Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Apr 2012
ReviewIntraoperative use of somatosensory-evoked potential in monitoring nerve roots.
Different intraoperative neuromonitoring modalities (mixed-nerve somatosensory-evoked potential [M-SSEP], dermatomal somatosensory-evoked potential [D-SSEP], compound motor-evoked potential [CMEP], electromyography [EMG], and the Hoffmann reflex [H-reflex]) have been developed for early detection of nerve root injury, for timely revision, and for damage reduction. In this study, we discuss the advantages and disadvantages of M-SSEP and D-SSEP by reviewing experimental evidence from animal models and clinical practice.
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J Clin Neurophysiol · Apr 2012
ReviewUtility of motor evoked potentials for intraoperative nerve root monitoring.
There is no entirely satisfactory way to monitor nerve root integrity during spinal surgery. In particular, standard free-running electromyography carries a high false-positive rate and some false-negative rate of injury. Stimulated electromyography to direct root stimulation can only be done intermittently, and roots are often inaccessible. ⋯ Only amplitude reduction warning criteria have been studied, but no percentage cutoff consensus has emerged, and this approach is troubled by response variability. There is some evidence that MEPs might reduce false electromyographic results. In conclusion, muscle MEPs could compliment electromyography but seem unlikely to completely solve the problem of nerve root monitoring.
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J Clin Neurophysiol · Apr 2012
EditorialNIOM for spinal deformity surgery: there's more than one way to skin a cat.
This was a 23-year retrospective study of 3436 consecutive pediatric orthopedic spinal surgery patients between 1995 and 2008. ⋯ The combined use of somatosensory evoked potentials, transcranial electric motor evoked potentials, descending neurogenic evoked potentials, and electromyography monitoring allowed accurate detection of permanent neurologic status in 99.6% of 3436 patients and reduced the total number of permanent neurologic injuries to 6.
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EEG is a popular, low-cost examination used in neurologic and nonneurologic evaluations. Nevertheless, the diagnostic usefulness of EEG has some limitations, and it may increase medical costs. The manifestations of syncope may lead to misdiagnoses, and frequently, it is mislabeled as epilepsy. ⋯ Bilateral slow waves were more prevalent among adults. We conclude that EEG is not useful for evaluating the diagnosis of syncope because of its very low diagnostic yield. Patients with syncope must have a correct history and physical examination plus cardiovascular tests.