Motor Evoked Potentials: Issues in Safety and Operative Monitoring
The monitoring of the motor system is an important goal for spinal cord evaluation. Ideally we need a safe procedure, easily used, reliable, and able to indicate problems with the upper or lower motor neuron pathways. Until a few years ago little was available in such a direction. However, the advent of both spinal cord stimulation and transcranial motor pathway stimulation has offered the opportunity to develop such testing. A particularly useful type of transcranial stimulation in the awake patient is the magnetic stimulator, first described in 1985 by Dr. Anthony Barker. This stimulator was initially limited by the large surface area of brain which it stimulated, and by the fact that it was just powerful enough to stimulate awake patients. Therefore it was often not reliable on an anesthetized patient with a higher stimulus threshold. The technology of these devices is evolving rapidly, and more powerful stimulators are being tested by Novametrix and Cadwell Labs, as well as some other groups. The one which has been initially evaluated for the operating room is the Cadwell MES-10. This can stimulate patients in the operating room under some conditions.
KeywordsDepression Europe Bromide Cortisol Peri
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- 3.Bridge SL, Delaney RC (1989) Transcranial magnetic stimulation: An Assessment of Cognitive and other cerebral effects. Neurology 39: 417–419, 1989Google Scholar
- 6.Levy WJ (1987) SEP vs MEP debate: the monitoring of motor pathways. Clin Neurosurg 34: 239–260Google Scholar
- 9.Levy WJ, Oro J, Tucker D (1989) Safety studies of electrical and magnetic stimulation for the production of motor evoked potentials. In: Magnetic stimulation in clinical neurophysiology. Butterworth, LondonGoogle Scholar
- 10.Moller AR (1987) Electrophysiological monitoring of cranial nerves in operations in the skull base. In: Sekar LN, Schramm V (eds) Tumors of the cranial base: diagnosis and treatment. Futura, Mt. KiscoGoogle Scholar
- 12.Moller AR, Jannetta PJ (1985) Monitoring of facial nerve function during removal of acoustic tumor. Am J Otol [November Suppl]: 27–29Google Scholar
- 14.Raudzens PA (1982) Intraoperative monitoring of evoked potentials. In: BodisWollner I (ed) Evoked potentials. New York Academy of Sciences, New York, pp 308–325Google Scholar