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Somatosensory evoked potentials as a screening tool for diagnosis of spinal pathologies in children with treatment
David Terence Thomas1, Sevim Yener2, Aybegum Kalyoncu2
1Department of Pediatric Surgery, Maltepe University Faculty of Medicine, Istanbul, Turkey.
Insights
Somatosensory evoked potential (SEP) effectively screens for spinal pathologies in children with refractory overactive bladder (OAB). A normal SEP may preclude the need for further MRI investigations in these patients.
Area of Science:
- Pediatric Urology
- Neurology
- Diagnostic Imaging
Background:
- Overactive bladder (OAB) in children can be refractory to standard treatments.
- Spinal pathologies, such as tethered cord, can present with or exacerbate OAB symptoms.
- Accurate screening for spinal abnormalities is crucial in managing treatment-refractory OAB.
Purpose of the Study:
- To assess the utility of somatosensory evoked potential (SEP) as a screening tool for spinal pathologies in children with treatment-refractory overactive bladder (OAB).
- To determine the diagnostic accuracy of SEP in identifying spinal abnormalities in this patient population.
Main Methods:
- Prospective study involving children over 5 years old with treatment-refractory OAB, excluding other known causes of incontinence.
- Patients underwent urodynamic studies, spinal MRI, and somatosensory evoked potential (SEP) testing.
- Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for SEP.
Main Results:
- Thirty-one children were included (average age 8.3 years).
- SEP was abnormal in 41.9% of patients, while MRI revealed abnormalities in 25.8%.
- SEP demonstrated a sensitivity of 87.5%, specificity of 73.9%, PPV of 53.85%, and NPV of 94.4% for detecting spinal pathologies.
Conclusions:
- Somatosensory evoked potential (SEP) serves as a valuable screening tool for identifying spinal pathologies, including tethered cord, in children with treatment-refractory OAB.
- A normal SEP result in this cohort suggests that further investigation with spinal MRI may not be necessary, potentially avoiding unnecessary procedures and costs.
Purpose:
To evaluate the usefulness of somatosensory evoked potential as a screening tool for spinal pathologies in patients with treatment refractory overactive bladder.
Methods:
This prospective study was performed between January 2011 and January 2014. Children >5 years old with treatment refractory overactive bladder were enrolled after exclusion of anatomical and neurological causes of incontinence. All patients underwent urodynamic studies, spinal MRI, and somatosensory evoked potential (SEP). Sensitivity, specificity, PPV, and NPV were calculated for SEP.
Results:
Thirty-one children (average age 8.3 ± 2.9 years) were included in the study. SEP was abnormal in 13 (41.9%), and MRI was abnormal in 8 (25.8%) patients. SEP was found to have a sensitivity of 87.5%, a specificity of 73.9%, positive predictive value of 53.85%, and negative predictive value (NPV) of 94.4%.
Conclusion:
In patients with treatment refractory OAB, SEP is an important tool for the screening of tethered cord/spinal pathologies. Our results suggest that a child with a normal SEP study in this group of patients may not require further investigation with MRI.
