Spinal and pudendal nerve modulation  of human corticoanal motor pathways

We investigated the effects of lumbosacral and pudendal nerve stimulation on the corticofugal pathways to the human external anal sphincter. In 11 healthy subjects, anal sphincter electromyographic responses, evoked to transcranial magnetic stimulation of the motor cortex, were recorded 5–500 ms after lumbosacral root or pudendal nerve stimulation. Lumbosacral and pudendal nerve stimulation alone evoked responses with amplitudes of 293 ± 73 and 401 ± 153 μV and latencies of 3.2 ± 0.2 and 2.2 ± 0.2 ms, respectively. Cortical stimulation also evoked responses with amplitudes of 351 ± 104 μV and latencies of 20.9 ± 1.1 ms. When lumbosacral or pudendal nerve stimulation preceded cortical stimulation, the cortically evoked responses were facilitated ( P < 0.01), with the effect appearing greatest at 5–20 ms after both lumbosacral and pudendal excitation and at 50–100 ms after lumbosacral excitation alone. Our results demonstrate that cortical pathways to the external anal sphincter are facilitated by prior lumbosacral and pudendal nerve stimulation, indicating that sensorimotor interactions are important in the central neural control of sphincter function.

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The role of Pudendal Nerve Terminal Motor Latency (PNTML) in the assessment of the external anal sphincter function

Galle Medical Journal ◽

10.4038/gmj.v11i1.1108 ◽

2009 ◽

Vol 11 (1) ◽

pp. 3 ◽

Cited By ~ 2

Author(s):

MSB Tillakaratne ◽

DN Samarasekera

Keyword(s):

Anal Sphincter ◽

Nerve Terminal ◽

External Anal Sphincter ◽

Pudendal Nerve ◽

Sphincter Function ◽

Anal Sphincter Function ◽

Motor Latency

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Faculty Opinions recommendation of Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1163119.623783 ◽

2009 ◽

Author(s):

Anton Emmanuel

Keyword(s):

Fecal Incontinence ◽

Anal Sphincter ◽

Nerve Stimulation ◽

Sacral Nerve Stimulation ◽

External Anal Sphincter ◽

Sphincter Defect ◽

Sacral Nerve ◽

Anal Sphincter Defect

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The short-term efficacy of electrical pudendal nerve stimulation versus intravesical instillation for the urethral pain syndrome: a randomized clinical trial

World Journal of Urology ◽

10.1007/s00345-021-03698-2 ◽

2021 ◽

Author(s):

Tian Li ◽

Xin Y. Feng ◽

Xiao M. Feng ◽

Jian W. Lv ◽

Ting T. Lv ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Nerve Stimulation ◽

Pudendal Nerve ◽

Pain Syndrome ◽

Intravesical Instillation ◽

Short Term ◽

Pudendal Nerve Stimulation ◽

Term Efficacy ◽

Urethral Pain

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Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report

BMC Urology ◽

10.1186/s12894-021-00808-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shan Chen ◽

Siyou Wang ◽

Yunqiu Gao ◽

Xiaolian Lu ◽

Jiasheng Yan ◽

...

Keyword(s):

Urinary Tract ◽

Nerve Stimulation ◽

Lower Urinary Tract ◽

Pudendal Nerve ◽

Sacral Neuromodulation ◽

Lower Urinary Tract Dysfunction ◽

Urinary Frequency ◽

Pudendal Nerve Stimulation ◽

Additional Therapy ◽

Lower Urinary

Abstract Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM.

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Intraoperative monitoring for tethered cord surgery: an update

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.2.1 ◽

2004 ◽

Vol 16 (2) ◽

pp. E8 ◽

Cited By ~ 71

Author(s):

Karl F. Kothbauer ◽

Klaus Novak

Keyword(s):

Electrical Stimulation ◽

Anal Sphincter ◽

External Anal Sphincter ◽

Continuous Monitoring ◽

Pudendal Nerve ◽

Tethered Cord ◽

Sensory Pathways ◽

Functional Integrity ◽

Muscle Responses ◽

Stimulation Of

Object Intraoperative neurophysiological recording techniques have found increasing use in neurosurgical practice. The development of new recording techniques feasible while the patient receives a general anesthetic have improved their practical use in a similar way to the use of digital recording, documentation, and video technology. This review intends to provide an update on the techniques used and their validity. Methods Two principal methods are used for intraoperative neurophysiological testing during tethered cord release. Mapping identifies functional neural structures, namely nerve roots, and monitoring provides continuous information on the functional integrity of motor and sensory pathways as well as reflex circuitry. Mapping is performed mostly by using direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle. Sensory mapping can also be performed with peripheral stimulation and recording within the surgical site. Monitoring of the motor system is achieved with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from limb muscles and the external anal sphincter. The presence or absence of muscle responses are the parameters monitored. Sensory potentials evoked by tibial or pudendal nerve stimulation and recorded from the dorsal columns via an epidurally inserted electrode and/or from the scalp as cortical responses are used to access the integrity of sensory pathways. Amplitudes and latencies of these responses are then interpreted. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording of muscle responses in the external anal sphincter, is used for continuous monitoring of the reflex circuitry. Presence or absence of this response is the pertinent parameter that is monitored. Conclusions Intraoperative neurophysiology provides a wide and reliable set of techniques for intraoperative identification of neural structures and continuous monitoring of their functional integrity.

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