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Changing stimulation parameters for motor evoked potentials: a case study.

Roger S Noss1, Christopher Ames

  • 1Department of Neurological Surgery, University of California, San Francisco, California 94143-0220, USA. roger.noss@ucsfmedctr.org

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|June 4, 2005
PubMed
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This case study reveals intraoperative motor evoked potentials (MEPs) are sensitive to stimulation parameters. Adjusting pulse duration and number of pulses can restore MEPs, reducing false alarms during cervical spine surgery.

Area of Science:

  • Neuroscience
  • Spine Surgery

Background:

  • Intraoperative monitoring of motor evoked potentials (MEPs) is crucial for preserving neurological function during cervical spine surgery.
  • Unexplained loss of MEPs can lead to unnecessary surgical interventions or delays.

Observation:

  • An abrupt, unilateral loss of MEPs occurred during cervical spine surgery without apparent surgical or anesthetic causes.
  • A systematic exploration of stimulation parameters (voltage, interpulse interval, pulse duration, number of pulses) was initiated.

Findings:

  • MEP responses were unexpectedly sensitive to specific combinations of pulse duration and number of pulses, rather than solely voltage or interpulse interval.
  • Distinct parameter sets were required for upper and lower extremity MEPs: (9 pulses, 350 V, 2.5 ms IPI, 200 µs pulse duration) and (4 pulses, 220 V, 2.5 ms IPI, 500 µs pulse duration).

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  • Responses were abolished when parameters deviated significantly from these identified sets.

    • Implications:

    • Exploring alternative stimulation parameters can help reduce the false-alarm rate of MEP monitoring.
    • This approach may restore MEP signals without altering the surgical plan, preserving patient neurological status.
    • Optimizing MEP stimulation parameters offers a potential strategy to improve the reliability of intraoperative neurophysiological monitoring.