最佳脉冲间隔时间用于经颅电刺激产生上肢和下肢靶肌肉最大幅度的运动诱发电位。

Optimum interpulse interval for transcranial electrical train stimulation to elicit motor evoked potentials of maximal amplitude in both upper and lower extremity target muscles.

机构信息

Department of Orthopedics, Sint Maartenskliniek, Postbus 9011, 6500 GM, Nijmegen, The Netherlands.

出版信息

Clin Neurophysiol. 2013 Oct;124(10):2054-9. doi: 10.1016/j.clinph.2013.04.011. Epub 2013 Jun 2.

DOI:10.1016/j.clinph.2013.04.011

PMID:23735307

Abstract

OBJECTIVE

The aim of this study was to determine the optimum interpulse interval (OIPI) for transcranial electrical train stimulation to elicit muscle motor evoked potentials (TES-MEP) with maximal amplitude in upper and lower extremities during intra-operative spinal cord monitoring.

METHODS

Intraoperative spinal cord monitoring with TES-MEP was performed in 26 patients who had (corrective) spine surgery. Optimum interpulse interval (OIPI) were determined for the abductor pollicis brevis muscle (APB) representing the upper extremity and the anterior tibialis muscle (TA) representing the lower extremity. The IPI was varied between 0.5 and 4.0ms, where the OIPI was defined as the IPI with the highest muscle MEP amplitude for each muscle group. Differences between upper and lower extremity OIPIs were analyzed. Furthermore, the MEP amplitudes difference between the upper and lower extremity OIPIs and between the OIPI and IPI 2 ms was determined.

RESULTS

The mean OIPI(APB) representing the upper extremity was 1.78 ± 1.09 ms on the left side and 1.82 ± 0.93 ms on the right side. The lower extremity showed a mean OIPI(TA) of 2.26 ± 1.16 ms on the left and 2.73 ± 0.88 ms on the right side. The mean differences between the OIPI(APB) and OIPI(TA) were significant for p=0.019 (Student's T-test). No within patient differences in OIPIs between the left and the right side were found. The mean MEP amplitude reduction, the APB amplitude at OIPI(TA) compared to the APB at OIPI(APB), was 32.5 ± 27.9%. For the TA a mean amplitude reduction of 33.4 ± 27.4% was found. The mean amplitude reduction for the OIPI amplitudes compared to the amplitudes at IPI 2 ms was 53.6 ± 25.5% for the APB and 45.8 ± 28.3% for the TA.

CONCLUSION

Large intra- and interindividual differences were found between the mean OIPIs of the TA and APB muscles (range 1.78-2.73 ms) representing the upper and lower extremity.

SIGNIFICANCE

Based on the results of this study, it is advisable to perform a set-up procedure for each individual patient undergoing TES-MEP to determine the optimal parameter settings when using supramaximal intensity of TES.

摘要

目的

本研究旨在确定经颅电刺激诱发术中脊髓监测时上肢和下肢运动诱发电位（TES-MEP）的最佳脉冲间隔（OIPI），以获得最大振幅。

方法

对 26 例行（矫正）脊柱手术的患者进行术中脊髓监测 TES-MEP。确定了代表上肢的拇短展肌（APB）和代表下肢的胫骨前肌（TA）的最佳间隔（OIPI）。IPI 在 0.5 至 4.0ms 之间变化，其中 OIPI 定义为每组肌肉中具有最高肌肉 MEP 振幅的 IPI。分析了上肢和下肢 OIPI 之间的差异。此外，还确定了上肢和下肢 OIPI 之间以及 OIPI 和 2ms 的 IPI 之间的 MEP 振幅差异。

结果

代表上肢的左侧 APB 的平均 OIPI 为 1.78±1.09ms，右侧为 1.82±0.93ms。左侧下肢 TA 的平均 OIPI 为 2.26±1.16ms，右侧为 2.73±0.88ms。OIPI（APB）和 OIPI（TA）之间的平均差异有统计学意义（p=0.019）（学生 t 检验）。未发现左、右侧 OIPI 之间的患者内差异。与 OIPI（APB）相比，OIPI（TA）时的 APB 振幅减少 32.5±27.9%。TA 平均振幅减少 33.4±27.4%。与 IPI 2ms 时的振幅相比，OIPI 振幅的平均减少幅度为 53.6±25.5%APB 和 45.8±28.3%TA。