Pelvic Floor Muscle Electromyography as a Guiding Tool During Lead Placement and (Re)Programming in Sacral Neuromodulation Patients: Validity, Reliability, and Feasibility of the Technique

Vaganée, Donald; Borne, Sigrid Van de; Zalm, Petra Voorham-van der; Voorham, Jeroen; Fransén, Erik; Wachter, Stefan De

doi:10.1111/ner.13177

Cited by 9 publications

(2 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, it is shown that PFM EMG is a feasible tool to assist during lead electrode placement 12 as well as during (re)programming. 7 Research such as this, which attempts to "neuromap" the pelvic floor, has the potential to provide more guidance during lead electrode placement and (re)programming, ultimately resulting in improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The contraction for PFM is electrically used as a prognostic marker for good lead placement, 6 and can be reliably measured using electromyography (EMG). 7 EMG is an electrodiagnostic technique for evaluating and recording the electrical activity in striated muscles, through detection of the electric potential generated by muscle cells upon electrical activation. 8 A clearer insight in PFM activation upon lead stimulation could provide more guidance during placement, programming, and troubleshooting in SNM patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pelvic floor activation upon stimulation of the sacral spinal nerves in sacral neuromodulation patients

Vaganée

Voorham

Borne

et al. 2020

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Purpose To assess the activation of the different parts of the pelvic floor muscles (PFM) upon electrical stimulation of the sacral spinal nerves while comparing the different lead electrode configurations. Material and Methods PFM electromyography (EMG) was recorded using an intravaginal multiple array probe with 12 electrodes pairs, which allows to make a distinction between the different sides and depths of the pelvic floor. In addition concentric needle EMG of the external anal sphincter was performed to exclude far‐field recording. A medtronic InterStim tined lead (model 3889) was used as stimulation source. Standard SNM parameters (monophasic pulsed square wave, 210 microseconds, 14 Hz) were used to stimulate five different bipolar electrode configurations (3+0−/3+2−/3+1−/0+3−/1+3−) up to and around the sensory threshold. Of each EMG signal the stimulation intensity needed to evoke the EMG signals as well as its amplitude and latency were determined. Linear mixed models was used to analyse the data. Results Twenty female patients and 100 lead electrode configurations were stimulated around the sensory response threshold resulting in 722 stimulations and 12 times as many (8664) EMG recordings. A significant increase in EMG amplitude was seen upon increasing stimulation intensity (P < .0001). Large differences were noted between the EMG amplitude recorded at the different sides (ipsilateral>posterior>anterior>contralateral) and depths (deep>center>superficial) of the pelvic floor. These differences were noted for all lead electrodes configurations stimulated (P < .0001). Larger EMG amplitudes were measured when the active electrode was located near the entry point of the sacral spinal nerves through the sacral foramen (electrode #3). No differences in EMG latency could be withheld, most likely due to the sacral neuroanatomy (P > .05). Conclusions A distinct activation pattern of the PFM could be identified for all stimulated lead electrode configurations. Electrical stimulation with the most proximal electrode (electrode #3) as the active one elicited the largest PFM contractions.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%