caa a22 4500 605509581 CHVBK 20210128100641.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10877-014-9565-7 doi (NATIONALLICENCE)springer-10.1007/s10877-014-9565-7 Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery [Elektronische Daten] [Shunji Tsutsui, Hiroshi Iwasaki, Hiroshi Yamada, Hiroshi Hashizume, Akihito Minamide, Yukihiro Nakagawa, Hideto Nishi, Munehito Yoshida] 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 11-75years), TcMEPs from the abductor hallucis (AH) and quadriceps femoris (QF) were analyzed. A multipulse (train) stimulus with an individual pulse width of 0.5ms and an inter-pulse interval of 2ms was delivered repeatedly (2-7 times) at different rates (2, 5, and 10Hz). TcMEP amplitudes increased with the number of train stimuli for AH, with the strongest facilitation observed at 5Hz. 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. Springer Science+Business Media New York, 2014 Intraoperative neurophysiologic monitoring nationallicence Motor evoked potential nationallicence Multi-train transcranial electrical stimulation nationallicence Spinal surgery nationallicence Tsutsui Shunji Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Iwasaki Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Yamada Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Hashizume Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Minamide Akihito Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Nakagawa Yukihiro Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Nishi Hideto Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Yoshida Munehito Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 35-39 1387-1307 29:1<35 2015 29 10877 https://doi.org/10.1007/s10877-014-9565-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10877-014-9565-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tsutsui Shunji Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Iwasaki Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Yamada Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Hashizume Hiroshi Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Minamide Akihito Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Nakagawa Yukihiro Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Nishi Hideto Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 700 1- Yoshida Munehito Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, 641-8510, Wakayama, Japan aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 35-39 1387-1307 29:1<35 2015 29 10877