Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery
Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery
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DOI：
10.1007/s10877-014-9565-7
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发表时间：
2015-02-01
影响因子：
2.2
通讯作者：
Yoshida, Munehito
中科院分区：
文献类型：
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作者：
Tsutsui, Shunji;Iwasaki, Hiroshi;Yoshida, Munehito
经颅运动诱发电位（TcMEP）被广泛用于脊柱手术中的运动功能监测。经颅刺激技术和全身麻醉的改进使得记录可靠和可重复的电位成为可能。然而，与最大外周神经刺激诱发的复合肌肉动作电位（CMAP）相比，TcMEP的幅度要小得多。本研究采用多序列经颅电刺激（mt-TES）增强TcMEP，并对mt-TES的最佳设置进行了研究。在30例接受脊柱畸形手术矫正的患者（4例男性和26例女性，运动状态正常;年龄范围11-75岁）中，分析了拇展肌（AH）和股四头肌（QF）的TcMEP。以不同的速率（2、5和10 Hz）重复（2-7次）递送单个脉冲宽度为0.5 ms且脉冲间间隔为2 ms的多脉冲（序列）刺激。TcMEP振幅增加的火车刺激AH的数量，与最强的促进观察5 Hz。与单串经颅电刺激（st-TES）相比，反应幅度平均增加6.1倍。资历架构亦有此趋势。无不良事件（例如，癫痫发作、心律失常、头皮烧伤、患者运动引起的意外损伤）。尽管在经颅电刺激之前，使用中枢或外周刺激的几种促进技术最近已被用于在手术期间增强TcMEP，但反应仍然比CMAP小得多。从传统的st-TES到mt-TES的变化有可能大大增强TcMEP反应。
Transcranial motor evoked potentials (TcMEPs) are widely used to monitor motor function during spinal surgery. Improvements in transcranial stimulation techniques and general anesthesia have made it possible to record reliable and reproducible potentials. However, TcMEPs are much smaller in amplitude compared with compound muscle action potentials (CMAPs) evoked by maximal peripheral nerve stimulation. In this study, multi-train transcranial electrical stimulation (mt-TES) was introduced to enhance TcMEPs, and the optimal setting of mt-TES was investigated. In 30 patients undergoing surgical correction of spinal deformities (4 males and 26 females with normal motor status; age range 11-75 years), TcMEPs from the abductor hallucis (AH) and quadriceps femoris (QF) were analyzed. A multipulse (train) stimulus with an individual pulse width of 0.5 ms and an inter-pulse interval of 2 ms was delivered repeatedly (2-7 times) at different rates (2, 5, and 10 Hz). TcMEP amplitudes increased with the number of train stimuli for AH, with the strongest facilitation observed at 5 Hz. The response amplitude increased 6.1 times on average compared with single-train transcranial electrical stimulation (st-TES). This trend was also observed in the QF. No adverse events (e.g., seizures, cardiac arrhythmias, scalp burns, accidental injury resulting from patient movement) were observed in any patients. Although several facilitative techniques using central or peripheral stimuli, preceding transcranial electrical stimulation, have been recently employed to augment TcMEPs during surgery, responses are still much smaller than CMAPs. Changing from conventional st-TES to mt-TES has potential to greatly enhance TcMEP responses.