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The Percentage of Amplitude Decrease Warning Criteria for Transcranial MEP Monitoring.

Henricus L Journée1, Hanneke I Berends, Moyo C Kruyt

  • 1*Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; †Department of Orthopedics, VU medical center, Amsterdam, the Netherlands; ‡Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; and §Department of surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|January 4, 2017
PubMed
Summary

This study introduces a model to standardize transcranial electrical stimulation (TES) for monitoring muscle motor evoked potentials (MEPs) during surgery. It aims to improve the reliability of MEP monitoring by reducing variations and enhancing warning criteria.

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Muscle motor evoked potentials (MEPs) are crucial for monitoring brain and spinal cord function during surgery.
  • Current MEP monitoring lacks standardized criteria, with wide variations in amplitude decrease percentages (30-100%) hindering interpretation.
  • MEPs are sensitive to interfering factors, leading to trial-to-trial variations that complicate real-time analysis.

Purpose of the Study:

  • To develop an operational model for interpreting MEP-TES voltage curves and predicting MEP amplitude variations.
  • To address the lack of consensus in MEP monitoring criteria by proposing standardized TES parameters.
  • To improve the specificity and sensitivity of warning criteria for MEP amplitude reduction during surgery.

Main Methods:

  • Proposed an operational model based on neurophysiologic principles to analyze MEP-TES voltage curves.
  • Investigated the influence of TES parameters on MEP amplitude variations and voltage curve characteristics.
  • Utilized two case examples to validate the model's predictions regarding the correlation between slope (gain) and MEP amplitude variations.

Main Results:

  • The developed model predicts a correlation between the slope (gain) of the MEP-TES voltage curve and spontaneous MEP amplitude variations.
  • Demonstrated that controllable TES parameters can potentially reduce trial-to-trial MEP variations.
  • Case examples supported the model's findings on the relationship between curve characteristics and MEP stability.

Conclusions:

  • Standardizing TES set-up procedures and parameters, such as voltage/current relative to motor threshold and supramaximal levels, can improve MEP monitoring reliability.
  • The proposed model offers a framework for more consistent interpretation of MEPs, potentially enhancing surgical outcome studies.
  • Developing strategies to desensitize MEPs to controllable parameter variations is key to improving monitoring accuracy.