Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. We report on the results of multimodality IONM during 18 cases in which a TIVA regimen incorporating dexmedetomidine (Precedex, Hespira, Lake Forest, IL) was used. Monitoring techniques included sensory (SSEP) and motor evoked potentials (MEP), as well as pedicle screw stimulation. SSEPs were maintained within an acceptable range of baseline amplitude (50%) and latency (10%), and MEPs remained elicitable throughout each case. We therefore found that the anesthetic regimen did not significantly interfere with any of the monitoring modalities used and conclude that IONM in the presence of dexmedetomidine is feasible under appropriate conditions.

The findings of this study indicate that patients with MS are mostly adherent to their existing treatments. Patients with greater medication adherence may have increased cost, but their physical outcomes are better. This finding may shed light on other chronic disease entities and how we view the success of treatments.

Meige syndrome, also known as blepharospasm-oromandibular dystonia, is a neurological movement disorder that involves the involuntary muscle contractions of the eyes, mouth, tongue, and jaw. It is often associated with other disorders, such as Parkinson's disease. We describe a case of an 87-year-old man with Meige syndrome who was successfully treated with oral baclofen.

This review shows the importance of sudden sensorineural hearing loss (SSNHL) as a significant cause of hearing loss that often goes under-recognized, especially by primary care physicians. Contrasted with conductive hearing loss, SSNHL involves inner ear damage. This work reviewed the diagnostic methods and treatments of SSNHL in the U.S. and Canada, including treatment options. It is imperative that primary care physicians and providers be able to recognize this condition early so that treatment may be initiated without delay as hearing loss can become permanent if not managed immediately.