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Updated: Feb 4, 2026

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Lower Extremity Somatosensory Evoked Potential P37 Waveform Optimization.

Stephanie L Schwartz1, Emily B Kale1, Aatif M Husain2,3,4

  • 1a Neurodiagnostic Ancillary Services , Duke University Medical Center , Durham , North Carolina.

The Neurodiagnostic Journal
|September 27, 2018
PubMed
Summary

The P37 waveform in tibial nerve somatosensory evoked potentials (SEPs) for neurophysiologic intraoperative monitoring (NIOM) did not show a single best scalp electrode derivation. Using multiple derivations is recommended for optimal P37 recording.

Keywords:
OptimizationP37 waveformsomatosensory evoked potentialstibial

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Area of Science:

  • Neuroscience
  • Clinical Neurophysiology
  • Surgical Monitoring

Background:

  • Somatosensory evoked potentials (SEPs) are crucial for intraoperative monitoring (NIOM).
  • The P37 waveform, generated by tibial nerve stimulation, is a key component of SEPs.
  • Identifying the optimal scalp electrode derivation for P37 recording is essential for accurate NIOM.

Purpose of the Study:

  • To determine the most effective scalp electrode derivation for recording the P37 waveform during tibial nerve SEP NIOM.
  • To compare the amplitude of the P37 waveform across different derivations.

Main Methods:

  • Retrospective review of surgical cases utilizing tibial nerve SEP NIOM.
  • Analysis of P37 waveform amplitude from three specific derivations: centroparietal ipsilateral-centroparietal contralateral (CPi-CPc), centroparietal midline-frontopolar midline (CPz-Fpz), and centroparietal midline-centroparietal contralateral (CPz-CPc).
  • Statistical comparison of mean P37 amplitudes across derivations using a chi-square test.

Main Results:

  • The P37 waveform's highest amplitude was observed with CPz-Fpz (35.4%), CPz-CPc (35.4%), and CPi-CPc (24.4%) derivations.
  • No significant difference in mean P37 amplitude was found between the analyzed derivations.
  • The optimal derivation for the P37 waveform was inconsistent between the left and right limbs within the same patient (10/39 patients).

Conclusions:

  • A single, superior derivation for recording the P37 waveform in tibial nerve SEP NIOM was not identified.
  • Utilizing multiple scalp electrode derivations is recommended to maximize P37 waveform capture.
  • When channel limitations exist, prioritizing CPz-Fpz and CPz-CPc derivations is advised.