Is the triple stimulation technique a better quantification tool of motor dysfunction than motor evoked potentials in multiple sclerosis?

2018 ◽  
Vol 119 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Xavier Giffroy ◽  
Dominique Dive ◽  
Jean-François Kaux ◽  
Nathalie Maes ◽  
Adelin Albert ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Motor Dysfunction ◽  
Stimulation Technique ◽  
Triple Stimulation Technique

The size of motor-evoked potentials: influencing parameters and quantification

2012 ◽  
Author(s):  
Kai M. Rösler ◽  
Michel R. Magistris
Keyword(s):  
Evoked Potentials ◽  
Motor Neurons ◽  
Healthy Subjects ◽  
Motor Evoked Potentials ◽  
Conduction Block ◽  
Phase Cancellation ◽  
Pathological Conditions ◽  
The Central Nervous System ◽  
Stimulation Technique ◽  
Triple Stimulation Technique

This article discusses parameters influencing the size of motor-evoked potentials (MEPs) in normal and pathological conditions, and the methods of meaningful quantification of the MEPs. MEPs are widely used to study the physiology of corticospinal conduction in healthy subjects and in patients with diseases of the central nervous system. The characteristics of MEP size are, stimulus intensity, coil positioning, and facilitation. MEPs show variability in size and shape from one stimulus to the next, even if the stimulus parameters are kept constant. This article describes the triple stimulation technique (TST), which was developed to eliminate the effects of phase cancellation from the MEPs, to allow for a better quantification. Pathological conditions may modify the parameters discussed in the article and influence the size of the MEPs by lesions of motor neurons or of their axons, central conduction velocity slowing, or conduction block.

Motor evoked potentials in clinically isolated syndrome suggestive of multiple sclerosis

2009 ◽  
Vol 15 (3) ◽  
pp. 355-362 ◽  
Author(s):  
A Rico ◽  
B Audoin ◽  
J Franques ◽  
A Eusebio ◽  
F Reuter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Amplitude Ratio ◽  
Motor Evoked Potentials ◽  
Clinically Isolated Syndrome ◽  
Conduction Time ◽  
Motor Pathway ◽  
Clinical Sensitivity ◽  
Conduction Failure ◽  
Stimulation Technique

The aim of the present study was to determine the sensitivity and the profile of motor evoked potentials (MEP) in patients with clinically isolated syndrome (CIS) suggestive of multiple sclerosis (MS). We measured the central motor conduction time (CMCT), amplitude ratio (AR), and surface ratio (SR) in tibialis anterior and first dorsal interosseous muscles in 22 patients with CIS. In 12 patients, the triple stimulation technique (TST) was also performed. AR was abnormal in 50% of patients, CMCT in 18% of patients, and TST in 25% of patients. AR had the highest sub-clinical sensitivity and the best positive predictive value. In the absence of clinical pyramidal signs, an early AR decrease seems to result from demyelination inducing excessive temporal dispersion of the MEP, while in territories with clinical pyramidal signs, it seems to result from conduction failure, which suggests that clinical pyramidal signs may be attributable to conduction failure. This study demonstrates that MEP, especially the AR, is sensitive to motor pathway dysfunction right from the early stages of MS.

scholarly journals A clinical study of motor evoked potentials using a triple stimulation technique

Brain ◽  
1999 ◽  
Vol 122 (2) ◽  
pp. 265-279 ◽  
Author(s):  
M. R. Magistris ◽  
K. M. Rösler ◽  
A. Truffert ◽  
T. Landis ◽  
C. W. Hess
Keyword(s):  
Clinical Study ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Stimulation Technique ◽  
Triple Stimulation Technique

Motor evoked potentials in a mouse model of chronic multiple sclerosis

2006 ◽  
Vol 33 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Stefano Amadio ◽  
Stefano Pluchino ◽  
Elena Brini ◽  
Paolo Morana ◽  
Roberta Guerriero ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Mouse Model ◽  
Evoked Potentials ◽  
Motor Evoked Potentials

Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves

2006 ◽  
Vol 104 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Minoru Fujiki ◽  
Yoshie Furukawa ◽  
Tohru Kamida ◽  
Mitsuhiro Anan ◽  
Ryo Inoue ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Motor Function ◽  
Wave Amplitude ◽  
Motor Evoked Potentials ◽  
Motor Dysfunction ◽  
Cortical Gray Matter ◽  
Group A ◽  
Group B ◽  
Group D ◽  
D Wave

Object The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function. Methods Muscle and spinal MEPs were simultaneously recorded during surgery in 80 patients harboring brain tumors. Each case was assigned to one of four groups according to final changes in the MEPs: 1) Group A, in which there was an increased amplitude in the muscle MEP with an increased I3 wave amplitude (12 cases); 2) Group B, in which there was no significant change in the MEP (43 cases); 3) Group C, in which there was a decreased muscle MEP amplitude (< 35% of the control) with a decreased I wave amplitude but an unchanged D wave (15 cases); or 4) Group D, in which there was an absent muscle MEP with a decreased D wave amplitude (10 cases). In patients in Group A, the increase in the amplitude of the muscle MEP (range of increase 128–280%, mean increase 188.75 ± 48.79%) was well correlated with the increase in the I3 wave in corticospinal MEPs. Most of these patterns were observed in patients harboring meningiomas (10 [83.3%] of 12 cases). Patients in Group B displayed no changes in muscle and corticospinal MEPs and no signs of postoperative neurological deterioration. Patients in Group C showed a substantial decrease in the amplitude of the muscle MEP (range of decrease 5.3–34.8% based on the control waveform, mean change 21.81 ± 10.93%) without deterioration in the corticospinal D wave, and exhibited severe immediate postoperative motor dysfunction. This indicates dysfunction of the cortical gray matter, including the motor cortices, which are supposed to generate I waves. Patients in Group D exhibited decreases in the corticospinal D wave (range of decrease 21.5–55%, mean decrease 39.75 ± 11.45%) and an immediate cessation of the muscle MEP as well as severe permanent motor paresis. Conclusions These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).

Natalizumab restores evoked potential abnormalities in patients with relapsing–remitting multiple sclerosis

2010 ◽  
Vol 17 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Sven G Meuth ◽  
Stefan Bittner ◽  
Carola Seiler ◽  
Kerstin Göbel ◽  
Heinz Wiendl
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Sum Score ◽  
Relapsing Remitting ◽  
Natalizumab Treatment ◽  
Remitting Multiple Sclerosis ◽  
Sum Scores ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Background and Objective: The objective of this study was to examine the effects of natalizumab on functional parameters assessed by evoked potentials (visual [VEP], somatosensory [SEP] and motor evoked potentials [MEP]) in a cohort study in relapsing–remitting multiple sclerosis patients. Methods: EP data of 44 patients examined 12 months prior to natalizumab treatment, at the timepoint of treatment initiation and 1 year later were compared. Sum scores (VEP, MEP, SEP) were evaluated and correlated with the Expanded Disability Status Scale. Results: Improvement of the VEP sum score was found in 33% of natalizumab-treated patients but only in 9% of the same patients prior to treatment ( p = 0.041). A comparable situation was found for SEP (improvement: 32% versus 5%; worsening: 11% versus 37%; p = 0.027). For MEP no significant differences were seen (improvement: 10% versus 18%; worsening: 5% versus 29%; p = 0.60). EP recordings (VEP = SEP > MEP) have the capacity to demonstrate treatment effects of natalizumab on a functional level. Conclusions: Natalizumab therapy increases the percentage of patients showing stable or even ameliorated electrophysiological parameters in the investigated functional systems.

Improvement in motor evoked potentials and clinical course post-steroid therapy in multiple sclerosis

1992 ◽  
Vol 108 (2) ◽  
pp. 184-188 ◽  
Author(s):  
J.Y. Salle ◽  
J. Hugon ◽  
F. Tabaraud ◽  
J.M. Boulesteix ◽  
J.M. Vallat ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Steroid Therapy ◽  
Clinical Course ◽  
Motor Evoked Potentials

scholarly journals Cortical Relay Time for Long Latency Reflexes in Patients with Definite Multiple Sclerosis

2004 ◽  
Vol 31 (2) ◽  
pp. 229-234 ◽  
Author(s):  
Cengiz Tataroglu ◽  
Ahmet Genc ◽  
Egemen Idiman ◽  
Raif Cakmur ◽  
Fethi Idiman
Keyword(s):  
Multiple Sclerosis ◽  
Evoked Potentials ◽  
Somatosensory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Clinical Form ◽  
Control Subjects ◽  
Long Latency ◽  
Cortical Involvement ◽  
And Control ◽  
Long Latency Reflexes

AbstractBackground:Long latency reflexes (LLR) include afferent sensory, efferent motor and central transcortical pathways. It is supposed that the cortical relay time (CRT) reflects the conduction of central transcortical loop of LLR. Recently, evidence related to the cortical involvement in multiple sclerosis (MS) has been reported in some studies. Our aim was to investigate the CRT alterations in patients with MS.Methods:Upper extremity motor evoked potentials (MEP), somatosensory evoked potentials (SEP) and LLR were tested in 28 patients with MS and control subjects (n=22). The patients with MS were classified according to the clinical form (relapsing-remitting [R-R] and progressive groups). The MS patients with secondary progressive and primary progressive forms were considered as the “progressive” group. CRT for LLR was calculated by subtracting the peak latency of somatosensory evoked potentials (SEP) and that of motor evoked potentials (MEP) by transcranial magnetic stimulation from the onset latency of the second component of LLR (LLR2) (CRT = LLR2 – [MEP latency + N20 latency])Results:Cortical relay time was calculated as 7.4 ± 0.9 ms in control subjects. Cortical relay time was prolonged in patients with MS (11.2 ± 2.9 ms) (p<0.0001). The latencies of LLR, MEP and SEP were also prolonged in patients with MS. Cortical relay time was not correlated with disease severity and clinical form in contrast to other tests.Conclusions:Our findings suggested that CRT can be a valuable electrophysiological tool in patients with MS. Involvement of extracortical neural circuits between sensory and motor cortices or cortical involvement due to MS may cause these findings.

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