Holdefer R N, MacDonald D B, Guo L, Skinner S A
Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 359740, Seattle, WA 98104-2499, USA.
Section of Clinical Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC 76, PO Box 3354, Riyadh, Saudi Arabia.
Clin Neurophysiol. 2016 Feb;127(2):1717-1725. doi: 10.1016/j.clinph.2015.09.133. Epub 2015 Oct 14.
MEPs are used as surrogate endpoints to predict the effectiveness of interventions, made in response to MEP deterioration, in avoiding new postoperative deficits. MEP performance in capturing intervention effects on these outcomes was investigated.
A meta-analysis of studies using MEPs during intracranial vascular surgeries between 2003 and 2014 was performed. MEP diagnostic performance and relative risk of new postoperative deficits for reversible compared with irreversible MEP changes were determined. Intervention efficacy in reversing MEP deterioration and postoperative outcomes was compared across studies.
MEP diagnostic performance compared favorably with that of other tests used in medicine, with all likelihood ratios >10. The summary relative risk comparing reversible and irreversible changes was 0.40, indicating a 60% decrease in new deficits for reversible MEP changes. The proportion of MEP deteriorations which recovered was negatively correlated with the proportion of new postoperative deficits (r=-0.81, p<.005).
The effectiveness of interventions in recovering an MEP decline was predictive of preserved neurologic status. MEPs are provisionally qualified as surrogate endpoints given potentially major harms to the patient if they are not used, compared to the minimal harms and costs associated with their use.
The performance of MEPs as substitute, or surrogate, endpoints during intracranial vascular surgeries for new deficits in motor strength in the immediate postoperative period was directly assessed for ten recent studies.
运动诱发电位（MEP）被用作替代终点，以预测针对MEP恶化所采取的干预措施在避免新的术后神经功能缺损方面的有效性。研究了MEP在捕捉干预对这些结果的影响方面的表现。
对2003年至2014年期间颅内血管手术中使用MEP的研究进行荟萃分析。确定了MEP的诊断性能以及与不可逆MEP变化相比，可逆MEP变化导致新的术后神经功能缺损的相对风险。对各研究中逆转MEP恶化的干预效果和术后结果进行了比较。
MEP的诊断性能优于医学中使用的其他测试，所有似然比均>10。比较可逆和不可逆变化的汇总相对风险为0.40，表明可逆MEP变化导致新的神经功能缺损减少60%。MEP恶化恢复的比例与新的术后神经功能缺损的比例呈负相关（r=-0.81，p<.005）。
恢复MEP下降的干预措施的有效性可预测神经功能状态的保留。鉴于不使用MEP可能对患者造成重大危害，而使用MEP的危害和成本最小，MEP暂时有资格作为替代终点。
对最近的十项研究直接评估了MEP在颅内血管手术中作为术后即刻运动力量新缺损的替代或替代终点的表现。
