A multi-train electrical stimulation protocol facilitates transcranial electrical motor evoked potentials and increases induction rate and reproducibility even in patients with preoperative neurological deficits
A multi-train electrical stimulation protocol facilitates transcranial electrical motor evoked potentials and increases induction rate and reproducibility even in patients with preoperative neurological deficits
复制标题
DOI：
10.1007/s10877-017-0045-8
复制
发表时间：
2018-06-01
影响因子：
2.2
通讯作者：
Okawa, Atsushi
中科院分区：
文献类型：
--
作者：
Ushio, Shuta;Kawabata, Shigenori;Okawa, Atsushi
本研究旨在评价脊柱手术期间重复多序列经颅电刺激（mt-TES）对经颅电运动诱发电位（Tc-MEP）监测的促进作用，并评估脊髓或脊神经受损导致运动功能受损患者的诱导率。我们研究了32例连续的运动功能受损的患者，他们接受了颈椎或胸椎手术（470块肌肉）。术前以2种重复频率（1和5 Hz）输送了一系列10个TES（5个脉冲串）。测量10个TES诱发的上下肢肌MEP的峰-峰振幅。下肢肌肉的诱导率也通过肌肉和术前下肢运动功能评分进行评估。在每块肌肉中，MEP振幅在1Hz时增加约2-3倍，在5 Hz时增加约5-6倍。在5 Hz条件下，所有肢体肌肉都表现出明显的放大作用。此外，在所有术前运动功能评分组中，下肢肌肉的振幅和诱导率均显著增加。此外，易化效应往往在10个TES系列的后半部分达到峰值。在术前神经功能缺损患者的所有评分组中，以5 Hz的频率提供的重复mt-TES显著促进了所有肢体肌肉的MEP，并增加了诱导率。我们推荐这种方法来提高脊柱手术术中监测的可靠性。
This study sought to evaluate the facilitation effect of repetitive multi-train transcranial electrical stimulation (mt-TES) at 2 repetition rates on transcranial electrical motor evoked potential (Tc-MEP) monitoring during spinal surgery, and to assess the induction rate in patients with impaired motor function from a compromised spinal cord or spinal nerve. We studied 32 consecutive patients with impaired motor function undergoing cervical or thoracic spinal surgery (470 muscles). A series of 10 TESs with 5 pulse trains were preoperatively delivered at 2 repetition rates (1 and 5 Hz). All peak-topeak amplitudes of the MEPs of the upper and lower extremity muscles elicited by the 10 TESs were measured. The induction rates of the lower extremity muscles were also assessed with muscle and preoperative lower extremity motor function scores. In each of the muscles, MEP amplitudes were augmented by about 2-3 times at 1 Hz and 5-6 times at 5 Hz. Under the 5-Hz condition, all limb muscles showed significant amplification. Also, in all preoperative motor function score groups, the amplitudes and induction rates of the lower extremity muscles were significantly increased. Moreover, the facilitation effects tended to peak in the last half of the series of 10 TESs. In all score groups of patients with preoperative neurological deficits, repetitive mt-TES delivered at a frequency of 5 Hz markedly facilitated the MEPs of all limb muscles and increased the induction rate. We recommend this method to improve the reliability of intraoperative monitoring during spinal surgery.