Evaluation of the diagnostic value of transcranial electrical stimulation (TES) to assess neuronal functional integrity in horses.

Unlabelled: Medical imaging allows for the visualization of spinal cord compression sites; however, it is impossible to assess the impact of visible stenotic sites on neuronal functioning, which is crucial information to formulate a correct prognosis and install targeted therapy. It is hypothesized that with the transcranial electrical stimulation (TES) technique, neurological impairment can be reliably diagnosed.

Objective: To evaluate the ability of the TES technique to assess neuronal functional integrity in ataxic horses by recording TES-induced muscular evoked potentials (MEPs) in three different muscles and to structurally involve multiple ancillary diagnostic techniques, such as clinical neurological examination, plain radiography (RX) with ratio assessment, contrast myelography, and post-mortem gross and histopathological examination.

Risk factors for neurophysiological events related to intraoperative halo-femoral traction in spinal deformity surgery.

Purpose: This study identifies risk factors for neurophysiological events caused by intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), and neuromuscular scoliosis (NMS).

Methods: Neurophysiological integrity was monitored using motor evoked potentials (MEPs). IONM event was defined as a decreased MEP amplitude of more than 80% of baseline in, at least, one muscle.

Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation in Horses.

Depending on the localization of the lesion, spinal cord ataxia is the most common type of ataxia in horses. Most prevalent diagnoses include cervical vertebral stenotic myelopathy (CVSM), equine protozoal myeloencephalitis (EPM), trauma and equine degenerative myeloencephalopathy (EDM). Other causes of ataxia and weakness are associated with infectious causes, trauma and neoplasia.

Safety issues during surgical monitoring.

While intra-operative neuro-physiologic assessment and monitoring improve the safety of patients, its use may also introduce new risks of injuries. This chapter looks at the electric safety of equipment and the potential hazards during the set-up of the monitoring. The physical and functional physiologic effects of electric shocks and stimulation currents, standards for safety limits, and conditions for tissue damage are described from basic physical principles.

Trapezius Motor Evoked Potentials From Transcranial Electrical Stimulation and Transcranial Magnetic Stimulation: Reference Data, Characteristic Differences and Intradural Motor Velocities in Horses.

Reason For Performing Study: So far, only transcranial motor evoked potentials (MEP) of the extensor carpi radialis and tibialis cranialis have been documented for diagnostic evaluation in horses. These allow for differentiating whether lesions are located in either the thoraco-lumbar region or in the cervical myelum and/or brain. Transcranial trapezius MEPs further enable to distinguish between spinal and supraspinal located lesions.

Comparison of Muscle MEPs From Transcranial Magnetic and Electrical Stimulation and Appearance of Reflexes in Horses.

Introduction: Transcranial electrical (TES) and magnetic stimulation (TMS) are both used for assessment of the motor function of the spinal cord in horses. Muscular motor evoked potentials (mMEP) were compared intra-individually for both techniques in five healthy horses. mMEPs were measured twice at increasing stimulation intensity steps over the extensor carpi radialis (ECR), tibialis cranialis (TC), and caninus muscles.

Extramuscular Recording of Spontaneous EMG Activity and Transcranial Electrical Elicited Motor Potentials in Horses: Characteristics of Different Subcutaneous and Surface Electrode Types and Practical Guidelines.

Introduction: Adhesive surface electrodes are worthwhile to explore in detail as alternative to subcutaneous needle electrodes to assess myogenic evoked potentials (MEP) in human and horses. Extramuscular characteristics of both electrode types and different brands are compared in simultaneous recordings by also considering electrode impedances and background noise under not mechanically secured (not taped) and taped conditions.

Methods: In five ataxic and one non-ataxic horses, transcranial electrical MEPs, myographic activity, and noise were simultaneously recorded from subcutaneous needle (three brands) together with pre-gelled surface electrodes (five brands) on four extremities.

Influence of the Montage of Stimulation Electrodes for Intraoperative Neuromonitoring During Orthopedic Spine Surgery.

Purpose: In transcranial electrical stimulation, induced motor evoked potentials (MEPs) are influenced by the montage of stimulation electrodes. Differences are to be examined between coronal and sagittal stimulation.

Methods: Forty-five patients with idiopathic scoliosis were included.

Multipulse transcranial electrical stimulation (TES): normative data for motor evoked potentials in healthy horses.

Background: There are indications that transcranial electrical stimulation (TES) assesses the motor function of the spinal cord in horses in a more sensitive and reproducible fashion than transcranial magnetic stimulation (TMS). However, no normative data of TES evoked motor potentials (MEP) is available.

Results: In this prospective study normative data of TES induced MEP wave characteristics (motor latency times (MLT); amplitude and waveform) was obtained from the extensor carpi radialis (ECR) and tibial cranialis (TC) muscles in a group of healthy horses to create a reference frame for functional diagnostic purposes.

Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery.

Purpose: Patients with tethered spinal cord have been investigated for short-term effects after tethered spinal cord surgery in the past. However, little is known about the long-term effects in this patient group. In this retrospective, longitudinal, observational study, a patient sample of a previous report of 65 patients was reassessed to observe the long-term effects of intraoperative neurophysiological monitoring-assisted tethered cord surgery.

The Percentage of Amplitude Decrease Warning Criteria for Transcranial MEP Monitoring.

Muscle motor evoked potentials (MEPs) from transcranial electrical stimulation (TES) became a standard technique for monitoring the motor functions of the brain and spinal cord at risk during spinal and brain surgery. However, a wide range of criteria based on the percentage of amplitude decrease is used in practice. A survey of the current literature on clinical outcome parameters reveals a variety of percentages in a range of 30% to 100% (50% to 100% spinal procedures) with no consensus.

Movement Along the Spine Induced by Transcranial Electrical Stimulation Related Electrode Positioning.

Study Design: A prospective, nonrandomized cohort study.

Objective: To describe a technique quantifying movement induced by transcranial electrical stimulation (TES) induced movement in relation to the positioning of electrodes during spinal deformity surgery.

Summary Of Background Data: TES induced movement may cause injuries and delay surgical procedures.

Multimodality intraoperative neuromonitoring in extreme lateral interbody fusion. Transcranial electrical stimulation as indispensable rearview.

Purpose: To optimize intraoperative neuromonitoring during extreme lateral interbody fusion (XLIF) by adding transcranial electrical stimulation with motor evoked potential (TESMEP) to previously described monitoring using spontaneous EMG (sEMG) and peripheral stimulation (triggered EMG: tEMG).

Methods: Twenty-three patients with degenerative lumbar scoliosis had XLIF procedures and were monitored using sEMG, tEMG and TESMEP. Spontaneous and triggered muscle activity, and the MEP of 5 ipsilateral leg muscles, 2 contralateral leg muscles and 1 arm muscle were monitored.

Recovery of TES-MEPs during surgical decompression of the spine: a case series of eight patients.

Purpose: This study aimed to illustrate the recovery of transcranial electrical stimulation motor evoked potentials during surgical decompression of the spinal cord in patients with impaired motor function preoperatively. Specific attention was paid to the duration of neurologic symptoms before surgery and the postoperative clinical recovery.

Methods: A case series of eight patients was selected from a cohort of 74 patients that underwent spine surgery.

The added value of semimicroelectrode recording in deep brain stimulation of the subthalamic nucleus for Parkinson disease.

Object: Accurate placement of the leads is crucial in deep brain stimulation (DBS). To optimize the surgical positioning of the lead, a combination of anatomical targeting on MRI, electrophysiological mapping, and clinical testing is applied during the procedure. Electrophysiological mapping is usually done with microelectrode recording (MER), but the relatively undocumented semimicroelectrode recording (SMER) is a competing alternative.

Optimum interpulse interval for transcranial electrical train stimulation to elicit motor evoked potentials of maximal amplitude in both upper and lower extremity target muscles.

Objective: The aim of this study was to determine the optimum interpulse interval (OIPI) for transcranial electrical train stimulation to elicit muscle motor evoked potentials (TES-MEP) with maximal amplitude in upper and lower extremities during intra-operative spinal cord monitoring.

Methods: Intraoperative spinal cord monitoring with TES-MEP was performed in 26 patients who had (corrective) spine surgery. Optimum interpulse interval (OIPI) were determined for the abductor pollicis brevis muscle (APB) representing the upper extremity and the anterior tibialis muscle (TA) representing the lower extremity.

Experimental study of the course of threshold current, voltage and electrode impedance during stepwise stimulation from the skin surface to the human cortex.

Background: Transcranial electric stimulation as used during intraoperative neurostimulation is dependent on electrode and skull impedances.

Objective: Threshold currents, voltages and electrode impedances were evaluated with electrical stimulation at 8 successive layers between the skin and the cerebral cortex.

Patients And Methods: Data of 10 patients (6f, 53 ± 11 years) were analyzed.

The value of intraoperative neurophysiological monitoring in tethered cord surgery.

Purpose: The value of intraoperative neurophysiological monitoring (IONM) with surgical detethering in dysraphic patients has been questioned. A retrospective analysis of our series of 65 patients is presented with special focus on technical set-up and outcome.

Methods: All patients were diagnosed with a tethered cord (TC) due to spinal dysraphism.

Survey on environmental monitoring requirements of European ports.

A group of 26 European ports was interviewed to understand their requirements for environmental information and to establish how widespread the use of Earth Observation (EO) data was amongst them. Aspects covered by the research included port profile characterisation, environmental management activities, environmental needs and current monitoring practices. The study reflected the diversity amongst European ports and their environmental performances.

Intraoperative neurophysiological assessment of disabling symptoms in DBS surgery.

Introduction: Neurophysiological assessment can provide quantitative measures for the selected motor signs that have been targeted for surgery and may be helpful in predicting the therapeutic effects of deep brain stimulation (DBS) on pathological tremor, motor performance, and rigidity.

Objective: To present a survey and demonstrate the contribution of neurophysiological assessment of side effects and effects on disabling motor symptoms at various steps of DBS surgery, and to confirm its role for optimal target localization, as an adjuvant to anatomic imaging.

Material And Methods: The data result from 192 nuclei in 118 procedures on patients with Parkinson's disease (84), essential tremor (24), Hallenvorder Spatz dystonia (4), multiple sclerosis (4), and Holmes tremor (2).

Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery A review and discussion of the literature.

Transcranial electrical stimulated motor evoked potential monitoring (TES-MEP) has proven to be a successful and reliable neuromonitoring technique during spinal correction surgery. However, three criteria for TES-MEP monitoring have been described in the literature. This study aims at discussing and comparing the following criteria: (1) the "threshold level criterion" introduced by Calancie et al.

Conditioning stimulation techniques for enhancement of transcranially elicited evoked motor responses.

Introduction: In spite of the use of multipulse, transcranial electrical stimulation (TES) is still insufficient in a subgroup of patients to elicit motor-evoked potentials during intraoperative neurophysiological monitoring (IONM). Classic facilitation methods used in awake patients are precluded under general anaesthesia. Conditioning techniques can be used in this situation.

Computer simulation of corticospinal activity during Transcranial Electrical Stimulation in neurosurgery.

Transcranial Electrical Stimulation (TES) is an important procedure in intraoperative motor monitoring. When neurosurgery is performed at certain difficult locations within the central nervous system (CNS), TES evaluates CNS functions during surgical manipulations to prevent post-operative complications. In TES, electrical stimulation is provided to the motor cortex through electrodes placed on the scalp, generating action potentials which travel through the nervous system.

Detection of tremor bursts by a running second order moment function and analysis using interburst histograms.

Introduction: Conventional linear signal processing techniques are not always suitable for the detection of tremor bursts in clinical practice due to inevitable noise from electromyographic (EMG) bursts. This study introduces (1) a non-linear analysis technique based on a running second order moment function (SOMF) and (2) auto- and cross-interburst interval histograms (IBIH) showing distributions of interburst interval EMG bursts of pathological tremors illustrating an application of the SOMF.

Materials And Methods: EMG recordings from extensors and flexors of two patients with Parkinson's disease with a rest tremor and from a healthy subject during sustained muscular contraction were preliminary analyzed in a pilot study.

Chronic stimulation of the subthalamic nucleus increases daily on-time without dyskinesia in advanced Parkinson's disease.

We assessed the efficacy of chronic stimulation of the subthalamic nucleus (STN-DBS) in 20 patients with Parkinson's disease (PD) by means of clinical assessments and patient diaries 12 months after surgery. STN-DBS reduced the UPDRS part III off-medication score by 33%, and successively improved complete daily on-time without dyskinesia at 12 months significantly. In conclusion, our study demonstrates the efficacy of chronic STN-DBS on motor features in a selected population of advanced PD patients.