Somatosensory Evoked Potentials Alterations Research Articles

Impaired pain processing and its association with attention disturbance in patients with amyotrophic lateral sclerosis.

Cognitive dysfunction characterized by executive dysfunction and persistent attention function has been reported in patients with amyotrophic lateral sclerosis (ALS); however, it is unclear if this contributes to the pain processing deficits associated with the disease. We clarified the relationship between pain processing and both cognitive function and sensory symptoms in patients with ALS. We enrolled 23 patients with ALS and 14 healthy control subjects. We examined pain-related somatosensory evoked potentials (SEPs) using an intra-epidermal needle electrode. We evaluated cognitive function and the clinical characteristics of sensation and analyzed their relationships with pain-related SEPs. Pain-related SEP amplitudes were significantly lower, while the rate of amplitude attenuation due to habituation or change in attention was significantly greater in patients with ALS than in control subjects. There were no significant differences in pain-related SEP parameters between patients with or without sensory symptoms. Instead, pain-related SEP amplitude and its rate of attenuation were correlated with cognitive dysfunction, particularly with attention domains. Our results suggest that attention deficit, but not sensory nerve involvement, is a major cause of the alterations in pain-related SEP in patients with ALS.

Early Somatosensory Processing Over Time in Individuals at Risk to Develop Psychosis.

Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has been demonstrated to influence SEP parameters in individuals at risk to develop psychosis. The aim of this study was to explore the course of SEP changes and the impact of concomitant cannabis use in individuals at risk to develop psychosis who sought medical help.Methods: Median nerve SEPs including high-frequency oscillations (HFOs) superimposed on the primary cortical response (N20) were investigated using multichannel EEG in individuals (n = 54 at baseline) remaining at risk to develop psychosis at follow-up after 1 year (high-risk: n = 19; ultra-high-risk: n = 27) vs. subjects with conversion to psychosis (n = 8) and a healthy control group (n = 35). Longitudinal and cross-sectional analyses of SEP components as estimated by dipole source analysis were performed.Results: The longitudinal development of the N20 strength depended on cannabis use. In cannabis non-users, a greater decrease of N20 strengths over time was associated with more negative symptoms at baseline. At baseline, converters did not differ from subjects remaining at risk. At follow-up, converters showed increased low- and high-frequency activity than at-risk subjects and did not differ from controls.Conclusion: The results of this study lead to the suggestion that the deficits in early somatosensory processing in individuals at risk to develop psychosis may not represent a marker for a genetic risk for psychosis but rather reflect state-dependent factors such as negative symptoms. On the other hand, the transition to psychosis seems to represent an interstage between reduced sensory registration from the at-risk state and gating deficits in the chronic state.

Does Location of Tonic Pain Differentially Impact Motor Learning and Sensorimotor Integration?

Recent work found that experimental pain appeared to negate alterations in cortical somatosensory evoked potentials (SEPs) that occurred in response to motor learning acquisition of a novel tracing task. The goal of this experiment was to further investigate the interactive effects of pain stimulus location on motor learning acquisition, retention, and sensorimotor processing. Three groups of twelve participants (n = 36) were randomly assigned to either a local capsaicin group, remote capsaicin group or contralateral capsaicin group. SEPs were collected at baseline, post-application of capsaicin cream, and following a motor learning task. Participants performed a motor tracing acquisition task followed by a pain-free retention task 24–48 h later while accuracy data was recorded. The P25 (p < 0.001) SEP peak significantly decreased following capsaicin application for all groups. Following motor learning acquisition, the N18 SEP peak decreased for the remote capsaicin group (p = 0.02) while the N30 (p = 0.002) SEP peaks increased significantly following motor learning acquisition for all groups. The local, remote and contralateral capsaicin groups improved in accuracy following motor learning (p < 0.001) with no significant differences between the groups. Early SEP alterations are markers of the neuroplasticity that accompanies acute pain and motor learning acquisition. Improved motor learning while in acute pain may be due to an increase in arousal, as opposed to increased attention to the limb performing the task.

Conjunct SEP and MEP monitoring in resection of infratentorial lesions: lessons learned in a cohort of 210 patients.

During the surgical removal of infratentorial lesions, intraoperative neuromonitoring is mostly focused on cranial nerve assessment and brainstem auditory potentials. Despite the known risk of perforating vessel injury during microdissection within the vicinity of the brainstem, there are few reports about intraoperative neuromonitoring with somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) assessing the medial lemniscus and corticospinal tract. This study analyses the occurrence of intraoperative changes in MEPs and SEPs with regard to lesion location and postoperative neurological outcome. The authors analyzed 210 cases in which patients (mean age 49 ± 13 years, 109 female) underwent surgeries involving the skull base (n = 104), cerebellum (n = 63), fourth ventricle (n = 28), brainstem (n = 12), and foramen magnum (n = 3). Of 210 surgeries, 171 (81.4%) were uneventful with respect to long-tract monitoring. Nine (23%) of the 39 SEP and/or MEP alterations were transient and were only followed by a slight permanent deficit in 1 case. Permanent deterioration only was seen in 19 (49%) of 39 cases; the deterioration was related to tumor dissection in 4 of these cases, and permanent deficit (moderate-severe) was seen in only 1 of these 4 cases. Eleven patients (28%) had losses of at least 1 modality, and in 9 of these 11 cases, the loss was related to surgical microdissection within the vicinity of the brainstem. Four of these 9 patients suffered a moderate-to-severe long-term deficit. For permanent changes, the positive predictive value for neuromonitoring of the long tracts was 0.467, the negative predictive value was 0.989, the sensitivity was 0.875, and the specificity 0.918. Twenty-eight (72%) of 39 SEP and MEP alterations occurred in 66 cases involving intrinsic brainstem tumors or tumors adjacent to the brainstem. Lesion location and alterations in intraoperative neuromonitoring significantly correlated with patients' outcome (p < 0.001, chi-square test). In summary, long-tract monitoring with SEPs and MEPs in infratentorial surgeries has a high sensitivity and negative predictive value with respect to postoperative neurological status. It is recommended especially in those surgeries in which microdissection within and in the vicinity of the brainstem might lead to injury of the brainstem parenchyma or perforating vessels and a subsequent perfusion deficit within the brainstem.

Early somatosensory processing in individuals at risk for developing psychoses

Human cortical somatosensory evoked potentials (SEPs) allow an accurate investigation of thalamocortical and early cortical processing. SEPs reveal a burst of superimposed early (N20) high-frequency oscillations around 600 Hz. Previous studies reported alterations of SEPs in patients with schizophrenia. This study addresses the question whether those alterations are also observable in populations at risk for developing schizophrenia or bipolar disorders. To our knowledge to date, this is the first study investigating SEPs in a population at risk for developing psychoses. Median nerve SEPs were investigated using multichannel EEG in individuals at risk for developing bipolar disorders (n = 25), individuals with high-risk status (n = 59) and ultra-high-risk status for schizophrenia (n = 73) and a gender and age-matched control group (n = 45). Strengths and latencies of low- and high-frequency components as estimated by dipole source analysis were compared between groups. Low- and high-frequency source activity was reduced in both groups at risk for schizophrenia, in comparison to the group at risk for bipolar disorders. HFO amplitudes were also significant reduced in subjects with high-risk status for schizophrenia compared to healthy controls. These differences were accentuated among cannabis non-users. Reduced N20 source strengths were related to higher positive symptom load. These results suggest that the risk for schizophrenia, in contrast to bipolar disorders, may involve an impairment of early cerebral somatosensory processing. Neurophysiologic alterations in schizophrenia precede the onset of initial psychotic episode and may serve as indicator of vulnerability for developing schizophrenia.

Merit of quinacrine in the decrease of ingested sulfite-induced toxic action in rat brain

We aimed at investigating the effects of sulfite-induced lipid peroxidation and apoptosis mediated by secretory phospholipase A2 (sPLA2) on somatosensory evoked potentials (SEP) alterations in rats. Thirty male albino Wistar rats were randomized into three experimental groups as follows; control (C), sodium metabisulfite treated (S), sodium metabisulfite+quinacrine treated (SQ). Sodium metabisulfite (100mg/kg/day) was given by gastric gavage for 5weeks and 10mg/kg/day quinacrine was applied as a single dose of intraperitoneal injection for the same period. The latencies of SEP components were significantly prolonged in the S group and returned to control levels following quinacrine administration. Plasma-S-sulfonate level was increased in S and SQ groups. TBARS levels in the S group were significantly higher than those detected in controls. Quinacrine significantly decreased brain TBARS levels in the SQ group compared with the S group. Quinacrine treatment did not have an effect on the increased sPLA2 level of the sulfite administered group. Immunohistochemistry showed that sulfite caused an increase in caspase-3 and TUNEL positive cells, restored to control levels via quinacrine administration. This study showed that sPLA2 might play a role in ingested sulfite-induced SEP alterations, oxidative stress, apoptotic cell death and DNA damage in the brain.

High-Frequency (600Hz) SEP Oscillations – Generators and Pathophysiological Aspects

Human median nerve somatosensory evoked potentials (SEP) contain a low-amplitude (<500 nV) high-frequency (˜600Hz) burst of repetitive wavelets (HFOs) which are superimposed onto the primary cortical response 'N20'. The following studies in human subjects are aimed to further clarify the cortical and subcortical structures involved in the generation of the HFOs and the (patho)physiological meaning of this somatosensory oscillatory activity. 1) 128-channel SEP recordings were obtained to right median nerve stimulation and ulnar nerve stimulation. Different source evaluation strategies provided converging evidence for a cortical HFO origin, with two different almost orthogonally oriented generators being active in parallel. The cortical HFO source constellation points to a „precortical“ source in terminals of thalamocortical fibers and a second intracortical HFO origin. Additionally, generation of the HFOs was localized in subcortical, near thalamic and subthalamic source sites. 2) We tested the hypothesis that HFOs might be more sensitive to temporal dispersion caused by demyelinating lesions in multiple sclerosis (MS) than the N20. HFOs in median nerve SEPs in 50 patients with definite MS and in 30 healthy controls were recorded. Three patterns of SEP alterations were found: (i) abolished HFOs with either normal (11% of stimulated limbs), or delayed N20 (16%); (ii) an attenuation of N20 amplitude with preserved HFOs (13%); and (iii) a mixture of both patterns (21%). The first pattern -normal N20 with abolished HFOs- indicates that the HFOs are a sensitive marker of slight demyelination. The second pattern is suggestive of a mainly axonal lesion type, while the third pattern points to a combined axonal/demyelinating process or a conduction block. Analysis of HFOs allows identification of slight demyelinating processes in MS patients in whom the N20 SEP component remains unaffected. 3) The behavior of HFOs in a cohort of schizophrenic patients in comparison to an age- and sex-matched group of controls was tested. HFOs in the group of patients showed a delayed latency. In the low frequency part of the SEPs an increase in amplitude was found. These results are interpreted as a lack of somatosensory inhibition in the somatosensory pathway, either on a thalamic or a cortical level. HFOs are an interesting tool to explore functionality and pathophysiology of the lemniscal system, especially of dysfunctions in thalamocortical impulse propagation.

Effects of thiamylal, sevoflurane and isoflurane on the cortically recorded somatosensory evoked potentials

Effects of thiamylal, sevoflurane and isoflurane on the cortically recorded somatosensory evoked potentials

Somatosensory evoked potentials correlate with genetics in Huntington's disease.

Abnormalities of somatosensory evoked potentials (SEPs) have been reported in Huntington's disease, a neuropsychiatric disorder caused by the expansion of a CAG trinucleotide repeat. The aim of our study was to determine the relationship between these electrophysiological changes and the length of the nucleotide repeat. We found a striking correlation between the decrease in the early component amplitudes (N20 and N30) of the median nerve SEP and the repeat length, suggesting that these SEP alterations are indeed related to the genetically determined pathological process. The cortical components of the tibial nerve SEP exhibited a dramatic alteration in the patient group and were the only SEP changes found in the group of asymptomatic carriers of the mutation, being more sensitive than the median nerve SEPs.

Sensibilité, spécificité et impact sur la stratégie chirurgicale du neuromonitorage peropératoire par potentiels évoqués somesthésiques en chirurgie vasculaire pratiquée avec arrêt circulatoire sous hypothermie profonde

Median nerve somatosensory evoked potentials (SEP) monitoring performed in deep hypothermic circulatory arrest is useful in determining when brain cooling may sufficiently permit circulatory arrest, and to immediately indicate when brain injury occurs. The aim of this retrospective study, including 58 patients, is to determine SEP sensitivity, specificity and impact on the surgical strategy. Sensitivity was determined on patients presenting new neurological complications. Specificity was measured on the patients without any new neurological defect. The impact of intraoperative SEP on the surgical strategy was determined when the occurrence of SEP alterations had provoked a modification of the surgical procedure. Five patients died intraoperatively due to non-neurological complications. Fourteen patients presented new neurological complications. SEP sensitivity reaches 64.3% when all the complications are included, but increases to 100% in our series if late postoperative complications, paraplegia and tibial posterior nerve lesion are excluded because median nerve SEP are not able to detect such complications. SEP monitoring was uneventful in the 39 patients whose did not present neurological complication: thus SEP specificity is absolute in our series. SEP had an impact on the surgical procedure whenever neurological complications due to hemodynamic disturbances occurred. This retrospective study shows the interest of intraoperative SEP as an useful tool for promptly identifying and preventing the neurological complication of hypothermic circulatory arrest.

Motor neuron disease with pyramidal tract dysfunction involves the cortical generators of the early somatosensory evoked potential to tibial nerve stimulation.

We evaluated somatosensory evoked potentials (SEPs) to tibial nerve stimulation in 39 patients with sporadic motor neuron disease using multiple scalp derivations (earlobe reference). SEPs were altered in 22 of 29 amyotrophic lateral sclerosis (ALS) patients, whereas they were unaffected in 10 progressive muscular atrophy (PMA) patients. The main changes involved the amplitude and the field distribution of the early P40 and N37 cortical potentials with different modalities varying from a selective loss of the P40 potential (33% of tested sides) to absence of all early cortical SEPs (22% of tested sides). The later components following N50 were generally spared. The commonly used Cz-Fz montage was inadequate for detecting these alterations. Central afferent conduction was slightly affected. The selective loss of cortical SEPs and their close correlation with clinicoelectrophysiologic evidence of central motor system involvement strongly support a cortical origin of the SEP alterations in ALS. We suggest that neuronal loss in the somatosensory cortex may selectively affect the generator sites of the cortical SEPs to lower limb stimulation.

Cadmium induced alterations in somatosensory evoked potentials.

Pregnant Swiss albino rats were divided into three groups: control (C), cadmium (Cd) and non-cadmium (NCd) groups. Control animals received tap water; the Cd rats received Cd as CdCl2 in their drinking water during the experimental period, while the NCd group was given Cd during pregnancy, and given tap water after birth. Twenty-two days after birth, 15 rats (for each group) were taken from their mothers and continued to be treated with Cd (Cd group) or tap water (C and NCd groups) for an additional 38 days. After the treatment period, somatosensory evoked potentials (SEPs) of the three groups were recorded from central (Cz) referenced to frontal (Fz) following left posterior tibial nerve (PTN) stimulation. Amplitude spectra of SEPs were computed by fast Fourier transform (FFT) algorithm. There was a significant amplitude decrease in 1-3.5 Hz in the NCd group and 1-3.5 and 14-20 Hz frequency bands of the Cd group compared with the control group.

Multilevel somatosensory evoked potentials (SEPs) for spinal cord monitoring in descending thoracic and thoraco-abdominal aortic surgery

The usefulness of somatosensory evoked potential (SEP) monitoring as a means of preventing paraplegia in descending aorta surgery was evaluated in 47 consecutive cases operated on for isthmic (14 cases), thoracic (22 cases), or thoraco-abdominal (11 cases) repair. An aortic dissection was found in 11 cases (acute in 6). Somatosensory evoked potentials were obtained by unilateral left and right posterior tibial nerve (PTN) stimulation at the ankle and recordings were performed on four channels: peripheral nerve, lumbar spinal, brain-stem, and cortical recordings. Our experience led to the following current strategy: the establishment of atrio(aorto)-femoral(aortic) bypass (29 cases), proximal and distal aortic cross-clamping, aortic repair with reimplantation of the culprit artery(ies) as indicated by SEP alterations. Five types of SEP alterations were defined on the basis of the neural level involved: type I (27.7% of cases) = distal spinal ischemia due to proximal aortic cross-clamping in the absence of bypass; type II (21.3%) = PTN ischemia due to left common femoral artery cross-clamping; type III (12.8%) = segmental spinal ischemia due to the exclusion of critical feeding arteries; type IV (4.3%) = ischemia in the left carotid artery territory; type V (4.3%) = global brain hypoperfusion due to systemic hypotension. Forty-five patients survived the operation and could be tested for neurological dysfunction. Three patients presented a postoperative spinal cord deficit, but this deficit was already present preoperatively in one case, so that the actual incidence of a new paraplegia in our series was 2/45 cases (4.4%). One of the two cases was clearly a delayed paraplegia with SEP alterations appearing several hours after the operation. Somatosensory evoked potentials were evaluated on the basis of their sensitivity, specificity, and impact on the surgical strategy. Regarding SEP sensitivity, we did not encounter any unexpected immediate paraplegia, but the critical factor appeared to be the duration of SEP absence due to spinal cord ischemia, which, according to the literature, should never exceed 30 min; after a longer absence, SEP return does not guarantee neurological recovery. Somatosensory evoked potential specificity was also 100%, but only 58% of the abnormalities found were actually consequent to spinal cord ischemia, the rest of the abnormalities being consequent to peripheral nerve or brain ischemia. Finally, SEP monitoring had a significant impact on surgical strategy in 19% of the cases. It is concluded that distal aortic perfusion and multilevel SEP monitoring play a significant role in preventing paraplegia in descending aorta surgery.

Median Nerve Somatosensory Evoked Potentials in Cervical Syringomyelia

Median nerve somatosensory evoked potentials (SEPs) were recorded in 30 patients with cervical syringomyelia before and after surgery. The different SEP components were compared with clinical somatosensory findings. The N13 potential (generated in the dorsal horn at C5-C6) was pathological in 85% of the upper extremities, or 90% of the patients, and correlated with pain/temperature as well as vibration/joint position sense; it was of higher sensitivity in syringomyelia than any other clinical symptom or SEP component. P14 (brain stem) and N20 (postcentral cortex) were less often affected and correlated with only vibration/joint position sense. Short-term postoperative clinical or SEP changes were most often seen after syringoendoscopy and less often after syringostomy, resection of cerebellar tonsils, or tumor extirpation. Alterations of SEPs after surgery occurred in more patients (60%) than did changes in clinical condition (approximately 27%); there was, however, no general correlation between these findings. We conclude that median nerve SEP testing with a proper recording technique identifying the different subcortical components is a valuable supplement in the pre- and postoperative diagnostic evaluation of syringomyelia and is of higher sensitivity than clinical somatosensory examination alone.

Somatosensory evoked potentials and intracranial pressure during chronic dilatation of an artificial extraparenchymal space-occupying lesion in cats.

Somatosensory evoked potentials (SEP) and intracranial pressure (ICP) were studied in cats, suffering from a chronic space-occupying lesion produced by enlargement of an epidural balloon over the left sensomotory cortex. Our study shows that latency alterations of SEP are not dependent on the degree of ICP. Additionally, the results obtained demonstrate that chronic space-occupying lesions cause continuous prolongation of SEP latencies, probably produced by atrophy of the compressed tissue. Regarding the clinical importance of SEP measurements, we concluded that they are not suitable for estimating the degree of ICP. However, they are useful to evaluate tissue damage caused by mass effects in the acute and chronic phase of various space-occupying processes.

Intraoperative Monitoring of Somatosensory Evoked Potentials

Somatosensory evoked potentials (SEPs) were monitored during 20 operations, 13 for tumors in the posterior fossa and upper cervical region and seven for the treatment of aneurysms or carotidcavernous fistulae. Monitoring was technically satisfactory in 16 patients (80%). In two patients, monitoring was compromised by contamination with electrical noise. Two patients with mass lesions in the upper cervical region and posterior fossa were operated in the park bench position and SEP wave forms disappeared, probably because of the positioning, which included head flexion and rotation. Three of the 16 patients (19%) showed alterations in SEP wave forms. The changes were transient in two patients, who had no postoperative neurological deficits, and permanent in one, who exhibited motor palsy postoperatively. Intraoperative SEP alterations corresponded to the postoperative neurological findings in 14 cases (88%). Two patients with no intraoperative SEP alteration were found to have pyramidal tract damage postoperatively (false negative results). Intraoperative SEP monitoring appears useful in terms of minimizing the risk of neurological damage during occlusion of major cerebral arteries and also during manipulation in the upper cervical region. However, it appears necessary to develop a new monitoring method that will reflect the functional integrity of the motor pathway itself. SEPs and brainstem auditory evoked potentials (BAEPs) were simultaneously monitored during 10 posterior fossa operations, and SEP monitoring appeared to be a less sensitive indicator of brainstem function than BAEP monitoring. The authors' results suggest that alterations in the SEP wave form are reversible, reverting to normal if surgical manipulation is stopped immediately after the disappearance of the wave form.

Response variability of somatosensory evoked potentials during scoliosis surgery.

Somatosensory evoked potentials (SSEP) were recorded from the scalp for intraoperative monitoring of patients undergoing surgical correction of spine deformities or spine fractures. Alterations in the SSEP with distraction, spine manipulation, anesthesia, hypotension, and other intraoperative variables are described. When loss of the SSEP occurred and a waiting period was undertaken until it returned, all patients with an SSEP present upon closing, which was within +/- 2 SD of their anesthetized control values, had no neurologic complications. Alterations in SSEP consisting of increases in latency of 15% and decreases in amplitude of 50% were not associated with any postoperative neurologic deficits.

Monitoring of subcortical and cortical somatosensory evoked potentials during carotid endarterectomy: comparison with stump pressure levels

Monitoring of multichannel somatosensory evoked potentials (SEPs) has been performed in 40 cases of carotid endarterectomy (CEA). SEPs were obtained after median nerve stimulation at wrist, recording from 2nd cervical and from the scalp parietal (ipsi- and contralateral) and central (contralateral) positions. The reduction of CBF due to clamping of the carotid artery provoked SEP abnormalities in 10 of the 40 cases. None of the 30 patients with unmodified SEPs developed post-surgical neurological sequelae. SEP alterations were characterized exclusively by amplitude decrements and latency increases of the cortical components, the subcortical ones being unaffected. In 5 of these patients, SEPs returned to normal values before the end of the intervention and no neurological deficit was observed on awakening. In the remaining 5 cases SEPs retained their abnormalities and patients developed post-surgery neurological sequelae (4 immediately, 1 the day after). SEP alterations affected parietal and central components to a similar extent; however, in a few cases cerebral blood flow deficits provoked by carotid clamping modified differently the central P22 and the parietal N20–P25 waves. Comparisons with stump (back) pressure in the carotid artery revealed a higher sensitivity of the SEP technique in detecting vascularization problems due to carotid clamping. The time course of the appearance of SEP abnormalities seems to discriminate alterations secondary to collateral revascularization from those determined by embolization.