Experimental study of medullary trigeminal evoked potentials: development of a new method of intraoperative monitoring of the medulla oblongata

2000 ◽  
Vol 93 (1) ◽  
pp. 68-76 ◽  
Author(s):  
Tomoyoshi Oikawa ◽  
Masato Matsumoto ◽  
Tatsuya Sasaki ◽  
Namio Kodama
Keyword(s):  
Electrical Stimulation ◽  
Evoked Potentials ◽  
Medulla Oblongata ◽  
Intraoperative Monitoring ◽  
New Method ◽  
Infraorbital Nerve ◽  
Content Type ◽  
Lateral Portion ◽  
Fine Print ◽  
Stimulation Of

Object. The goal of this study was to develop a new method of intraoperative monitoring of functions located in the lateral portion of the medulla oblongata. Based on the fact that the spinal trigeminal nucleus and tract are located in the lateral portion of the medulla oblongata, the authors intended to investigate the efficacy of trigeminal evoked potentials (TEPs) in intraoperative monitoring for assessing functions of the medulla oblongata.Methods. Trigeminal evoked potentials induced by electrical stimulation of the infraorbital nerve were recorded from the dorsolateral portion of the medulla oblongata (M-TEP) and the cerebral sensory cortex (C-TEP) in dogs. When the lateral one-sixth portion of the medulla was cut, the amplitude of the M-TEP decreased markedly, but the amplitude of the C-TEP and the somatosensory evoked potential (SSEP) did not decrease. When the lateral one-third portion of the medulla was cut, the amplitude of the SSEP decreased, but that of the C-TEP showed no change. When the medulla was retracted, the amplitude of the M-TEP was more sensitive than that of SSEP. Pathological examinations revealed that retraction force less than 10 g and a reduction in the amplitude of the M-TEP less than 50% were safe.Conclusions. These results suggest that M-TEPs obtained from the dorsolateral portion of the medulla oblongata by electrical stimulation of the trigeminal nerve are clinically applicable as a new means of intraoperative monitoring of the functions of the medulla oblongata.

Transcranial electrical stimulation through screw electrodes for intraoperative monitoring of motor evoked potentials

2004 ◽  
Vol 100 (1) ◽  
pp. 155-160 ◽  
Author(s):  
Katsushige Watanabe ◽  
Takashi Watanabe ◽  
Akio Takahashi ◽  
Nobuhito Saito ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Evoked Potentials ◽  
Intraoperative Monitoring ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Transcranial Electrical Stimulation ◽  
Content Type ◽  
Motor Pathways ◽  
Fine Print

✓ The feasibility of high-frequency transcranial electrical stimulation (TES) through screw electrodes placed in the skull was investigated for use in intraoperative monitoring of the motor pathways in patients who are in a state of general anesthesia during cerebral and spinal operations. Motor evoked potentials (MEPs) were elicited by TES with a train of five square-wave pulses (duration 400 µsec, intensity ≤ 200 mA, frequency 500 Hz) delivered through metal screw electrodes placed in the outer table of the skull over the primary motor cortex in 42 patients. Myogenic MEPs to anodal stimulation were recorded from the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles. The mean threshold stimulation intensity was 48 ± 17 mA for the APB muscles, and 112 ± 35 mA for the TA muscles. The electrodes were firmly fixed at the site and were not dislodged by surgical manipulation throughout the operation. No adverse reactions attributable to the TES were observed. Passing current through the screw electrodes stimulates the motor cortex more effectively than conventional methods of TES. The method is safe and inexpensive, and it is convenient for intraoperative monitoring of motor pathways.

Origin of surface potentials evoked by electrical stimulation of oculomotor nerves: are they related to electrooculographic or electromyographic events?

2002 ◽  
Vol 97 (4) ◽  
pp. 941-944 ◽  
Author(s):  
Tatsuya Sasaki ◽  
Kyouichi Suzuki ◽  
Masato Matsumoto ◽  
Taku Sato ◽  
Namio Kodama ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Evoked Potentials ◽  
Eye Movement ◽  
Extraocular Muscles ◽  
Oculomotor Nerve ◽  
Content Type ◽  
Surface Electrodes ◽  
Oculomotor Nerves ◽  
Fine Print ◽  
Stimulation Of

Object. Evoked potentials elicited by electrical stimulation of the oculomotor nerve and recorded from surface electrodes placed on the skin around the eyeball reportedly originate in the eye and are represented on electrooculograms. Because evoked potentials recorded from surface electrodes are extremely similar to those of extraocular muscles, which are represented on electromyograms, the authors investigated the true origin of these potentials. Methods. Evoked potentials elicited by electrical stimulation of the canine oculomotor nerve were recorded from surface electrodes placed on the skin around the eyeball. A thread sutured to the center of the cornea was pulled and the potentials that were evoked during the resultant eye movement were recorded. These potentials were confirmed to originate in the eye and to be represented on electrooculograms because their waveforms were unaffected by the administration of muscle relaxant. To eliminate the influence of this source, the retina, a main origin of standing potentials of the eyeball, was removed. This resulted in the disappearance of electrooculography (EOG) waves elicited by eye movement. Surface potentials elicited by oculomotor nerve stimulation were the same before and after removal of the retina. Again the oculomotor nerve was electrically stimulated and electromyography (EMG) response of the extraocular muscles was recorded at the same time that potentials were recorded from the surface electrodes. In their peak latencies, amplitudes, and waveforms, the evoked potentials obtained from surface electrodes were almost identical to EMG responses of extraocular muscles. Conclusions. Evoked potentials elicited by electrical stimulation of the oculomotor nerves and obtained from surface electrodes originated from EMG responses of extraocular muscles. These evoked potentials do not derive from the eye.

Olfactory evoked potentials: experimental and clinical studies

1996 ◽  
Vol 85 (6) ◽  
pp. 1122-1126 ◽  
Author(s):  
Masanori Sato ◽  
Namio Kodama ◽  
Tatsuya Sasaki ◽  
Mamoru Ohta
Keyword(s):  
Electrical Stimulation ◽  
Evoked Potentials ◽  
Olfactory System ◽  
Olfactory Nerve ◽  
Olfactory Mucosa ◽  
Content Type ◽  
Negative Peak ◽  
Olfactory Tract ◽  
Fine Print ◽  
Stimulation Of

✓ Olfactory evoked potentials (OEPs), obtained by electrical stimulation of the olfactory mucosa, were recorded in dogs and humans to develop an objective method for evaluating olfactory functions. In dogs, OEPs were recorded from the olfactory tract and the scalp. The latency of the first negative peak was approximately 40 msec. A response was not obtained after stimulation of the nasal mucosa and disappeared after sectioning of the olfactory nerve. With increasing frequencies of repetitive stimulation, the amplitude was reduced, suggesting that the response was synaptically mediated. These results demonstrate that evoked potentials from the olfactory tract and the scalp following electrical stimulation of the olfactory mucosa originate specifically from the olfactory system. In humans, a stimulating electrode with a soft catheter was fixed on the olfactory mucosa. The OEPs from the olfactory tract, recorded with a negative peak of approximately 27 msec, had similar characteristics to OEPs found in dogs. The OEPs from the olfactory tract in humans also originate specifically from the olfactory system. The authors postulate that OEPs obtained by electrical stimulation of the olfactory mucosa may prove useful for intraoperative monitoring of olfactory functions.

The mechanism and effect of chronic electrical stimulation of the globus pallidus for treatment of Parkinson disease

2004 ◽  
Vol 100 (6) ◽  
pp. 997-1001 ◽  
Author(s):  
Mitsuhiro Ogura ◽  
Naoyuki Nakao ◽  
Ekini Nakai ◽  
Yuji Uematsu ◽  
Toru Itakura
Keyword(s):  
Electrical Stimulation ◽  
Parkinson Disease ◽  
Globus Pallidus ◽  
Rating Scale ◽  
Underlying Mechanism ◽  
Clinical Effects ◽  
Content Type ◽  
Chronic Electrical Stimulation ◽  
Fine Print ◽  
Stimulation Of

Object. Although chronic electrical stimulation of the globus pallidus (GP) has been shown to ameliorate motor disabilities in Parkinson disease (PD), the underlying mechanism remains to be clarified. In this study the authors explored the mechanism for the effects of deep brain stimulation of the GP by investigating the changes in neurotransmitter levels in the cerebrospinal fluid (CSF) during the stimulation. Methods. Thirty patients received chronic electrical stimulation of the GP internus (GPi). Clinical effects were assessed using the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr Staging Scale at 1 week before surgery and at 6 and 12 months after surgery. One day after surgery, CSF samples were collected through a ventricular tube before and 1 hour after GPi stimulation. The concentration of neurotransmitters such as γ-aminobutyric acid (GABA), noradrenaline, dopamine, and homovanillic acid (HVA) in the CSF was measured using high-performance liquid chromatography. The treatment was effective for tremors, rigidity, and drug-induced dyskinesia. The concentration of GABA in the CSF increased significantly during stimulation, although there were no significant changes in the level of noradrenaline, dopamine, and HVA. A comparison between an increased rate of GABA concentration and a lower UPDRS score 6 months postimplantation revealed that the increase in the GABA level correlated with the stimulation-induced clinical effects. Conclusions. Stimulation of the GPi substantially benefits patients with PD. The underlying mechanism of the treatment may involve activation of GABAergic afferents in the GP.

Intraoperative monitoring of brain-stem auditory evoked potentials

1982 ◽  
Vol 57 (5) ◽  
pp. 674-681 ◽  
Author(s):  
Betty L. Grundy ◽  
Peter J. Jannetta ◽  
Phyllis T. Procopio ◽  
Agnes Lina ◽  
J. Robert Boston ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Nerve ◽  
Intraoperative Monitoring ◽  
Cerebellopontine Angle ◽  
Auditory Evoked Potentials ◽  
Irreversible Loss ◽  
Content Type ◽  
Complete Obliteration ◽  
Fine Print

✓ Brain-stem auditory evoked potentials (BAEP) were monitored during 54 neurosurgical operations in the cerebellopontine angle. The BAEP were irreversibly obliterated in five patients who required deliberate section of the auditory nerve. Technical difficulties interfered with monitoring in three cases, and three patients had deafness and absent BAEP preoperatively. Reversible alterations in BAEP were seen during 32 operations, with recovery after as long as 177 minutes of virtually complete obliteration. Changes in BAEP were associated with surgical retraction, operative manipulation, positioning of the head and neck for retromastoid craniectomy, and the combination of hypocarbia and moderate hypotension. In 19 cases, waveforms improved after specific interventions made by the surgeon or anesthesiologist because of deteriorating BAEP. In 13 other cases, BAEP recovered after maneuvers not specifically related to the electrophysiological monitoring, most often completion of operative manipulation. Whenever BAEP returned toward normal by the end of anesthesia, even after transient obliteration, hearing was preserved. Irreversible loss of BAEP occurred only when the auditory nerve was deliberately sacrificed. The authors conclude that monitoring of BAEP may help prevent injury to the auditory nerve and brain stem during operations in the cerebellopontine angle.

Anorectal pressure monitoring during surgery on sacral lipomeningocele

1986 ◽  
Vol 64 (1) ◽  
pp. 155-156 ◽  
Author(s):  
Kiyonobu Ikeda ◽  
Toshihiko Kubota ◽  
Kengo Kashihara ◽  
Shinjiro Yamamoto
Keyword(s):  
Electrical Stimulation ◽  
Monitoring System ◽  
Intraoperative Monitoring ◽  
Physiological Function ◽  
Dermal Sinus ◽  
Pressure Monitoring ◽  
Content Type ◽  
Congenital Dermal Sinus ◽  
Fine Print ◽  
Anorectal Pressure

✓ Intraoperative monitoring of anorectal pressure was used in a case of sacral lipomeningocele accompanied by congenital dermal sinus to protect the physiological function of the anorectal sphincters. This monitoring system consists of a manometric anorectal balloon and neural electrical stimulation. The system was able to differentiate functioning neural structures from surrounding tissues during the operation.

Functional magnetic resonance imaging of somatosensory cortex activity produced by electrical stimulation of the median nerve or tactile stimulation of the index finger

2000 ◽  
Vol 93 (5) ◽  
pp. 774-783 ◽  
Author(s):  
Maxwell Boakye ◽  
Sean C. Huckins ◽  
Nikolaus M. Szeverenyi ◽  
Bobby I. Taskey ◽  
Charles J. Hodge
Keyword(s):  
Electrical Stimulation ◽  
Median Nerve ◽  
Somatosensory Cortex ◽  
Tactile Stimulation ◽  
Index Finger ◽  
Functional Magnetic Resonance ◽  
Content Type ◽  
The Right ◽  
Fine Print ◽  
Stimulation Of

Object. Functional magnetic resonance (fMR) imaging was used to determine patterns of cerebral blood flow changes in the somatosensory cortex that result from median nerve stimulation (MNS).Methods. Ten healthy volunteers underwent stimulation of the right median nerve at frequencies of 5.1 Hz (five volunteers) and 50 Hz (five volunteers). The left median nerve was stimulated at frequencies of 5.1 Hz (two volunteers) and 50 Hz (five volunteers). Tactile stimulation (with a soft brush) of the right index finger was also applied (three volunteers). Functional MR imaging data were transformed into Talairach space coordinates and averaged by group. Results showed significant activation (p < 0.001) in the following regions: primary sensorimotor cortex (SMI), secondary somatosensory cortex (SII), parietal operculum, insula, frontal cortex, supplementary motor area, and posterior parietal cortices (Brodmann's Areas 7 and 40). Further analysis revealed no statistically significant difference (p > 0.05) between volumes of cortical activation in the SMI or SII resulting from electrical stimuli at 5.1 Hz and 50 Hz. There existed no significant differences (p > 0.05) in cortical activity in either the SMI or SII resulting from either left- or right-sided MNS. With the exception of the frontal cortex, areas of cortical activity in response to tactile stimulation were anatomically identical to those regions activated by electrical stimulation. In the SMI and SII, activation resulting from tactile stimulation was not significantly different (p > 0.05) from that resulting from electrical stimulation.Conclusions. Electrical stimulation of the median nerve is a reproducible and effective means of activating multiple somatosensory cortical areas, and fMR imaging can be used to investigate the complex network that exists between these areas.

Magnetic and electrical stimulation of the auditory cortex for intractable tinnitus

2004 ◽  
Vol 100 (3) ◽  
pp. 560-564 ◽  
Author(s):  
Dirk De Ridder ◽  
Gert De Mulder ◽  
Vincent Walsh ◽  
Neil Muggleton ◽  
Stefan Sunaert ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Transcranial Magnetic Stimulation ◽  
Auditory Cortex ◽  
Magnetic Stimulation ◽  
Cortical Plasticity ◽  
Cortical Reorganization ◽  
Complete Suppression ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

✓ Tinnitus is a distressing symptom that affects up to 15% of the population for whom no satisfactory treatment exists. The authors present a novel surgical approach for the treatment of intractable tinnitus, based on cortical stimulation of the auditory cortex. Tinnitus can be considered an auditory phantom phenomenon similar to deafferentation pain, which is observed in the somatosensory system. Tinnitus is accompanied by a change in the tonotopic map of the auditory cortex. Furthermore, there is a highly positive association between the subjective intensity of the tinnitus and the amount of shift in tinnitus frequency in the auditory cortex, that is, the amount of cortical reorganization. This cortical reorganization can be demonstrated by functional magnetic resonance (fMR) imaging. Transcranial magnetic stimulation (TMS) is a noninvasive method of activating or deactivating focal areas of the human brain. Linked to a navigation system that is guided by fMR images of the auditory system, TMS can suppress areas of cortical plasticity. If it is successful in suppressing a patient's tinnitus, this focal and temporary effect can be perpetualized by implanting a cortical electrode. A neuronavigation-based auditory fMR imaging-guided TMS session was performed in a patient who suffered from tinnitus due to a cochlear nerve lesion. Complete suppression of the tinnitus was obtained. At a later time an extradural electrode was implanted with the guidance of auditory fMR imaging navigation. Postoperatively, the patient's tinnitus disappeared and remains absent 10 months later. Focal extradural electrical stimulation of the primary auditory cortex at the area of cortical plasticity is capable of suppressing contralateral tinnitus completely. Transcranial magnetic stimulation may be an ideal method for noninvasive studies of surgical candidates in whom stimulating electrodes might be implanted for tinnitus suppression.

Chronic electrical stimulation of the gasserian ganglion for the relief of pain in a series of 34 patients

1997 ◽  
Vol 86 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Ethan Taub ◽  
Michael Munz ◽  
Ronald R. Tasker
Keyword(s):  
Electrical Stimulation ◽  
Facial Pain ◽  
Prophylactic Antibiotic ◽  
Stage Ii ◽  
Gasserian Ganglion ◽  
Content Type ◽  
Antibiotic Drugs ◽  
Chronic Electrical Stimulation ◽  
Fine Print ◽  
Stimulation Of

✓ The use of an implanted system for chronic electrical stimulation of the gasserian ganglion for relief of facial pain was described in 1980 by Meyerson and Håkansson. Between 1982 and 1995, the senior author (R.R.T.) performed gasserian ganglion stimulation in 34 patients for the relief of chronic medically intractable facial pain. The etiology of pain was peripheral damage to the trigeminal nerve in 22 patients (65%), central (stroke) damage in seven (21%), postherpetic neuralgia in four (12%), and unclassifiable cause in one (3%). All patients received a trial of transcutaneous stimulation (Stage I). Successful trials in 19 patients (56%) were followed by implantation of a permanent system (Stage II). Trial and postimplantation stimulation were deemed successful when there was a reduction of pain by at least 50% whenever the stimulator was on. Success rates varied from five (71%) of seven patients for central pain to five (23%) of 22 for peripheral pain and none (0%) of four for postherpetic neuralgia. The median follow-up duration in successful cases was 22.5 months. Infections occurred in seven patients, all of whom had undergone Stage II treatment. Infections were more frequent when the stimulating electrode from Stage I was left in place for Stage II (six [43%] of 14) than when completely new hardware was used and prophylactic antibiotic drugs were administered (one [20%] of five). Other complications included iatrogenic injury to the trigeminal nerve or ganglion in three cases (9%), transient diplopia in two (6%), increased pain in two (6%), and various technical problems in 10 (29%). It is concluded that pain of central origin (stroke) is the type most likely to be relieved by this procedure. This finding is new, as the few other clinical series reported to date contain no patients with this type of pain. The risk of infection seems to be lower when completely new hardware is used for Stage II and prophylactic antibiotic drugs are administered.

Electrical stimulation of the brain in treatment of chronic pain

1985 ◽  
Vol 62 (3) ◽  
pp. 389-396 ◽  
Author(s):  
Ronald F. Young ◽  
Richard Kroening ◽  
Wayne Fulton ◽  
Robert A. Feldman ◽  
Israel Chambi
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Gray Matter ◽  
Pain Treatment ◽  
Psychiatric Evaluation ◽  
Content Type ◽  
The Brain ◽  
Fine Print ◽  
Stimulation Of

✓ Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

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