplitude following surgery (67 +/- 11 to 41 +/- 16%, P < 0.001). Cirrhotic rats exhibited an increase in motor evoked potentials latency after the appearance of ascites (4.65 +/- 0.43 to 5.15 +/- 0.67 ms., P = 0.04). Increasing doses of propofol produced a decrease in the amplitude and an increase in the latency of motor evoked potentials.

CONCLUSION

It is possible to reproduce functional abnormalities of the central motor tract in rats with portocaval anastomosis and carbon tetrachloride induced cirrhosis. The development of motor abnormalities in experimental models of minimal hepatic encephalopathy offers the possibility to investigate the mechanisms involved in the pathogenesis of hepatic encephalopathy and test therapeutic strategies.

Measurement of motor evoked potentials following repetitive magnetic motor cortex stimulation during isoflurane or propofol anaesthesia

BACKGROUND

Isoflurane and propofol reduce the recordability of compound muscle action potentials (CMAP) following single transcranial magnetic stimulation of the motor cortex (sTCMS). Repetition of the magnetic stimulus (repetitive transcranial magnetic stimulation, rTCMS) might allow the inhibition caused by anaesthesia with isoflurane or propofol to be overcome.

METHODS

We applied rTCMS (four stimuli; inter-stimulus intervals of 3, 4, 5 ms (333, 250, 200 Hz), output 2.5 Tesla) in 27 patients and recorded CMAP from the hypothenar and anterior tibial muscle. Anaesthesia was maintained with fentanyl 0.5-1 microg kg(-1) x h(-1) and either isoflurane 1.2% (10 patients) or propofol 5 mg kg(-1) x h(-1) with nitrous oxide 60% in oxygen (17 patients).

RESULTS

No CMAP were detected during isoflurane anaesthesia. During propofol anaesthesia 333 Hz, four-pulse magnetic stimulation evoked CMAP in the hypothenar muscle in 75%, and in the anterior tibial muscle in 65% of the patients. Less response was obtained with 250 and 200 Hz stimulation.

CONCLUSIONS

In most patients, rTCMS can overcome suppression of CMAP during propofol/nitrous oxide anaesthesia, but not during isoflurane anaesthesia. A train of four magnetic stimuli at a frequency of 333 Hz is most effective in evoking potentials from the upper and lower limb muscles. The authors conclude that rTCMS can be used for evaluation of the descending motor pathways during anaesthesia.

Amplitudes and intrapatient variability of myogenic motor evoked potentials to transcranial electrical stimulation during ketamine/N2O- and propofol/N2O-based anesthesia

The aim of the current study was to investigate whether there are differences in amplitudes and intrapatient variability of motor evoked potentials to five pulses of transcranial electrical stimulation between ketamine/N2O- and propofol/N2O-based anesthesia. Patients in the propofol group (n = 13) and the ketamine group (n = 13) were anesthetized with 50% N2O in oxygen, fentanyl, and 4 mg/kg/hr of propofol or 1 mg/kg/hr of ketamine, respectively. The level of neuromuscular blockade was maintained at an M-response amplitude of approximately 50% of control. Motor evoked potentials in response to multipulse transcranial electrical stimulation were recorded from the right adductor pollicis brevis muscle, and peak-to-peak amplitude and onset latency of motor evoked potentials were evaluated. To estimate intrapatient variability, the coefficient of variation (standard deviation/mean x 100%) of 24 consecutive responses was determined. Motor evoked potential amplitudes in the ketamine group were significantly larger than in the propofol group (mean, 10th-90th percentile: 380 microV, 129-953 microV; 135 microV, 38-658 microV, respectively; P <.05). There were no significant differences in motor evoked potential latency (mean +/- standard deviation: 20.9 +/- 2.2 msec and 21.4 +/- 2.2 msec, respectively) and coefficient of variation of amplitudes (median [range]: 32% [22-42%] and 26% [18-41%], respectively) and latencies (mean +/- standard deviation: 2.1 +/- 0.7% and 2.1 +/- 0.7%, respectively) between the ketamine and propofol groups. In conclusion, intrapatient variability of motor evoked potentials to multipulse transcranial stimulation is similar between ketamine/N2O- and propofol/N2O-based anesthesia, although motor evoked potential amplitudes are lower during propofol/N2O-based anesthesia than ketamine/N2O-based anesthesia.

Transcranial electrical motor evoked potential monitoring for brain tumor resection

OBJECTIVE

This study was designed to examine whether transcranial electrical motor evoked potential (MEP) monitoring is safe, feasible, and valuable for brain tumor surgery.

METHODS

Fifty consecutive patients undergoing brain tumor resection were studied, using nitrous oxide/propofol anesthesia. MEPs were continuously recorded throughout surgery, using a Sentinel 4 evoked potential system (Axon Systems, Inc., Hauppauge, NY). The MEPs were elicited by transcranial electrical stimulation (train of 5; stimulation rate, 0.5-2 Hz; square wave pulse with a time constant of 0.5 ms; stimulation intensity, 40-160 mA) through spiral electrodes placed over the primary motor cortex and were recorded by needle electrodes inserted into the contralateral orbicularis oris, biceps, abductor pollicis brevis, and anterior tibialis muscles. When MEP amplitudes decreased by more than 50%, MEP stimulation was repeated, with increased stimulation intensity, and MEP changes were reported to the surgeon. The motor function of each patient was examined before and after surgery, using a reproducible scale. The relationship between MEP amplitude decreases and worsening motor status was analyzed using linear regression.

RESULTS

Preoperative neurological examinations revealed mild to moderate motor deficits (2/5 to 4/5) for 38% of patients (19 of 50 patients). Most of the patients (96%) exhibited recordable baseline MEPs. Persistent MEP decreases of more than 50% were noted for eight patients (16%) (11 muscles). The MEPs were completely abolished in two patients (three muscles). The degree of postoperative worsening of motor status was correlated with the degree of intraoperative MEP amplitude reduction (r = -0.864; P < 0.001).

CONCLUSION

Persistent intraoperative MEP reductions of more than 50% were associated with postoperative motor deficits. The degree of MEP amplitude reduction was correlated with postoperative worsening of motor status. Transcranial electrical MEP monitoring is feasible, safe, and valuable for brain tumor surgery.

Transcranial magnetic-evoked potentials under total intravenous anaesthesia and nitrous oxide

Magnetic stimulation of the cortex and recording of the motor-evoked potentials (MEPs) by electromyography (EMG) is a well proven method to assess the descending pathways of the spinal cord and detect neurological impairment. We have assessed, in 33 adult patients undergoing spinal surgery, the influence of four total i.v. anaesthesia regimens (TIVA) on this recording technique. In 20 patients, the effect of 50% nitrous oxide was also studied. MEP amplitudes, latencies and success rates of stimulation were obtained in the steady-state after induction of anaesthesia. Combinations of midazolam and ketamine, and alfentanil and etomidate had the least effect on MEPs. Propofol (in combination with alfentanil or ketamine) showed marked depression of the MEP amplitude and the lowest success rates of stimulation. The latencies did not change at all. The addition of nitrous oxide significantly depressed the registered MEPs and lowered the success rates.

Low dose propofol as a supplement to ketamine-based anesthesia during intraoperative monitoring of motor-evoked potentials

STUDY DESIGN

Motor-evoked potentials (MEPs) were analyzed using transcranial electrical stimulation during spinal surgery in patients under ketamine-based anesthesia, with and without propofol.

OBJECTIVE

To investigate the effects of propofol on MEPs and ketamine-induced adverse effects during spinal surgery in patients under ketamine-based anesthesia.

SUMMARY OF BACKGROUND DATA

Intraoperative monitoring of transcranial motor-evoked responses provides a method for monitoring the functional integrity of descending motor pathways. However, because these responses are sensitive to suppression by most anesthetic agents, anesthetic technique is limited during the monitoring of MEPs. Ketamine has been reported to have little effect on MEPs but may produce adverse effects such as psychedelic effect and hypertension. Recently, it has been reported that propofol may be able to inhibit ketamine-induced adverse effects.

METHODS

Intraoperative monitoring of MEPs was performed in 58 patients who underwent elective spinal surgery. Anesthesia was maintained with nitrous oxide-fentanyl-ketamine without or with low-dose (1-3 mg/kg/hr) of propofol (K group; n = 34, KP group; n = 24, respectively). Transcranial stimulation with single or paired pulses or a train of three or five pulses (interstimulus interval, 2 msec) were delivered to the scalp, and compound muscle action potentials were recorded from the left and right tibialis anterior muscles. To investigate the dose effects of propofol on MEPs, propofol was administered at an infusion rate of 6, 4, and 2 mg/kg/hr and then discontinued in 14 patients.

RESULTS

Results of MEPs were comparable between the K and KP groups. The incidence of postoperative psychedelic effect was significantly less in the KP group (14%) than in the K group (41%). Although propofol inhibited MEPs dose dependently, the use of a train of pulses for stimulation could overcome such inhibition.

CONCLUSIONS

If a train of pulses were used for transcranial stimulation, low-dose propofol can be effectivelyused as a supplement to ketamine-based anesthesia during intraoperative monitoring of myogenic MEPs. Addition of propofol significantly reduced the ketamine-induced psychedelic effects.

Magnetic motor evoked potential monitoring in the rat

OBJECT

The authors conducted a study to provide an objective electrophysiological assessment of descending motor pathways in rats, which may become a means for predicting outcome in spinal cord injury research.

METHODS

Transcranial magnetic motor evoked potentials (TMMEPs) were recorded under various conditions in awake, nonanesthetized, restrained rats. Normative data were collected to determine the reproducibility of the model and to evaluate the effect of changing the stimulus intensity on the evoked signals. In addition, an experiment was performed to determine if the TMMEPs produced were the result of auditory startle response (ASR) potentials elicited by the sound generated by the movement of the copper coil inside its casing during magnetic stimulation. Transcranial magnetic motor evoked potentials were elicited after magnetic stimulation. At 100% stimulus intensity, the mean forelimb onset latency was 4.2 +/- 0.39 msec, and the amplitude was 9.16 +/- 3.44 mV. The hindlimb onset latency was 6.5 +/- 0.47 msec, and the amplitude was 11.47 +/- 5.25 mV. As the stimulus intensity was decreased, the TMMEP onset latency increased and the response amplitude decreased. The ASR potentials were shown to have longer latencies, smaller amplitudes, and were more variable than those of the TMMEPs.

CONCLUSIONS

These experiments demonstrate that TMMEPs can be recorded in awake, nonanesthetized rats. The evoked signals were easy to elicit and reproduce. This paper introduces noninvasive TMMEPs as a new technique for monitoring the physiological integrity of the rat spinal cord.

The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model

STUDY DESIGN

The effect of spinal canal narrowing and the timing of decompression after a spinal cord injury were evaluated using a rat model.

OBJECTIVE

To evaluate whether progressive spinal canal narrowing after a spinal cord injury results in a less favorable neurologic recovery. Additionally, to evaluate the effect of the timing of decompression after spinal cord injury on neurologic recovery.

SUMMARY OF BACKGROUND DATA

Results in previous studies are contradictory about whether the amount of canal narrowing or the timing of decompression after a spinal cord injury affects the degree of neurologic recovery.

METHODS

Forty adult male Sprague-Dawley rats were equally divided into a control group, in which spacers of 20%, 35%, and 50% were placed into the spinal canal after laminectomy, and an injury group in which the spacers were placed after a standardized incomplete spinal cord injury. After spacer removal, neurologic recovery in both was monitored by Basso, Beattie, Bresnahan (BBB) Locomotor Rating Scale (Ohio State University, Columbus, OH) motor scores and transcranial magnetic motor evoked potentials for 6 weeks followed by histologic examination of the spinal cords. Subsequently, 42 rats were divided into five groups in which, after spacer placement, the time until decompression was lengthened 0, 2, 6, 24, and 72 hours. Again, serial BBB motor scores and transcranial magnetic motor evoked potentials were used to assess neurologic recovery for 6 weeks until the animals were killed for histologic evaluation.

RESULTS

Spacer placement alone in the control animals resulted in no neurologic injury until canal narrowing reached 50%. All of the control groups (spacer only) exhibited significantly better (P < 0.05) motor scores compared with the injury groups (injury followed by spacer insertion). Within the injury groups the motor scores were progressively lower as spacer sizes increased from the no-spacer group to the 35% group. The results in the 35% and 50% groups were not statistically different. The results of the time until decompression demonstrated that the motor scores were consistently better the shorter the duration of spacer placement (P < 0.05) for each of the time groups (0, 2, 6, 24, and 72 hours) over the 6-week recovery period. Histologic analysis showed more severe spinal cord damage as both spinal canal narrowing and the time until decompression increased.

CONCLUSION

The results in this study present strong evidence that the prognosis for neurologic recovery is adversely affected by both a higher percentage of canal narrowing and a longer duration of canal narrowing after a spinal cord injury. The tolerance for spinal canal narrowing with a contused cord appears diminished, indicating that an injured spinal cord may benefit from early decompression. Additionally, it appears that the longer the spinal cord compression exists after an incomplete spinal cord injury, the worse the prognosis for neurologic recovery.

Comparing deficits following excitotoxic and contusion injuries in the thoracic and lumbar spinal cord of the adult rat

The majority of human spinal cord injuries involve gray matter loss from the cervical or lumbar enlargements. However, the deficits that arise from gray matter damage are largely masked by the severe deficits due to associated white matter damage. We have developed a model to examine gray matter-specific deficits and therapeutic strategies that uses intraspinal injections of the excitotoxin kainic acid into the T9 and L2 regions of the spinal cord. The resulting deficits have been compared to those from standard contusion injuries at the same levels. Injuries were assessed histologically and functional deficits were determined using the Basso, Beattie, and Bresnahan (BBB) 21-point open field locomotor scale and transcranial magnetic motor evoked potentials (tcMMEPs). Kainic acid injections into T9 resulted in substantial gray matter damage; however, BBB scores and tcMMEP response latencies were not different from those of controls. In contrast, kainic acid injections into L2 resulted in paraplegia with BBB scores similar to those following contusion injuries at either T9 or L2, without affecting tcMMEP response latencies. These observations demonstrate that gray matter loss can result in significant functional deficits, including paraplegia, in the absence of a disruption of major descending pathways.

Conduction pathways of motor evoked potentials following transcranial magnetic stimulation: a rodent study using a "figure-8" coil

We have examined the conduction pathways of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation, and their correlation with locomotor function in rats. MEPs were concomitantly recorded from the spinal cord (sMEPs) and the limb muscles (mMEPs) before and after various spinal tract ablations. Motor function was also examined using an inclined plane test. sMEPs were composed of four negative peaks (N1-N4) and mMEPs of high-voltage, biphasic waves. Ventral funiculus transection reduced the N1-N3 peaks and abolished mMEPs. Contrarily, dorsal funiculus transection including the pyramidal tract did not alter these MEPs. Motor performance on an inclined plane was worse after ventral funiculus transection than after other transections. These findings indicate that, in rats, the N1-N3 peaks of magnetic sMEPs conduct ventral funiculus activity, and that magnetic mMEPs mainly reflect extrapyramidal activities and are correlated with locomotor function.