Kim Ji-Sun, Choi Youngdoo, Jin Seung-Hyun, Kim Chi Heon, Park Chul-Kee, Kim Sung-Min, Lee Kwang-Woo, Chung Chun Kee, Paek Sun Ha
Department of Neurology, Korea University Guro Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Clin Neurophysiol. 2016 May;127(5):2208-13. doi: 10.1016/j.clinph.2016.01.018. Epub 2016 Mar 12.
The aim of this study was to evaluate and compare the advantages of post-tetanic motor-evoked potential (p-MEP) and conventional motor-evoked potential (c-MEP) in terms of MEP inter-trial variability and accuracy.
c-MEP and p-MEP were quantified in subjects who underwent brain surgery. c-MEP was generated by transcranial electrical stimulation (TES). p-MEP was generated using a preconditioning process involving tetanic stimulation at the left tibial nerve followed by TES. The presence of significant MEP deterioration was monitored during major surgical process. An additional 5-8 MEP obtained after major surgical process were used to analyze amplitude parameters such as mean, standard deviation, range, coefficient of variation (CV), and range to mean ratio.
When only irreversible MEP deteriorations were considered as positive results, the false-positive rate was identical for p-MEP and c-MEP. When total MEP deteriorations were considered as positive results, the false-positive rate of p-MEP was lower and p-MEP had higher specificity than c-MEP. The mean amplitude of p-MEP was significantly higher than that of c-MEP. The CV and range to mean ratio of p-MEP were less than those of c-MEP.
The p-MEP technique is useful for augmenting MEP amplitude and reducing inter-trial variability.
p-MEP has clinical significance as a useful technique for intraoperative monitoring.
本研究旨在评估和比较强直后运动诱发电位（p-MEP）和传统运动诱发电位（c-MEP）在运动诱发电位试验间变异性和准确性方面的优势。
对接受脑部手术的受试者进行c-MEP和p-MEP的量化。c-MEP通过经颅电刺激（TES）产生。p-MEP通过预处理过程产生，该过程包括对左侧胫神经进行强直刺激，随后进行TES。在主要手术过程中监测运动诱发电位显著恶化的情况。主要手术过程后额外获得的5-8个运动诱发电位用于分析平均、标准差、范围、变异系数（CV）和范围与均值比等幅度参数。
当仅将不可逆的运动诱发电位恶化视为阳性结果时，p-MEP和c-MEP的假阳性率相同。当将总的运动诱发电位恶化视为阳性结果时，p-MEP的假阳性率较低，且p-MEP比c-MEP具有更高的特异性。p-MEP的平均幅度显著高于c-MEP。p-MEP的CV和范围与均值比小于c-MEP。
p-MEP技术有助于增加运动诱发电位幅度并降低试验间变异性。
p-MEP作为一种用于术中监测的有用技术具有临床意义。
