The relationships among the severity of spinal cord injury,motor and somatosensory evoked potentials and spinal cord blood flow

To characterize the changes in axonal function in the motor and somatosensory tracts of the cord after spinal cord injury (SCI) and to correlate these changes with spinal cord blood flow (SCBF), the relationships among the severity of SCI, motor and somatosensory evoked potentials (MEPs and SSEPs) and SCBF were examined. Fifteen rats received a 1.5 g (n = 5), 20 g (n = 5) or 56 g (n = 5) clip compression injury of the cord at C8. SCBF at the injury site was measured by the hydrogen clearance technique 35 min before and 30 min after SCI. Concomitantly MEPs from the cord at T10 (MEP-C) and from the sciatic nerve (MEP-N) and SSEPs were recorded.A linear relationship (r = −0.89, P < 0.002) was found between the severity of SCI and the reduction in SCBF at the injury site. Linear discriminant analysis revealed that both the MEP (P < 0.0001) and SSEP (P < 0.003) were significantly related to the severity of SCI. Furthermore, the amplitude of the MEP (r = 0.65, P < 0.0001) and SSEP (r = 0.58, P < 0.0011) was significantly correlated with the posttraumatic SCBF. Multiple regression revealed that both the severity of cord injury and the degree of posttraumatic ischemia were significantly related to axonal dysfunction after SCI. While the MEP was more sensitive to injury than the SSEP, the SSEP more accurately distinguished between mild and moderate severities of cord injury.Axonal conduction in the motor and somatosensory tracts of the cord was significantly correlated with the reduction in posttraumatic SCBF and, therefore, these data provide quantitative evidence linking posttraumatic ischemia to axonal dysfunction following acute cord injury. Furthermore, this study validates the hypothesis that the combined recording of MEPs and SSEPs is an accurate technique to assess the physiological integrity of the cord after injury.     

Spinal cord evoked potentials and edema in the pathophysiology of rat spinal cord injury

Summary The possibility that nitric oxide is somehow involved in the early bioelectrical disturbances following spinal cord injury in relation to the later pathophysiology of the spinal cord was examined in a rat model of spinal cord trauma. A focal trauma to the rat spinal cord was produced by an incision of the right dorsal horn of the T 10–11 segments under urethane anaesthesia. The spinal cord evoked potentials (SCEP) were recorded using epidural electrodes placed over the T9 and T12 segments of the cord following supramaximal stimulation of the right tibial and sural nerves in the hind leg. Trauma to the spinal cord significantly attenuated the SCEP amplitude (about 60%) immediately after injury which persisted up to 1h. However, a significant increase in SCEP latency was seen at the end of 5h after trauma. These spinal cord segments exhibited profound upregulation of neuronal nitric oxide synthase (NOS) immunoreactivity, and the development of edema and cell injury. Pretreatment with a serotonin synthesis inhibitor drug p-chlorophenylalanine (p-CPA) or an anxiolytic drug diazepam significantly attenuated the decrease in SCEP amplitude, upregulation of NOS, edema and cell injury. On the other hand, no significant reduction in SCEP amplitude, NOS immunolabelling, edema or cell changes were seen after injury in rats pretreated with L-NAME. These observations suggest that nitric oxide is somehow involved in the early disturbances of SCEP and contribute to the later pathophysiology of spinal cord injury.     

急性脊髓损伤后大鼠电刺激运动诱发电位的变化

目的：比较不同程度脊髓损伤（SCI）与运动诱发电位（MEP）变化之间的关系,探索MEP检查在SCI早期诊断及预后中的价值。方法：27只雄性SD大鼠以改良Allen‘s打击法致伤T8－T9脊髓,按打击冲量随机分为空白对照组（n=5),SCI A组（50gcf,n=8),SCI B组（70gcf,n=8)和SCI C组（100gcf,n=6),采用单极经皮层电刺激,分别于损伤前、伤后即刻、15min、30min、1h、3h和6h连续观察scMEP变化,并计算脊髓出血坏死区域占脊髓横截面积的比率。结果：对照组MEP无显著改变,SCI A组和SCI B组动物MEP早成份波幅立即减低或消失,以后有所恢复,晚成份波消失后未再出现。SCI C组动物除2只大鼠SCI后MEP仍有所恢复外,其余动物再未出现MEP波。脊髓损伤随打击冲量增大而增加,与伤后1h scMEP最大波幅呈显著相关（r=-0.821)。结论：SCI后scMEP的变化程度与打击冲量和脊髓病理损伤面积相关,提示scMEP可以作为一种脊髓功能检测的客观指标。     

Growth hormone attenuates alterations in spinal cord evoked potentials and cell injury following trauma to the rat spinal cord

The influence of exogenous rat growth hormone on spinal cord injury induced alterations in spinal cord evoked potentials (SCEP) and edema formation was examined in a rat model. Repeated topical application of rat growth hormone (20microl of 1microg/ml solution) applied 30min before injury and at 0min (at the time of injury), 10min, 30min, 60min, 120min, 180min, and 240min, resulted in a marked preservation of SCEP amplitude after injury. In addition, the treated traumatised cord showed significantly less edema and cell changes. These observations suggest that growth hormone has the capacity to improve spinal cord conduction and attenuate edema formation and cell injury in the cord indicating a potential therapeutic implication of this peptide in spinal cord injuries.     

Electrophysiological characteristics of lumbosacral evoked potentials in patients with established spinal cord injury

Surface electrodes positioned over the S1 and T12 vertebrate and referenced to T6 were used to record spinal potentials evoked by unilateral stimulation of the posterior tibial nerve at the knee. Data were collected on 24 patients who received spinal cord injuries 2 months to 31 years previously. The recording sites were below the level of spinal injury. The lumbosacral evoked potentials (LSEPs) were compared with the results of measurements obtained from 19 neurologically healthy subject. Additional data were collected on each patient to characterize segmental reflex responses and preservation of sensory and motor functions associated with the L5 through S2 segments of the spinal cord. Assuming that the LSEP reflects demonstrate a degree of spinal cord dysfunctions caudal to the area of injury in s substantial number of the patients with spinal cord injury which we studied.     

Three-dimensional human somatosensory evoked potentials

Median nerve somatosensory evoked potentials were recorded from 30 normal adults using conventional scalp derivations and an orthogonal bipolar surface electrode montage. This allowed the determination of the spatial orientation of the hypothetical centrally located equivalent dipole derived from the evoked response recorded in 3-dimensional voltage space. The 3-dimensional voltage trajectory describing changes in equivalent dipole orientation and magnitude revealed 4 major apices between 5 and 25 msec, 3 of which corresponded to the traditional P14, N20 and P25 peaks. A fourth apex at 17 msec was not as evident in the conventional recordings and signaled a transition from a vertical P14–N18 generator process to a horizontal N20 generator process. The normal within- and between-subject variability of trajectory apices, segments and planes are described, along with the theoretical and practical implications of this recording technique.     

Somatosensory evoked potentials after removal of somatosensory cortex in man

Somatosensory evoked potentials (SEPs) to median nerve, ulnar nerve, thumb, middle finger, and posterior tibial nerve stimulation were recorded in a patient with a discrete resection of part of the postcentral somatosensory cortex as a treatment for focal epilepsy. Comparison of the different stimulation sites confirmed electrophysiologically the restricted locus of the lesion. The results strongly suggest that the early negative component (N20) and subsequent components recorded postcentrally are of cortical origin and depend upon postcentral gyrus cytoarchitectonic areas 3, 2, and 1. Moreover, these postcentral SEPs are distinct from precentrally recorded activity.     

Spatiotemporal pattern of TRAF3 expression after rat spinal cord injury

TNF receptor associated factor 3 (TRAF3), a member of the TRAF family of intracellular signaling proteins, can directly influence the phosphorylation status and activation of c-Jun N-terminal kinase, participating in CD40-induced apoptosis in carcinoma. However, its expression profile and function are still unclear in spinal cord injury (SCI). In this study, we performed an acute spinal cord contusion injury model in adult rats and detected the dynamic change patterns of TRAF3 expression in spinal cord. Western blot and immunohistochemistry revealed a striking upregulation of TRAF3 after SCI. Double immunofluorescence staining prompted that TRAF3 immunoreactivity was found in neurons rather than astrocytes. Moreover, co-localization of TRAF3/active caspase-3 was detected in neuronal nuclei. To further investigate the function of TRAF3, a neuronal cell line PC12 was employed to establish an apoptosis model in vitro. We analyzed the association of TRAF3 with active caspase-3 on PC12 cells by western blot and immunofluorescent labeling, which was parallel with the data in vivo. Additionally, knocking TRAF3 down with siRNA demonstrated the probable pro-apoptotic role of TRAF3 in the process of neuronal apoptosis. To summarize, we firstly uncover the temporal and spatial expression changes of TRAF3 in SCI. Our data suggest that TRAF3 might be implicated in central nervous system pathophysiology after SCI.     

Steady-state analysis of somatosensory evoked potentials

We report the development of a new method for frequency domain analysis of steady-state somatosensory evoked potentials (SEPs) to amplitude-modulated electrical stimulation, which can be recorded in significantly less time than traditional SEPs. Resampling techniques were used to compare the steady-state SEP to traditional SEP recordings, which are based on signal averaging in the time domain of cortical responses to repetitive transient stimulation and take 1–2 min or more to obtain a satisfactory signal/noise ratio. Median nerves of 3 subjects were stimulated continuously with electrical alternating current at several modulation frequencies from 7 to 41 Hz. Amplitude modulation was used to concentrate the power in higher frequencies, away from the modulation frequency, to reduce the amount of stimulus artifact recorded. Data were tested for signal detectability in the frequency domain using the T_circ² statistic. A reliable steady-state response can be recorded from scalp electrodes overlying somatosensory cortex in only a few seconds. In contrast, no signal was statistically discriminable from noise in the transient SEP from as much as 20 s of data. This dramatic time savings accompanying steady-state somatosensory stimulation may prove useful for monitoring in the operating room or intensive care unit.     

Strength-duration curve of conductive spinal cord evoked potentials in cats

Strength-duration curves of the ascending and descending conductive spinal cord potentials (SCEPs) in cats were obtained using constant current stimuli. For the formulation of numeric indices of excitability, the rheobase is defined as the minimal current strength below which response cannot occur even if the current continues, and the chronaxie is defined as the minimal duration of a current required to evoke the potential at twice the rheobase strength. The chronaxies and rheobases were calculated from the constructed strength-duration curves. The purpose of this study is to produce strength-duration curves and to evaluate the utility of chronaxies and rheobases for SCEPs. This study showed the following results: (1) there was a hyperbolic relationship between stimulus strength and stimulus duration at threshold values, similar to that seen in peripheral nerves; (2) the ascending and descending tracts of SCEP were mediated through the same pathway (based on the similar chronaxies and rheobases); (3) following spinal cord compression the chronaxie and rheobase increased significantly (P < 0.05), which is similar to peripheral nerve disturbance. However, the rheobase decreased significantly following slight spinal cord compression (P < 0.05) and systemic cooling (P < 0.01), and the strength-duration curve shifted showing a tendency towards decrease of the galvanic threshold therefore, amplitude augmentation with slight compression and with decrease in temperature seems to contribute to the reduction of the threshold. The strength-duration curve, the chronaxie and the rheobase may be useful in assessing spinal cord function.     

Physical medicine and rehabilitation: somatosensory evoked potentials in monitoring spinal operations

The Scientific Board of the California Medical Association presents the following inventory of items of progress in physical medicine and rehabilitation. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in physical medicine and rehabilitation that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Physical Medicine and Rehabilitation of the California Medical Association and the summaries were prepared under its direction.     

Neurometric evaluation of the cortical somatosensory evoked potential in acute incomplete spinal cord injuries

The clinical application of evoked potentials has at times been criticized for its failure to provide an objective quantifiable assessment of the processing of sensory information and a reflection of nervous system integrity at least comparable in accuracy to other methods of assessment. The challenge is to quantify the SEP in a manner that accurately reflects the function of the somatosensory system.Therefore, neurometrics, an approach which emphasizes the transformation of the neurophysiological data to a common metric of relative probability by reference to normative standards and the classification of critical features of data by multivariate statistics, was employed.The 3-part study involved the evaluation of the diagnostic, prognostic and localization functions of the cortical tibial SEP in patients with incomplete spinal cord injuries. Two neurometric indices which correlated well with concurrent and future neurological status were developed. The distributions of influence of dorsal columns and spino-thalamic tracts on the SEP were established.     

Changes of somatosensory evoked potentials with increase of intracranial pressure in the rat's brain

Somatosensory evoked potentials (SEPs) to various combinations of two independent brain compression modalities (localized epidural pressure and intracerebral pressure evoked by an inserted balloon) were investigated in 24 rats. The SEP pattern in response to gradually expanding volume wihtout additional epidural pressure remained unchanged for a certain period. SEP changes occurred only shortly prior to death. On the other hand, remarkable SEP changes were observed in a gradually expanding intracerebral mass, when combined with epidural pressure application at about 50% of the lethal volume. SEP changes in response to intermittent and continuous epidural pressure, in addition to a small intracerebral mass, were investigated too. Intermittent application of minor epidural pressure led to specific P1 changes, which recovered after each pressure step. The same pressure, administered continuously, evoked SEP changes with only partial recovery in some instances. Severe epidural pressure, administered intermittently, gave rise to severe SEP changes with only partial recovery after each step. The same epidural pressure delivered continuously led to SEP changes with very small recovery. SEPs have proved to be a reliable method for signalling brain dysfunction corresponding to various modalities and degrees of intracranial pressure.     

The change of negative components of the evoked potentials of spinal cord after irradiating of a SHF-waves

The influence of super high frequency (SHF) waves (lambda = 3 sm) nonthermal intensity (1.6 mWt/sm2) on work of regulator systems of a spinal cord (SC) of cats was considered. The estimation of parameters of negative components of cord dorsum potential (CDP) is made for stimulus, which apply on peripheral nerves or dorsal root earlier and after the influence of SHF on SC. Change in work of population of segmentary and non-segmentary interneurons after the SHF irradiation with 30 minutes exposition was shown. The authors consider that the main influence SHF waves is directed on a changes of membrane potential of SC neurons. The specified effect carries temporary and convertible character.     

Spine and scalp somatosensory evoked potentials in normal subjects and patients with spinal cord disease: Evaluation of afferent transmission

Spine and scalp somatosensory evoked potentials (SEPs) to peroneal nerve stimulation were recorded from 20 normal subjects using 1 restricted and 3 open frequency filter bandpasses. Spine to spine and spine to scalp propagation velocities were calculated. Of those recording parameters investigated, optimal recordings were obtained using an open bandpass (5–1500 or 30–1500 Hz) and recording from 3 surface spine bipolar channels and 1 scalp bipolar channel. This method was then investigated in 40 patients with disease of the spinal cord and peripheral nervous system. Focal spinal cord compressive lesions generally resulted in slowing of spine to spine and spine to scalp propagation velocities. Diffuse or multifocal lesions of the spinal cord generally resulted in the absence of scalp responses. Although there was no consistent correlation of the SEP findings with the sensory exam, there was a correlation of the SEP findings with the clinical prognosis.     

Ipsilateral median somatosensory evoked potentials recorded from human somatosensory cortex

Somatosensory evoked potentials (SEP) to ipsilateral and contralateral median nerve stimulations were recorded from subdural electrode grids over the perirolandic areas in 41 patients with medically refractory focal epilepsies who underwent evaluation for epilepsy surgery. All patients showed clearly defined, high-amplitude contralateral median SEPs. In addition, four patients showed ipsilateral SEPs. Compared with the contralateral SEPs, ipsilateral SEPs were very localized, had a different spatial distribution, were of considerably lower amplitude, had a longer latency (1.2–17.8 ms), did not show an initial negativity, and were markedly attenuated during sleep. Stimulation of the subdural electrodes overlying the sensory hand area was associated with contralateral hand paresthesias, but no ipsilateral hand paresthesias occurred. It was concluded that subdurally recorded cortical SEPs to ipsilateral stimulation of the median nerve (M) reflect unconscious sensory input from the hand possibly serving fast bimanual hand control. The anatomical pathway of these ipsilateral short-latency MSEPs is not yet known. Transcallosal transmission seems unlikely because of the short delay between the ipsilateral and contralateral responses in selected cases. The infrequent occurrence of ipsilateral subdurally recorded SEPs and their low amplitude and limited distribution suggest that they contribute very little to the short-latency ipsilateral median SEPs recorded on the scalp.     

Short-latency somatosensory evoked potentials in brain-dead patients

Ten adult brain-dead patients were evaluated for the presence of clearly defined median nerve short-latency somatosensory evoked potentials (SSEPs). All met clinical criteria recommended by the President's Commission report (1981), had positive apnea tests, and had electrocerebral silent EEGs. P13-P14 and N20 were absent in all scalp-scalp channels, although 3 patients showed P13-P14 in scalp-non-cephalic channels. Of 6 patients showing N13, 3 lacked P13-P14. Our data suggest a characteristic destruction of N20 and rostral P13-P14 generators, with variable rostral-caudal loss of lower generators, SSEPs can provide valuable information about brain-stem activity in the evaluation of suspected brain-dead patients.     

痛觉诱发电位的研究进展

痛觉诱发电位的研究在过去的几十年内取得了重要进展 ,出现了许多用于被试的诱发明确疼痛感的刺激技术 ,并与诱发电位方法学联合应用 ,已经成为脑映像学研究中重要的组成部分。本文从刺激技术、痛觉诱发电位成分分析和偶极子源分析等方面出发 ,讨论了痛觉诱发电位的研究进展