Brainstem Auditory and Somatosensory Evoked Potentials in Relation to Clinical and Neuroimaging Findings in Chiari Type 1 Malformation

Moncho, Dulce; Poca, M.A.; Minoves, Teresa; Ferré, Àlex; Rahnama, Kimia; Sahuquillo, Juan

doi:10.1097/wnp.0000000000000141

Cited by 14 publications

(30 citation statements)

References 16 publications

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“…BAEPs were abnormal in 77 patients (38.5%). Excluding our preliminary report published elsewhere, 31 to our knowledge, only 1 other study with more than 20 patients has described the findings of BAEPs in patients with classic CM-1. 17 Henriques Filho and Pratesi reported that the most frequent abnormality found in BAEPs in classic CM-1 was on a cochlear or auditory peripheral level.…”

Section: Ep Findingsmentioning

confidence: 87%

“…Methods described below have been described in detail elsewhere. 31 In summary, BAEPs and SSEPs in patients with CM-1 were recorded using a Nicolet Viking-IV EMG/EP unit (Nicolet) following the guidelines of the American Electroencephalographic Society, 1 the "Recommendations for the clinical use of somatosensory-evoked potentials," 14 and the "IFCN recommended standards for short latency somatosensory evoked potentials." 34 To obtain normative data, we used a second device, the Viking Select (Viasys Healthcare), acquired in 2010.…”

Section: Definitionsmentioning

confidence: 99%

“…30 The normal range was established from 50 healthy volunteers who were age-, sex-, and height-matched controls (19 men and 31 women, mean age 40.2 ± 12.6 years, mean height 166.1 ± 8.3 cm), a cohort that was described elsewhere. 31 BAEPs were considered abnormal when any of the following criteria was met: 1) absence of wave I, III, and/or V; 2) when the latency of waves I, III, and V and/or interpeak latencies (IPLs) I-III, III-V, and I-V exceeded the upper range of normality (1.83 msec for wave I, 4.04 msec for wave III, 6.12 msec for wave V, 2.51 msec for I-III IPL, 2.35 msec for III-V IPL, and 4.62 msec for I-V IPL); 3) asymmetry between both ears: the interside latencies and IPL differences were considered asymmetrical when they were greater than 0.30 msec; 4) when the wave V or IV-V complex had a significantly smaller amplitude than wave I (V/I and IV/I amplitude ratio were both lower than 0.5), especially when accompanied by abnormalities in latency. To classify posterior tibial nerve (PTN) SSEPs as abnormal the following criteria were used: 1) absence of the N8, N22, N28, and/or P37 waves, whereas the isolated absence of waves N22 and/or N28 was not considered abnormal; 2) when N22-P37 IPL exceeded 21.13 msec; 3) when P37/N45 amplitude was lower than 0.580 µV; a mild decrease (< 10%) in amplitude as an isolated finding was considered normal; 4) interside asymmetry: N22-P37 IPL was considered asymmetrical when the interside difference was greater than 2.6 msec, whereas the interside amplitude difference was considered abnormal when the difference was greater than 50% for P37/N45 amplitude.…”

Section: Definitionsmentioning

confidence: 99%

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Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Moncho

Poca

Minoves³

et al. 2017

JNS

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OBJECTIVE In this study, the authors describe the brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP) alterations found in a large cohort of patients with Chiari malformation Type 1 (CM-1), the relationship between the BAEPs/SSEPs and the clinical findings, the abnormalities in patients with associated syringomyelia, and the clinical and neuroradiological risk factors that are associated with abnormal evoked potentials (EPs). METHODS A prospectively collected database containing 545 patients with CM-1 was queried to search for patients satisfying the following criteria: 1) an age of at least 14 years, 2) neuroradiological criteria of CM-1, 3) no prior Chiari-related surgeries, and 4) preoperative EP studies conducted at the authors' institution. The 200 patients included in this cohort were classified into CM-0, CM-1, and CM-1.5 subtypes. Linear, planimetric, and angular measurements of the posterior fossa were conducted, as well as syringomyelia measurements. Two separate multiple logistic regression models were used, one to predict the covariates associated with abnormal BAEPs, and a second model to explore the variables associated with an abnormal SSEP. In these models, the BAEPs and SSEPs were dichotomized as being normal or abnormal. RESULTS Headaches were the main symptom in 70.5% of the patients, and Valsalva-induced headaches were most frequent in patients with CM-1 and CM-1.5 compared with patients with CM-0 (p = 0.031). BAEPs were abnormal in 38.5% of patients, and abnormal SSEPs were found in 43.5% of the entire cohort. Syringomyelia was most frequent in patients with CM-0 (64.3%) and CM-1 (51.1%) compared with those with CM-1.5 (34.7%; p = 0.03). Age (OR 1.03, 95% CI 1.00-1.06), the degree of tonsillar herniation (OR 1.08, 95% CI 1.01-1.16), and lower cranial nerve dysfunction (OR 3.99, 95% CI 1.29-14.01) had a statistically significant correlation with abnormal BAEPs. Only age (OR 1.07, 95% CI 1.04-1.10) and the degree of tonsillar herniation (OR 1.11, 95% CI 1.04-1.19) had a statistically significant correlation with abnormal SSEPs. CONCLUSIONS A high percentage of patients with CM-1 exhibited EP alterations regardless of their clinical or radiological findings. These findings suggest that EPs do not add any clinically relevant information nor are they helpful in establishing which symptomatic patients with CM should undergo surgical treatment. However, BAEP and SSEP studies clearly play an important role in incidentally detected patients with CM and may help to establish objective evidence of subclinical dysfunctions. In addition, neurophysiological studies may help to define subgroups of patients who require further testing and follow-up to personalize strategies for the management of incidental and oligosymptomatic patients.

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Section: Ep Findingsmentioning

confidence: 87%

Section: Definitionsmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

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Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Moncho

Poca

Minoves³

et al. 2017

JNS

Self Cite

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“…The association between intraspinal abnormality and neurophysiological monitoring has been documented in the literature 8 , 11 , 12 , 17 . Morioka et al .…”

Section: Discussionmentioning

confidence: 93%

Intra‐Operative Neurophysiological Monitoring in Patients with Intraspinal Abnormalities Undergoing Posterior Spinal Fusion

Qiu

Liu

Shi

et al. 2022

Orthopaedic Surgery

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Objective To analyze the intraoperative neurophysiological monitoring (IONM) data of patients with intraspinal abnormalities undergoing posterior spinal fusion and to determine how intraspinal abnormalities influence IONM results. Methods Patients with severe kyphoscoliosis and intraspinal abnormalities who underwent posterior spinal correction and fusion between September 2015 and January 2019 were retrospectively reviewed. Candidate intraspinal abnormalities included Chiari malformation, syringomyelia, split cord malformation, and tethered cord syndrome. Total intravenous anesthesia was administered, and no muscle relaxant or inhalation anesthesia was used for maintenance. IONM data, including somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP), were recorded. The P37 and N50 latencies and amplitude were recorded for SSEP, whereas only the amplitude was recorded for MEP. The possible high‐risk factors for abnormal IONM results were analyzed. Results The current study included 87 patients (40 men, 47 women) with an average age of 20.2 ± 10.4 years. The etiologies were neuromuscular in 45 patients, idiopathic in four, and congenital in 38. A total of 136 intraspinal abnormalities were detected, including Chiari malformation in 33 patients, syringomyelia in 55, split‐cord malformation in 25, and tethered cord syndrome in 23. Forty patients had one intraspinal abnormality, whereas 47 patients had two or three intraspinal abnormalities. The monitorabilities were 87.4% and 97.7% for the SSEP and MEP, respectively. SSEP alerts were reported in five patients and MEP alerts in four patients, and new neurological deficits were observed in three patients postoperatively. The sensitivity and specificity were 100% and 97.3% for SSEP, and 100% and 98.8% for MEP, respectively. A significant difference in MEP amplitude between the concave and convex sides was observed, while significantly higher SSEP latency was observed on the concave side in patients with preoperative neurological deficits. There were 52 (59.8%) patients with abnormal IONM data. Preoperative neurological deficits (χ 2 = 7.715, p = 0.005) and more than one intraspinal abnormality (χ 2 = 9.186, p = 0.004) indicated a higher risk of abnormal IONM data. Conclusions IONM can be effectively used in patients with intraspinal abnormalities who undergo posterior spinal fusion. Patients with preoperative neurological deficits and more than one intraspinal abnormality have a higher risk of abnormal IONM monitoring.

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“…While we agree with Dr. Adelson that the literature contains plenty of case reports, to our knowledge, only a few studies-all with very limited and heterogeneous series of patients-have described the findings of BAEPs and SSEPs in CM. With the exception of our preliminary article published elsewhere, 9 most studies (noted in our paper) included fewer than 28 patients. Based on the analysis of a large cohort, we aimed to answer some of the questions regarding the role of EPs in the diagnosis of the CM and their relationship with both the clinical findings and the severity of the malformation.…”

Section: The Reliability Of Eps and Their Clinical Usefulnessmentioning

confidence: 89%

Editorial: Evoked potentials and Chiari malformation Type 1

Adelson

2017

JNS

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Brainstem Auditory and Somatosensory Evoked Potentials in Relation to Clinical and Neuroimaging Findings in Chiari Type 1 Malformation

Abstract: A high percentage of patients with CM-1 show EP alterations regardless of their clinical or radiological findings, thus highlighting the necessity of performing these tests, especially in patients with few or no symptoms.

Cited by 14 publications

References 16 publications

Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Intra‐Operative Neurophysiological Monitoring in Patients with Intraspinal Abnormalities Undergoing Posterior Spinal Fusion

Editorial: Evoked potentials and Chiari malformation Type 1

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