Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Jun 2008
Pain ratings and somatosensory evoked responses to repetitive intramuscular and intracutaneous stimulation in fibromyalgia syndrome.
To determine the presence of perceptual sensitization and related brain responses we examined 15 patients with fibromyalgia syndrome and 15 healthy controls comparable in age and sex. Multichannel EEG recordings and pain ratings were obtained during the presentation of 800 painful electrical intramuscular and intracutaneous stimuli to the left m. erector spinae and the left m. extensor digitorum. The stimulus intensity was adjusted to 50% between pain threshold and tolerance. ⋯ In the EEG data the fibromyalgia syndrome patients showed higher N80 amplitudes compared with the healthy controls. Arm stimulation and intramuscular stimulation yielded higher N80 and N150 amplitudes compared with intracutaneous stimulation or stimulation of the back. These results indicate lower pain thresholds in the fibromyalgia syndrome patients after electrical stimulation and a higher N80 amplitude both indicative of enhanced sensory processing in this group.
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J Clin Neurophysiol · Feb 2008
Successful intraoperative spinal cord monitoring during scoliosis surgery using a total intravenous anesthetic regimen including dexmedetomidine.
Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. ⋯ Monitoring techniques included sensory (SSEP) and motor evoked potentials (MEP), as well as pedicle screw stimulation. SSEPs were maintained within an acceptable range of baseline amplitude (50%) and latency (10%), and MEPs remained elicitable throughout each case. We therefore found that the anesthetic regimen did not significantly interfere with any of the monitoring modalities used and conclude that IONM in the presence of dexmedetomidine is feasible under appropriate conditions.
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J Clin Neurophysiol · Aug 2007
ReviewNeurophysiology of surgical procedures for repair of the aortic arch.
Neurophysiologic monitoring during surgical procedures involving the aortic arch is very complex because of the number of different phases of the procedure, the high mortality rate, and the use of hypothermia. In this paper, the critical goals of neurophysiologic monitoring are discussed in the context of the different surgical events and the surgical options during the different phases of the procedure. ⋯ The role of EEG and evoked potentials in assessing the effect of hypothermia and circulatory arrest is also discussed. As these effects are predictable in large part, the neurophysiologist will be able to determine when changes in the neurophysiologic tests outside the norm occur and provide prompt warnings to the surgeon.
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J Clin Neurophysiol · Aug 2007
Neurophysiologic intraoperative monitoring during endovascular stent graft repair of the descending thoracic aorta.
Conventional surgery on the descending thoracic aorta for aneurysm or dissection repair typically involves open thoracotomy and cross-clamping of the aorta. These procedures are associated with the potential for significant neurologic morbidity due to spinal cord ischemia. ⋯ Several studies have demonstrated the utility of neurophysiologic intraoperative monitoring (NIOM) during conventional aortic surgery; however, less information is available regarding NIOM during EVSG repair. This paper reviews the data available regarding NIOM in EVSG repair of the descending thoracic aorta.
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J Clin Neurophysiol · Aug 2007
ReviewManagement of neurologic complications of thoracic aortic surgery.
Neurologic complications of thoracic aortic surgery are strongly associated with increased morbidity and mortality. Identifying preoperative risk factors for neurologic injury may enable us to refine our perioperative approach, and to lessen or avoid these complications. Methods to identify stroke and spinal ischemia intraoperatively such as neurophysiologic monitoring may enable us to improve outcomes in these patients by immediately instituting measures to improve brain and spine perfusion. The development of both protocols and therapies to treat these complications has allowed us to mitigate and, at times, reverse neurologic injury both intraoperatively and postoperatively.