Electrophysiological recordings in patients with spinal cord injury: significance for predicting outcome

Curt, Armin; Dietz, Volker

doi:10.1038/sj.sc.3100809

Cited by 172 publications

(118 citation statements)

References 51 publications

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“…Similarly, SSEPs and motor evoked potentials may provide prognostic information indicative of recovering ambulation, hand, and bladder function after spinal cord injury [127] or as a supplement to clinical testing to predict functional outcome measured by the Barthel Index [128]. These SSEP findings are even more robust when they fail to improve with time [129].…”

Section: Ssep In Spinal Cord Injurymentioning

confidence: 99%

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Rosenthal

2012

Neurotherapeutics

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Neuromonitoring is an emerging field that aims to characterize real-time neurophysiology to tailor therapy for acute injuries of the central nervous system. While cardiac telemetry has been used for decades among patients requiring critical care of all kinds, neurophysiology and neurotelemetry has only recently emerged as a routine screening tool in comatose patients. The increasing utilization of electroencephalography in comatose patients is primarily due to the recognition of the common occurrence of nonconvulsive seizures among comatose patients, the development of quantitative measures to detect regional ischemia, and the appreciation of electroencephalography phenotypes that indicate prognosis after cardiac arrest. Other neuromonitoring tools, such as somatosensory evoked potentials have a complementary role, surveying the integrity of the neuroaxis as an indicator of prognosis or illness progression in both acute brain and spinal injuries.

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Section: Ssep In Spinal Cord Injurymentioning

confidence: 99%

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Rosenthal

2012

Neurotherapeutics

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“…It has also been reported that neurophysiological studies in the early stages may predict the final neurological outcome following SCI in incomplete cases. 13 The requirements for a cure in the light of the neuropathology of SCI The voluntary motor system In principle, the aim is to reconnect the long CNS pathways both efferent and afferent, which were disrupted by the injury. The corticospinal pathway (pyramidal tracts) originates in the motor cortex and consists of the very long Betz cell axons.…”

Section: Clinicopathological Correlationmentioning

confidence: 99%

Neuropathology: the foundation for new treatments in spinal cord injury

2004

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The first step essential in the search for a cure of human spinal cord injury (SCI) is to appreciate the complexity of the disorder. In this regard, it is not only the loss of ambulation but the sensory and autonomic changes that are equally important in recovery. In addition, there are the serious social emotional psychological and lifestyle effects of SCI which should also be taken into account. It is also true that no two SCI lesions are alike as each is the result of a SCI unique to that individual. Clinically of utmost importance is the segmental level of injury and whether it is complete, incomplete or discomplete (loss of all neurological functions below the injury but with physiological or anatomical continuity of Central nervous system tracts across the lesion). We are not concerned here with primary and secondary prevention or methods designed to limit the severity of the lesion after the event, important as they are, but with the requirements for a cure. Clearly, the greater the number of nerve fibers that can be preserved in the acute stage, the better will be the end result. Our focus at present is on the end-stage lesion with the aim of showing that a cure for SCI will depend upon establishing functionally useful central axonal regeneration and reestablishing physiological reconnections. Existing experimental methods are based on stimulating axonal regeneration by neutralizing inhibitory factors, adding positive trophisms and creating a permissive environment. Better results are obtained by bridging the gap with grafts of peripheral nerves or transplants of Schwann cells and genetically engineered fibroblasts. Recently, the potential for stem cells to enhance this process has created great interest. This is because of the ability of pluripotential cells to differentiate into neural tissue. A cure based on the physiopathology of SCI requires pyramidal, extrapyramidal, sensory, cerebellar and autonomic pathways to be regenerated with their appropriate neurotransmitters restored and reflexes integrated physiologically and in synchrony. In human SCI, there is a very long distance anatomically for axonal regrowth to occur in order to reach their relevant nuclei. This is because of continuing Wallerian degeneration. It also presumes that the target neurons are intact and that there has been no transneuronal degeneration above or below the lesion. Alternatively, in place of regenerated long axons, a multisynaptic pathway may be constructed from stem cells that have developed into neurons. Whether such a pathway would restore useful neurological functions is unknown. At present, the transplant and grafting research teams are exploring these possibilities in experimental animals. Moderate success in gaining axonal regeneration has been reported; however, it must be appreciated that the human lesion differs considerably from that of the experimental animal. In order to be successful, the neuropathology and neurophysiology of human SCI must be taken into account. The purpose of this review is to place the req...

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“…Vibration and thermal sensation thresholds [1][2][3] and somatosensory and motor-evoked potentials 4 have been suggested as useful additions to clinical testing in evaluating SCI. Techniques utilising electrical current perception threshold have been used for assessing sensory function in different peripheral neuropathies, 5 particularly diabetic, [6][7][8] in radiculopathies 9,10 and posttransplant surgery, 11 but they have not been reported in patients with SCI so far.…”

Section: Introductionmentioning

confidence: 99%

Perceptual threshold to cutaneous electrical stimulation in patients with spinal cord injury

et al. 2006

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Study design: Prospective experimental. Objectives: The aim of this study was to develop a quantitative sensory test (QST) that could be used for assessing the level and the density (degree of impairment) of spinal cord injury (SCI) and for monitoring neurological changes in patients with SCI. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, UK. Methods: Perceptual threshold to 3 Hz cutaneous electrical stimulation was measured in 30 control subjects and in 45 patients with SCI at American Spinal Injuries Association (ASIA) sensory key points for selected dermatomes between C3 and S2 bilaterally. Electrical perceptual threshold (EPT) was recorded as the lowest ascending stimulus intensity out of three tests at which the subject reported sensation. The level of SCI according to EPT results was established for right and left sides as the most caudal spinal segment at which patient's EPT was within the control range (mean72 standard deviation (SD)). The level of SCI, according to EPT, was then compared with clinical sensory level derived according to ASIA classification. Results: In the control group, EPT depended on the dermatome tested and was lowest for T1 (1.0170.23 mA, mean7SD) and highest for L5 (3.3271.14 mA). There was strong correlation between corresponding right and left dermatomes and between repeated assessments. In the SCI group, the level of lesion according to EPT and clinical testing was the same in 43 of the 90 tests (48%). In 37 cases (41%), the EPT level was higher than the clinical level, and in 10 cases (11%), it was lower. Below the level of lesion in incomplete SCI and in the zone of partial preservation in complete SCI, the EPT values in most dermatomes were raised compared with the control group. Conclusions: EPT is a simple, reproducible QST that can assess both the level and the density of SCI. It seems to add sensitivity and resolution to the standard clinical testing and could be a useful adjunct in longitudinal monitoring of patients with SCI for research purposes during natural recovery and therapeutic interventions.

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Electrophysiological recordings in patients with spinal cord injury: significance for predicting outcome

Cited by 172 publications

References 51 publications

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Neuropathology: the foundation for new treatments in spinal cord injury

Perceptual threshold to cutaneous electrical stimulation in patients with spinal cord injury

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