Abstract
Somatosensory evoked potential (SSEP) is an electrophysiological test used to evaluate sensory innervations in peripheral and central neuropathies. Pudendal SSEP has been studied in dysfunctions related to the lower urinary tract and pelvic floor. Although some authors have already described technical details pertaining to the method, the standardization and the influence of physiological variables in normative values have not yet been established, especially for women. The aim of the study was to describe normal values of the pudendal SSEP and to compare technical details with those described by other authors. The clitoral sensory threshold and pudendal SSEP latency was accomplished in 38 normal volunteers. The results obtained from stimulation performed on each side of the clitoris were compared to ages, body mass index (BMI) and number of pregnancies. The values of clitoral sensory threshold and P1 latency with clitoral left stimulation were respectively, 3.64 +/- 1.01 mA and 37.68 +/- 2.60 ms. Results obtained with clitoral right stimulation were 3.84 +/- 1.53 mA and 37.42 +/- 3.12 ms, respectively. There were no correlations between clitoral sensory threshold and P1 latency with age, BMI or height of the volunteers. A significant difference was found in P1 latency between nulliparous women and volunteers who had been previously submitted to cesarean section. The SSEP latency represents an accessible and reproducible method to investigate the afferent pathways from the genitourinary tract. These results could be used as normative values in studies involving genitourinary neuropathies in order to better clarify voiding and sexual dysfunctions in females.
Highlights
The pudendal nerve is responsible for motor innervation of the urethral and anal sphincters as well as other muscles of the pelvic floor
The clinical use of evoked potentials has reported on its ability to demonstrate abnormalities in sensory function when the clinical history and physical or neurological examination are insufficient for diagnosis, contributing to the definition of the anatomical distribution of the pathology and to the monitoring of alterations during the evolution of neurological diseases [3]
Stimulus intensity between 2 and 3 times the perception threshold was well tolerated by the subjects
Summary
The pudendal nerve is responsible for motor innervation of the urethral and anal sphincters as well as other muscles of the pelvic floor. Electrical stimulation of sensory receptors generates action potentials, which travel through the peripheral nerve and spinal cord to the sensorimotor cortex [2]. This influx of impulses evokes a cortical response, which can be recorded by surface electrodes placed above the scalp overlaying the somatosensory cortex. The objective of this study was to establish reference latencies of clitoral sensory threshold and pudendal SSEP in normal women, observing physiologic factors, which could potentially influence the electrophysiological parameters
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