Levy W J, McCaffrey M, Goldman D, York D H
Neurosurgery. 1986 Aug;19(2):163-76. doi: 10.1227/00006123-198608000-00001.
There is a need to monitor the functional status of the motor pathways well enough to predict the state of that function during operations and in injured or diseased patients. We previously reported that a motor evoked potential (MEP) can be produced by direct or transcranial stimulation of the motor cortex in both cats and humans. This signal descends through both the dorsolateral and ventral spinal cord and is primarily localized in the pyramidal tracts, producing a peripheral nerve signal and an electromyogram (EMG) response. It is more sensitive to injury than the somatosensory evoked potential (SEP). We report here that one can stimulate the cerebellar cortex, either directly or transcranially, and produce a descending signal in the spinal cord that has different characteristics from the MEP. The cerebellar evoked potential (CEP), located in the dorsolateral and the ventral cord, has an earlier latency and a faster conduction velocity than the MEP. It is predominantly ipsilateral with some contralateral components and also produces EMG responses. In the peripheral nerves, the CEP often produces a pattern of several waves that is different from the one or two predominant contralateral waves of the MEP. The CEP is not diminished by pyramidotomy. It arises from two sites on the cerebellar cortex, medial and lateral. The pathways activated may be the vestibulospinal, rubrospinal, reticulospinal, and fastigiospinal systems. This test seems to offer a monitor of selected motor pathways in the spinal cord largely separate from and complementary to the MEP. The ventral pathways activated probably include those demonstrated to be most essential to basic ambulation after spinal cord injury in primates. Also of importance, one type of evoked potential can facilitate another, which provides additional diagnostic tests. The CEP should be of investigative and clinical value.
有必要充分监测运动通路的功能状态，以便预测手术过程中以及受伤或患病患者的该功能状态。我们之前报道过，在猫和人类中，通过直接或经颅刺激运动皮层均可产生运动诱发电位（MEP）。该信号通过背外侧和腹侧脊髓下行，主要定位于锥体束，产生外周神经信号和肌电图（EMG）反应。它比体感诱发电位（SEP）对损伤更敏感。我们在此报告，人们可以直接或经颅刺激小脑皮层，并在脊髓中产生一种与MEP具有不同特征的下行信号。位于背外侧和腹侧脊髓的小脑诱发电位（CEP），其潜伏期比MEP更早，传导速度更快。它主要是同侧的，有一些对侧成分，也会产生EMG反应。在周围神经中，CEP通常会产生几个波的模式，这与MEP的一两个主要对侧波不同。CEP不会因锥体束切断术而减弱。它起源于小脑皮层的内侧和外侧两个部位。激活的通路可能是前庭脊髓、红核脊髓、网状脊髓和顶核脊髓系统。该测试似乎可以对脊髓中选定的运动通路进行监测，在很大程度上与MEP相互独立且互为补充。激活的腹侧通路可能包括那些在灵长类动物脊髓损伤后对基本行走最为关键的通路。同样重要的是，一种诱发电位可以促进另一种诱发电位，这提供了额外的诊断测试方法。CEP应具有研究和临床价值。
