Thursday, August 16, 2007

Neuromuscular Scoliosis?- Intraoperative Neuromonitoring!!

Michael G Fehlings* and Michael O Kelleher

Correspondence

*Suite 4WW-446, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada

Email michael.fehlings@uhn.on.ca

This article has no abstract so we have provided the first paragraph of the full text.

The avoidance of iatrogenic neurological injury is of paramount importance during spinal surgery, and multimodality intraoperative monitoring using a combination of MEPs, SSEPs and electromyographic (EMG) signals is increasingly used in this setting.^1,² During corrective procedures for neuromuscular scoliosis, however, the successful application of intraoperative monitoring is a challenge, particularly in the most severely deformed and neurologically compromised patients.³ Difficulties in obtaining reliable baseline recordings of conventional (cortical and subcortical) SSEPs and transcranial
MEPs in patients with neuromuscular scoliosis has prompted the use of an epidural electrode to record spinal SSEPs and evoke neurogenic MEPs.

You do Spine surgery and Do not monitor nerves..Why?

Neuro monitoring (a.k.a.: Neurophysiologic Intraoperative Monitoring) may be one of the most exciting and important €œold€ innovations to come into spine and neuro surgery in decades.

Think of it, what surgeon would dare operate without blood gas monitoring? Or blood pressure monitoring?

So why operate without nerve monitoring?

We recently talked with Debra Zacharko, who teaches neuro monitoring for NeuroMatrix in Atlanta. She described a case in which one of her clients scheduled a straightforward laminectomy and declined to use neuro monitoring. €œSo, I told him that I'€™d perform the monitoring for free,€ said Zacharko, €œand when I showed him the wave form tapes

he was amazed to see how much nerve irritation there is even in a simple laminectomy.€

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Brain Trauma, check!!

Brain and Spine injuries, and traumatic brain injuries. If you are looking for information and support help, these are few places you might look for, do your own reading and diligence. I have done an independent thorough research on them, those NIH related sites are authentic, so do some of the others.
------------------------------------
National
NINDS
Acoustic NeuromaAssociation
Brain Trauma Foundation
Brain Injury Association of America
Brainline.org, Truamtic Brain injury info
National Brain Injury Foundation
Local
San Diego Brain Injury Foundation
International
International Brain Injury Association

more to come...!!

Health Care-Jobs!

In this terrible economy and devastating job loss, medical fields and health care areas are doing just fine and infact there is increasing demands for health care providers, whether it is highly specialized or just techs or nurses. For those who lost their jobs, look for opportunities in health care. Learn and equip yourself to change your future.

I will try to list a few websites related to health care Jobs. Today's site:

Find Health Care Jobs

Health care is the largest industry in the world -- there are about 15 million people in the US employed in the health care field. More new wage and salary jobs are being created in health care than in any other industry. Locate your new job TODAY at Health Care Hiring.

Science Talk from "Scientific American: PodCast on Neuroscience & Law, Ethics?

Google Search results on Neuromonitoring?

My Blog "NeuroMonitoring1" is the number 1 on Google search results,

this is pretty interesting. Blogging requires quite a lot of time and I often wondered, how much of my personal time was sucked out by blogging, just don't ask me?. So, wondered if I am wasting my precious time, it seems like I was after all not wasting time. The good news is my blog is one of the most visitedneuromonitoring/neuroscience blogs.

I also receive readers comments, since they reached me as a personal e-mails or feed back in person at a meeting or conference, I can't list them but certainly the feed back is like a fuel of energy as to why I do this blogging?. Now, as of today, the neuromonitoring1 tops the list of google search, here are the list of the top 9 or 10 sites for the Search "neuromonitoring".

NeuroMonitoring

- Apr 8

NEUROMONITORING is a common term used to describe Intra-Operative Neurophysiological Monitoring(IONM), an advanced multimodality neurophysiological testes ...
neuromonitoring1.blogspot.com/ - Cached - Similar pages -

Intraoperative neuromonitoring.

- 2 visits - Feb 17

BACKGROUND: Intraoperative neuromonitoring (IONM) has been a valuable part of surgical procedures for over 25 years. Insight into the nervous system during ...
www.ncbi.nlm.nih.gov/pubmed/12803681 - Similar pages -
by RE Minahan - 2002 - Cited by 12 - Related articles - All 4 versions

neuromonitoring.com

www.neuromonitoring.com · . Copyright Moberg Research, Inc. 2002. Contact the Webmaster.
www.neuromonitoring.com/ - Cached - Similar pages -

and more..............................!

CNIM Eligibility Requirements UPDATED?

Few months ago I wrote about the ABRET's new policy changes on the CNIM requirement, I criticized their new found love that all candidates should undergo EEG or EP registered/credentialed to be eligible for CNIM (Here is my Blog article: Ridcules?).And, I just returned from Vancover, where the annual ASNM meeting was held, it was a great meeting, one of the things I noticed that is worth mentioning here is the change in CNIM requirements.

Whether or not anyone from ABRET read my blog, regardless, I am delighted to see something good happened after I wrote about this policy. Good news to those undergraduates all over US, who worried about going through a crap called double credentialing, don't sweat, you can do your CNIM exam, as long as you meet 100 minimum case requirements and a CPR card and a batchlor degree in hand. You are good to go....?
This updated change in requirement for CNIM was published in the handbook of the ASNM annual meeting this year.

Encyclopedia of Surgery?

Here is yet another GEM of a site to know more about the surgical procedure names and related terms..........?The Encyclopedia of Surgery has been written by various experts in the field of surgery and has been written specifically for healthcare students and patients. The Encyclopedia covers 450 surgical procedures and topics such as laser surgery, hysterectomy, endoscopy, cryosurgery, anesthetics, biopsy, angioplasty, medications and postoperative care, and many related subjects. Each entry in the Encyclopedia of Surgery consists of a standardized format which includes the definition, purpose, diagnosis, aftercare, risks, mortality rates, and alternatives.
Encyclopedia of Surgery: A to
Ce Guide for Patients and Caregivers

Surgery:Ce-Fi
Surgery: Fi-La

Surgery: La-Pa

Surgery: Pa-St

Surgery: St-Wr

Virtual 3D Animation of Surgical/Medical Procedures!!

This virtual 3D animation of medical procedures is just like a caricature of real procedure that is carried out inside OR’s or clinical set up.

It is a simplified way of understanding certain surgical/ medical procedures orfor that matter a laboratory test routinely conducted to help patients from their disease conditions. Watching this animation is in no means will provide you a step by step complete procedure?, but I am going to compile some available YouTube video’s on real surgical procedure or complete animations here.

A picture or video is far simpler to understand and remember than reading tons of pages, though reading is a must on a daily basis. Watch out for my new section where I will brief a surgical procedure here with a video link to it.

Brain Briefings:-

brain Briefings, a two page newsletter

brought out by the society for neuroscience is a sweet little information pamphlet about latest discoveries or news in the field of brain research. In the September issue a report on learning multiple languages (bilingual brain) and it's beneficial effect

on memory and old age dementia is discussed.

The Bilingual Brain

As scientists unlock more of the neurological secrets of the bilingual brain, they're learning that speaking more than one language may have cognitive benefits that extend from childhood into old age.

New research into the neurobiology of bilingualism has found that being fluent in two languages, particularly from early childhood, not only enhances a person’s ability to concentrate, but might also protect against the onset of dementia and other age-related cognitive decline.

CPP = MAP - ICP

Cerebral Perfusion Pressure

Neurophysiologists in the OR must keep an eye on the levels of anesthesia used during surgical procedure, must record blood pressure and body temperature during surgery. This is the common practice, constant interaction with anesthesiologist and neurosurgeon inside the Operating Room is one of the important aspect of a good monitoring. But, that is not all, why an neurophysiologist might be attentive on any of the anesthetic agents or drugs administered to the patient.

Because, blood pressure changes in patients, especially someone with brain injury or trauma can help understand cerebral blood flow and intracranial pressure changes, as the anesthesiologists makes effort to keep the Mean Arterial Pressure at a required rate, in those patients with possible brain injury, these bood flow rate and intracranial pressure will be altered, could lead to localized ischaemia, neuromonitoring waveforms changes at these juctures will be much easier to interpret if you keep on eye on all these changes that the anesthesiologist is controlling using drugs and agents.

Find this brief but useful explanation of intracranial blood pressure

@ Neurotrauma.org

Cerebral Perfusion Pressure (CPP) is defined as the difference between the Mean Arterial Pressure (MAP) and the Intracranial Pressure (ICP).

CPP = MAP - ICP

This represents the pressure gradient driving cerebral blood flow (CBF) and hence oxygen and metabolite delivery. The normal brain autoregulates its blood flow to provide a constant flow regardless of blood pressure by altering the resistance of cerebral blood vessels.

NeuroMonitoring Basics Part-II

updated: Sept 10, 2007

INTRAOPERATIVE SPINAL CORD MONITORING Presented by David Houlden, PhD

Part of the Spine Block Curriculum in Neurosurgery - Electrophysiology Section
Introduction

Spinal cord injury is a rare but devastating complication of spinal surgery. Intraoperative spinal cord monitoring has been used to prevent spinal cord injury during operations which put the spinal cord at risk.

The most commonly used monitoring technique is somatosensory evoked potential (SSEP) which reflects activity in the large fibre sensory system. Motor evoked potential (MEP) monitoring is used less frequently and reflects activity in fast conducting motor pathways.

Together, these

techniques hold promise for early detection of functional compromise to the spinal cord so that immediate corrective surgical measures may be taken while spinal cord injury is still in a reversible stage.

Before monitoring the spinal cord with evoked potentials at least two monitoring tenants should be met:

a) It is possible to monitor the pathway at risk, and
b) significant changes in the evoked potential waveforms can change the course of surgery

Spinal Cord Monitoring Techniques
In general, two classes of monitoring techniques are available.

1) Distal stimulation with proximal recording, and
2) Proximal stimulation with distal recording

Class 1: Usually a peripheral nerve (ie. posterior tibial nerve at the ankle) is stimulated. Stimulation of skin, nerve root, cauda equina, or spinal cord may also be used. Recordings may be obtained from the nerve, spinal cord, subcortical or cortical levels.

Class 2: Usually the brain is stimulated via transcranial electric or magnetic stimulation but brainstem electric or direct cord stimulation may also be used. Distal recording may be obtained from the spinal cord, cauda equina, peripheral nerves or muscles.

Spinal Cord Monitoring
By
Cor J. Kalkman, MD PhD,
c.j.kalkman@azu.

The incidence and etiology of postoperative (iatrogenic) spinal cord injury varies with the type of surgery.
With neurosurgical removal of intramedullary tumors the lesion typically involves direct mechanical damage to long tract axons.

In contrast, after resection of thoraco-abdominal aortic aneurysms there is a high incidence of ischemic spinal cord injury, caused by temporary cross-clamping or permanent interruption of spinal cord blood supply.
In particular the anterior horn motor neurons and the spinal motoneuronal system are extremely vulnerable to ischemia.

When the aorta is simply cross-clamped and replaced without adjuncts to protect the spinal cord, there is a sigmoid relationship between duration of thoracic aortic cross-clamping and the probability of spinal cord injury.
If the time of aortic clamping is less than 30 minutes, the risk of postoperative neurological deficits appears to be small.
The probability of paraplegia increases linearly between 30 and 60 minutes of ischemia, to almost 90% after one hour of thoracic occlusion.
1 After spine surgery, such as correction of scoliosis, spinal cord injury occurs in 1-2% of cases. Here the injury is probably a combination of mechanical factors and reduced perfusion pressure, for example when instrumentation (laminar hooks, screws or wires) impinges on the cord in combination with low blood pressure.

Spinal cord monitoring is based on the premise that rapid detection of spinal cord conduction failure and immediate institution of corrective measures can prevent irreversible ischemic spinal cord injury resulting in paraplegia.
These measures may vary from simply increasing blood pressure, to removal of instrumentation (spine surgery), reattachment of segmental arteries in the aortic graft, or refraining from further resection in case of a spinal cord tumor.

September, 10, 2007
Facial Nerve Neuromonitoring (article referred by Dr.Jun)
Intraoperative Facial Nerve Monitoring

at Michigan Ear Institute
Jack M. Kartush, M.D.
Malcolm A. Graham, M.D.
Kenneth R. Bouchard, Ph.D.

Even the most experienced and capable surgeon may at times have difficulty identifying and preserving the facial nerve.

We have found intraoperative facial nerve monitoring to be an important adjunct to enhance facial nerve preservation, particularly when tumor, infection, or anatomic variations place the nerve at an increased risk.

Patients are routinely monitored using the Xomed-Treace Nerve Integrity Monitor-2 (NIM- 2)™ during acoustic neuroma resection, vestibular neurectomy, facial nerve displacement for skull base tumors and microvascular decompression at the cerebellopontine angle

. Relative indications have included congenital atresia, chronic suppurative otitis media (particularly revision cases) and cochlear implantation. As the means for intraoperative monitoring become more common place, we anticipate that the indications for routine use will broaden .

Neuromonitoring in the OR, why, when and how to monitor?
Electroencephalogr Clin Neurophysiol. 1998 Jan;106(1):1-21.
Guerit JM.
Clinical Neurophysiology Unit, Cliniques Saint-Luc, University of Louvain Medical School, Brussels, Belgium. guerit@nchm.ucl.ac.be

This review considers the main principles and indications of EEG and evoked potential (EP) neuromonitoring in the operating room.

Neuromonitoring has a threefold purpose: to warn the surgeon that he has to adjust his strategy, to confirm his decision, and to help him improve subsequent procedures.

The pathophysiology of intraoperative events liable to alter the EEG or the EPs is first considered. The usefulness of neuromonitoring in preventing neurological complication relies on its ability to detect neurological dysfunction at a reversible stage.

This applies especially to ischemia and compressive damage. The anesthetic influences on EEG and EPs are then considered.

Knowledge of them is essential to disentangle these neurophysiological alterations due to intraoperative events from those merely due to anesthesia and to use neurophysiological parameters to evaluate the depth of anesthesia.

Third, the main indications and limitations of neuromonitoring are considered: prevention of ischemic brain or spinal cord damage, prevention of mechanical injuries of the brain, spinal cord or peripheral nerve, and localization of the motor cortex in cortical neurosurgery or of cranial nerves in posterior fossa surgery.

Finally, the 3 levels of neuromonitoring (neurophysiological feature extraction, neurophysiological pattern recognition, clinical integration of the neurophysiological patterns) are discussed together with the rules that should guide the dialogue between the surgeon, the anesthesiologist, and the neurophysiologist.

Positional Brachial PLEXOPATHY

Patient who undergo Lumbar spinal or back surgery normally are positioned in a prone position, this can lead to pressure on the Axilla area might compress the brachial plexus.Monitoring SSEP of ulnar nerve is recommended and a useful test to prevent any damage to upper sensory system.

The following article/articles report the usage of SSEP test to detect any such damages.Prevention of Positional Brachial Plexopathy During Surgical Correction of Scoliosis.

Original Articles

Journal of Spinal Disorders. 13(2):178-182, April 2000.
Schwartz, Daniel M.; Drummond, Denis S. *; Hahn, Miah *; Ecker, Malcolm L. *; Dormans, John P. *

Abstract:
Summary: Continuous intraoperative monitoring of spinal cord function using somatosensory evoked potentials (SSEP) has gained nearly universal acceptance as a reliable and sensitive method for detecting and possibly preventing neurologic injury during surgical correction of spinal deformities.

In several reports, spinal cord injury was identified successfully based on changes in SSEP response characteristics, specifically amplitude and latency. Less well documented and used, however, is monitoring of peripheral nerve function with SSEPs to identify and prevent the neurologic sequel of prolonged prone positioning on a spinal frame. The authors describe a patient who underwent surgical removal of spinal instrumentation but was not monitored. Neurologic Deficits After Cervical Laminectomy in the Prone Position.

Case Reports

Journal of Neurosurgical Anesthesiology. 13(4):314-319, October 2001.

Bhardwaj, Anish et.al.,

SUMMARY: New neurologic deficits are known to occur after spine surgery. We present four patients with cervical myeloradiculopathy who underwent cervical laminectomy, fusion, or both in the prone position,

supported by chest rolls. Three patients were intubated and positioned while awake, whereas the fourth patient was positioned after induction. Surgeries were successfully carried out, except for transient episodes of relative hypotension intraoperatively. On recovery from anesthesia, all patients were noted to have new neurologic deficits. Immediate CT myelography or surgical reexploration was unremarkable.

Electromyography Monitoring for Percutaneous Placement of Iliosacral Screws.

Original Articles

Journal of Orthopaedic Trauma. 14(4):245-254, May 2000.
Webb, Lawrence X. *; de Araujo, William *; Donofrio, Peter +; Santos, Cesar +; Walker, Francis O. +; Olympio, Michael A. ++; Haygood, Tamara [S]

Abstract:
Objective: To report our experience with the use of continuous electromyography (EMG) for placement of iliosacral screws.

Data Sources: Concurrently acquired data as well as patient charts, intraoperative EMG records, x-rays, and pelvic computed tomography (CT) scans.

Design: The monitored group of twenty-nine patients was studied prospectively. The control group consisted of twenty-two patients studied retrospectively.

Setting: Level One trauma center.

Methods: Continuous electromyograms were recorded for twenty-nine patients and compared with those from a group of twenty-two antecedent patients who were not monitored. The primary parameter of interest of this study was the presence or absence of neurologic change after iliosacral screw placement.

This information was obtained prospectively in the study group and by retrospective review in the historical control.

ASET News!

http://www.aset.org/

ASET

news
New Publications
Available from ASET!

ASET is pleased to offer
Intraoperative Neurophysiological
Monitoring, 2nd Edition,
by Aage Moller, PhD. The book begins
with a discussion of the generation of
electrical activity by the nervous system
and the practical aspects of recording
evoked potentials from the nervous
system. The anatomy and physiology of
the sensory and motor systems and all
types of evoked potential monitoring, as
well as cranial nerve monitoring and
transcranial electrical motor evoked
potentials (TCeMEP) are described. Also
covered are peripheral nervous system
anatomy and physiology and the use of
techniques to map peripheral motor and
sensory nerves. There is a chapter
addressing anesthesia and it constraints
in monitoring motor and sensory
systems. General considerations of
working in the operating room (OR),
including electrical safety, electrical
noise, and troubleshooting are also.............

Ongoing Effort to
Collect Data on Burns
in the Operating Room
IIn March of 2006, ASET embarked on
an effort to collect data on burns in
the operating room. This effort was
spearheaded by Brett Netherton, MS,
CNIM and xxxx – others? .As part of this
initiative, a series of articles have been
and will appear in the American Journal of
Electroneurodiagnostic Technology dealing
with this topic. Because this has serious
implications for patient safety and care,
it’s important that we continue to
compile the data through burn incident
reports. ASET plans to publish the results
of these surveys so that our members can
be better informed about important
issues affecting our profession. If
significant safety issues prove to exist,
ASET will take a proactive role in making
our profession better.
We want to reemphasize that these
surveys will be confidential and only
the overall results will be released.
Refer to pages 9-10 for the Burn

drmuni.com

This Blog will be moved to my own website: drmuni.com It is directly linked now to my website url.

Updates about Blog Changes: Moving my blogger to drmuni.com is still pending, sorry. But, in the meanwhile, I am moving all the companies list, manufacturers list to a separate blog: Neuromonitoring Companies.

If you have a neuromonitoring company that is not listed on my Blog, or if you are neurophysiological/neurosurgical suppliers would like to list your company on the blog do email me. If there are other related sites that might be of some interest to neuromonitoring readers and to this field of health care, do feel free to email me the links or reference docs, I will include them in my list.

For Patients, Students and Beginners: A great Place to learn about Neck, Back, Spine & Brain!

If you are not a professional, scientist or a doctor, and if you are just a patient/student or an enthusiastic individual interested to learn, and to understand how the Neck, Back, Spinal cord and Brain is made up into an amazing moving machine and if you are interested in it's functions, I thought this is the place you must start. The illustrations are amazingly simple and quite interesting, which is ofcourse is an ingredient for a good learning......!.

I have to tell you, even professionals can find this a good place to refresh their knowledge.

09/01/2009
1. Cervical (Neck) Joint Pain: Where to look for basic information?.
What the heck is Zygapophyseal or Apophyseal Joints?

2. Cervical Corpectomy & Grafting: What can be done if there is a severe Cervical Stenosis or Bone spur that is putting pressure on the spinal cord?
Watch this Youtube video on Corpectomy

to be updated
3.

Hip and Knee Surgery!: What about Neuromonitoring for this surgery?.

Hip and Knee surgeries are minor procedures compared to other orthopaedic surgical procedures like Lumbar Fusion or Cervical decompression and Fusion, the risks of nerve damage or vascular damage might be one in several hundred but there is still a risks.

So the surgeon's who operate on those simple procedure must evaluate the benefits of using neuromonitoring, the safe outcome of patient from nerve or vascular damage will be enhanced with usage of neuromonitoring, for just a small amount of fee you will be better off using a neuromonitoring and having a specialist in the surgical team will give you the comfort of completing surgical procedure safely.

What are the complications in Hip Replacement Surgery:
RisksBy Mayo Clinic staff
Hip replacement surgery is generally safe, but as with any surgery, complications can occur. Although some complications are serious, most can be treated successfully. Complications of hip replacement include:

href="http://www.hipsandknees.com/hip/hipsurgerycomplications.htm">Dr.H.D.Huddelton's provides some basic ideas about the types of complications that could
occuring during such simple procedures like hip surgery in his website.

ARTHRITIS OF THE HIP JOINT
COMPLICATIONS OF HIP
REPLACEMENT SURGERY
Unfortunately, even the most minor of surgical
operations carries some risk of complications occurring. Hip replacement surgery
is very successful, and complications are relatively uncommon, considering the ...........!

Some Junk News or Real News, who knows?.

I do not like to publish or list news that does not have any proven basis, or experimentally reproducible evidences as far as neurological/Neurophysiological aspects concerned?. But at times, there are news like the following, creates a thought as to "What the Heck is this"?.

Back From the Dead

A small but passionate group of doctors say that electricity applied deep in the brain can jolt patients out of irreversible comas. That's when the real problems begin.

'''In November 1994, when Ivey was 17, a log truck T-boned her Chevy Blazer. She remembers nothing of the next two months. But it's all seared into the memory of her mother, Elaine, especially the part where the doctors told her that Candice, who was in a coma and breathing by respirator, should be pronounced dead. Her brain, they said, was entirely and irreversibly destroyed by a week of swelling and bleeding and being pushed up against the inside of her skull like a ship scuttled on a reef'''.

Dr.Jill Bolte Taylor, PhD and her Stroke Drama!

Neuroscientist Jill claims she had a stroke and she was able to recall the whole event stage by stage?.

While there is no doubt the episode of this kind is possible and some amount of recall is also possible from the memory stand point!, but the way this incident is played out on movies, video's and language style used to tell this real event story evokes questions?. The topic of her book "My Stroke of Insight" is the first place to make some sense of it?.

Some if not all her story is exaggerative recall, the Biochemist's own portraying of this incident is seriously questionable as to how much is genuine and how much is simply an hype to sell it?, the topic of her book is the first place to look, it is designed to sell the Book?. In any case, this is another news that I thought to pose a question is it junk or real. When I say Real here, I am not arguing that this incident did not happen or if this kind of things are not possible, I clarified it already. But, that is not the point, how much of it has direct science or medical evidence involved, and how much of it is fake is the Question??.

Blog Updates and Posts!.............Archived..!

. this is an Archive, the people behind law suits are checked out and Archived too?. Lol

To Readers and Blog visitors:

Thanks for being a Regular reader! I apologize for not updating and posting on my blog regularly off late, as I was caught up with some mindless and immoral people who tried to cause troubles at my Job.

It's been almost a year, I have been fighting and straightening up wested interests and certain things at my work place (sabatogers), as the brainless clowns (legally defeated and they ran for cover!?) been defeated and made to bowed down to my high Morality and good work , the truth triumphed and I can now focus back on my good work. And, I will make sure to update this Blog.

I will also create a column for legal issues for Neuromonitoring staff, if any Neurophysiologists or techs have problem with your ex-employee or wested interests hindering your growth and progress, do not just give up or succumb to the bullying and intimidation, write to me, I will help you out in whatever way possible. I must tell you that have to fight without any support or expert advice, I did this on my own, but I did not give up.....I finally taught a lesson to these people (most importantly two douche-bags and bunch of idiots who called themselves legal experts in small business, what a bunch of clowns!?). You can do too!. If any of you find yourself in trouble with a neuromonitoring company or employer, write to me.

Neuromonitoring & higher Standards of health care?

Georgetown Physician Update

GEORGETOWN PHYSICIAN UPDATE NEWSLETTER
November/December – Volume 2, Issue 6
Dr. Kimford J. Meador, Chairman of the Department of Neurology at Georgetown University Hospital, is excited that Drs. Robert E. Minahan and Allen S. Mandir have joined the department. “During brain and spine surgery, you can’t ask a patient, ‘How are you feeling? Do you have any weakness or numbness?’ It’s important to have excellent intraoperative neuromonitoring to tell you what the patient can’t. Minahan and Mandir are outstanding in the field.”

The two have been charged with revamping intraoperative monitoring services at Georgetown, and maintaining a topnotch program that reflects, and gives strong support to, the cutting edge neurosurgery being performed at the hospital. “Since it’s impossible to communicate with a patient who is under general anesthesia, surgeons must depend on electrophysiological measures to tell them how the patient’s nervous system is responding - otherwise there is little else to guide them. Dr. Mandir and I are developing a program that will consistently give them additional information about their patients during surgery, as well as an extra measure of safety, ” commented Dr. Minahan.

Regulatory, Medical & Legal Aspects of NEUROMONITORING!

Neuromonitoring Learning, courses, training & Degrees!? WHERE & WHEN?

Daniel M Schwartz and Anthony K.Sestokas

Surgical Monitoring Associates, Writes about the use of Neuromonitoring for Neurological injury detection and Implant Accuracy.

it is a Book Chapter, Chapter 12

Boo titled: Complications of Pediatric and Adult Spinal Surgery

Edited by
Alexander R.Vaccaro
John J.Regan
Alvin H.Crawford
Edward C.Benzel
D.Greg Anderson

this is good reference book for neurophysiologists and ortho and neurosurgeons and other allied health professionals. Check out the coverpage on top of this right side panel column.

Basic Intraoperative Monitoring (IOM)
Larry Head, R. EEG/EP T., CNIM, RPSGTand Larry Head Institutein association withJack Kartush, M.D.

and American NeuroMonitoringcombine their expertise to offer this most unique and first-of-its-kindIntraoperative Monitoring Training Program

WhatAmI Reading?:

I am a voracious, unquenchable Reader of all things?...Read a lot...
The following List is As and when I read something interesting, I will list them here for readers, ofcourse some of those topics will go as todays posting, some of my interesting reading list will be posted below, you can follow the trend with regard to what the heck I have been reading on Brain and Spine:
--------------------------------
September 20, 2014
New Insights about How brain Regulates its Blood Flow
--------------------------------
June 18, 2014
Steroid Injections in the Spine?: by Nancy E Epstein

Intraoperative Neurophysiological Monitoring

Yellow Page:

Brain and Spine Surgicals LLC specializes in patient care and safety in surgery by providing diagnostic tests inside the Operating Room. It is an evidence based Neurophysiological intraoperative monitoring in general called NEUROMONITORING.

****************************************
B&SS Services are available in the State of Nv, Ut, CA and soon to be in the state of Az..!.If you are a prudent Neurosurgeon/Orthopedic surgeon or a Hospital group looking for a highly qualified Neurophysiologists and expert in IONM to monitor your surgical procedures in any part of the US, we can arrange for it provided you make an advance appointment ( it might take a few days to weeks or 3-6 month) advance scheduling of the surgery date is advised, enough time is required for clearing local hospital privilege papers with the respective surgery centers that are not in my service areas.
Hours & scheduling:-For Hours of Services and scheduling,: Please contact Brain and Spine Surgicals LLC at 1 (702) 476-4326. Email: brainandspinellc@gmail.com or drsmuni@gmail.com

A Note..!

I am a very constructive and progressive blogger, nobody tells me what to do and no money can buy what I say. So, if you are going to post a comment as "annonymous" the chances of your comments approved on my blog is next to none unless it is so important, useful or full of substance.The rest will go to where it supposed to belong the shredder.

Also, remember that my time and energy is spent productively and it is very precious, I am not going to waste my time on petty and meaningless arguments. If you have any concern about some rare posting on a policy or organization or a topic, you must try to get to me with your real name and real credentials, only then I will consider to post them regardless of you agree or oppose my views, even if it is against my point of view, after all we have to be open minded to others views, this is not a place for name calling or he said, she said kind.

I will stand on my view points and Opinions, and if you differ or do not aggree, go your way or dispute it with a right approach. But, before you do so or if you say annonymous things, first read between lines, may be you will correct yourself when you had second chance to look at it. I encourage every one and I believe everyone can do things as per their skills and talents. My writing do not attack or degrade anyone, but I will most certainly stand and affirm only the highly qualified, the ones with highest academic, clinical and other qualifications earned and acheived by years of hard work and schooling, so read between the lines to get the right message. This Blog is for academics with PhD or clinicians with M.D and it is streamlined for these audience at a larger level, however if you are not an academic but a student or technician or something else, there are lots you can read, learn and understand.

Theta Rhythm to Reduce Epileptic Seizures by 90%?

This study though published almost three years ago is still an interesting concept?. Not sure about the latest updates from the same research lab. The authors claim that by using "theta" rhythms in septum, they were able to control the amount of seizure in epileptic rats, sounds like kind of treatment for epilepsy?.According to their study,

Septum keeps neurons in synch, can reduce epileptic seizures by 50 percent

June 20, 2006
In this study, the researchers induced epilepsy by injecting anesthetized rats with pilocarpine, a drug that excites the brain's neurons and activates the synapses between the neurons to produce status epilepticus, in which sustained seizures occur. The rats received diazepam three hours later to interrupt the seizures, but became chronically epileptic, experiencing 3-5 seizures weekly.

The researchers then used electrodes to record individual neurons within the septum of the anesthetized rats to see what happened within the nerve pathways. They found that the epileptic rats suffered significantly more epileptic episodes when the brain did not have the proper theta rhythm.

NERVE

NERVE- Neuroscience Education Resources Virtual Encycloportal?

Neuroscience teaching in schools and educational institutions that focus on early education such as K-12 is important. NERVE's initiatives will bring Neuroscientists, K-12 teachers and other stakeholders of school teachings together through this initiative, might help promote neuroscience at early ages through schools. This new site is part of the society for

neuroscience can be viewed at:
http://www.ndgo.net/sfn/nerve/

Society for neuroscience is already promoting several programes to promote neuroscience such as Brain Awarness Week, NERVE is the latestes effort by SFN.

SfN's new Web site NERVE, the Neuroscience Education Resources Virtual Encycloportal, provides a dynamic gateway to credible information and tools for teaching about the brain and nervous system.

CNIM Certification & Changes in Credentials from 2008

The CNIM certification policy has been changed by ABRET this year. The new updated policy is in effect as of now.
Read:

CNIM offered by ABRET
CNIM certification is intended for the monitoring personnel involved with the technical aspects of monitoring including patient preparation, equipment set-up, data acquisition and trending, and troubleshooting. ABRET’s certification consists of a written exam and monitoring experience. Current requirements for examination include a Bachelor’s degree or a recognized Allied Health Care/Nursing credential or degree.

In addition to these education requirements, documentation of supervised monitoring of 100 cases is also required with verification of these cases by the candidate's supervisor. By
2008, a candidate must meet the education requirements by presenting:

1) a Bachelor’s degree

or 2) credential as a R. EEG T., R. EP T., RNCST, or RET (Canadian EEG
credential).

Other Allied Health Care/Nursing credentials will no longer be accepted. The credentials listed above will be the only credentials accepted in lieu of a Bachelor’s
degree. The first re-certification is required after ten years, and every five years thereafter.

Neurophysiological Monitoring Fellow (inner sunset / UCSF)

Here is a good Opportunity for a PhD or MD, who is interested in getting into NeuroPhysiological Monitoring field:

Check this out:

Required Qualifications
• PhD or MD degree
• Electrophysiology Experience
• Research background and experience
• Passing score on in-house or CNIM examination within six months of hire
• Verbal and Written fluency in English.
• Computer literacy
• Working knowledge of neuroanatomy and neurophysiology.
• Attention to detail, vigilance, poise and composure in stressful situations
• Clear, concise written documentation and interpersonal communication skills
• Ability to learn independently from scientific literature

Economic Crisis & What about Health Care Industry?:- News!

The worst economic crisis after 1929-30's great depression is in progress which lead to the housing market collapse, then the stock market collapse in the last several weeks, further leading to job loss to food crisis to what not?. While most of the sectors are already dangerously affected by the economy, there is one sector the health care industry is going ok and would not see much damage even next year. It is true we need to keep the health care industry going to safeguard and protect patients and people suffering from various illness, what will happen after a year from now or two years from now with this kind of economic conditions is a question with no clear answer.However, what is clear is on the short term and for now, health care industry is doing fine and will probably continue do so for a while,

are the pundits say the same too..., oh Yea, this is the only place we can read some news and agree to some extent, elsewhere such as banking or housing just do not believe the news papers or pundits saying yea...we are fundamentally strong?. It is just a Bull... here is an analysis of the allied health industry companies doing good and forecast a good 2009?. Medical Device Industry Optimistic About 2009 Despite Global Economic Worries - Emergo Group Finds

Main Category: Medical Devices / Diagnostics
Article Date: 23 Oct 2008 - 9:00 PDT

Key findings:- A majority - 61% - expect overall sales for their company to increase in 2009, and 84% expect their company to employ the same number or more people one year from now. Only 9% expect sales to decrease. Emergo Group Ho

Nature Network: I got a senior scientist to Blog?

Nature (NPG), www.nature.com

Subject: “I got a senior scientist to Blog?”

Dear Matt and the Team,

Blogging is the newest way of dissemination of information, but most strikingly to take the information to peers in our field of interests as well as to the public.

Blogging also differs from the traditional or even for that matter the digital publications of scientific work in a way that any common man with little knowledge can go to the blog site and try to grasp a comment, discussion or an article as much as possible.

More importantly, if the blogger is a good writer, he or she will incorporate some simplicity to the writing style, simplicity into the comprehension, content and to the grammatical English to make it easy for all to understand.

The question is how many scientists, or how many senior scientists or great scientists can bring their science to common man to understand?.

This is a daunting question all along scientific research was ever established and it is true even now, because this used to be and still is one of the great lacunae, we need to take our science to the people.

Blogging is a great place where we can do this, we can take the science to people.

It is more important than ever in the history of scientific research to do so! because the policy makers, the funders and the govt authorities constitutes the public in addition to lay man. Blogging can be a platform where scientists walk along with others who cannot understand the intricacies of doing science, but can understand a simplified science if we can tell them simple story of our science. That would have great impact on improving science funding and attention to our scientific crisis via blogging.

If you carefully look around various scientific societies and organizations, they are constantly asking people for support for science, if we can make them understand the importance, values and results of science to our day to day living, what better way we can do science, blogging can bring such understanding in which traditional or journal publications sure will utterly fail or they do not have an option to make their publications understandable to public?. You see!?.

Science funding is diminished so badly that scientists and their research work is suffering from this financial crisis, on top of all we are having the greatest financial crisis [current economic disaster in US is shuddering the world economic conditions] ever at this moment.

But, hopefully things will turn out one or the other day in the future if not in the near future.

Blogging could bring in more attention to this crisis, yes it is a good initiative, but first ask the younger generation to participate morein numbers before going for the senior scientists.

Having said the above, are the senior scientists (whatever is your criteria is to be senior, which I do not see in your message?) equipped or skilled enough to use blogs, do they understand the basics and technical handling of a Blog, or a blog design or how to blog?. If they know, then why are we not seeing senior scientists blogging?. What is the reason we do not see many scientists blogging?.

In my neuroscience field, I can’t even find a few names of scientist who blog or even write to some blog platforms? or I do not see them writing atleast personal blogs? let alone senior scientists?.

So, how many senior scientists will be able to blog?, if we can get them, it certainly will be a boost to your initiative.

But the question still is why get some senior scientists to blog, while we not have young scientists blogging??.

Blog and blogging is primarily a new tool, newest of all communication modality that we have today, if the younger generation did not catch up with the ongoing trend, how would you expect a senior scientist to grasp and get involved?.

I think the need of the hour is to encourage as many young scientists and graduates to get involved in writing their work, their experiences and whatever they wanted to write about, so more bloggers will join science blogging.

More and more science blogging will encourage the senior scientists accross all spectrum of the academy, then we will be looking at senior scientists blogging and pushing this science blogging to the next level.

Hope this helps.

Muni Subramani M.Phil., PhD
Neurophysiologist
My blog: http://neuromonitoring1.blogspot.com

kind of wondering about your topic “Get a Senior Scientists Blogging” if this is appropriate topic?.

IntraOperative Tests on Patients: Are you aware!

Inside the OR, when you are conducting intraoperative tests on patients, multi-modality approach such as conducting Motor, Sensory, EMGs and other reflex tests is the most effective means of assessing neurological issues during the surgical procedures..In this column, I gather some practical tips and list them, do write to me if you have a say on them?. Transcranial Motor evoked potentials (TcMEPs):

Do you know that there are certain conditions under which transcranial testing of motor cortex excluded, you must discuss this with your surgeon and anesthesiologists and advice them.

In general techs and NPhy's will tell you only a couple of things such as Epilepsy or pace maker in the body?...

But, here is the list:

1.Epilepsy

2.Head injury

3.Stroke

4.Seizures

5.Neurologic or psychiatric disorders

6.Cerebral aneurysms

7.Implanted biomedical devices in patients body

such as Cardiac Pacemakers, Intrathecal drug delivery pumps, Spinal cord or Vagus nerve stimulators

8.Metalic parts in the head

9. May be, just check with your patient whether or not they are wearing acoustic devices!?

Between sub-dermal Needle Electrode and Surface Electrode what would you use why? Many Introperative professionals and techs use needle electrodes for EMGs, some use needle for even SSEP tests (in the hands and feet instead of sticky pads?)?

Watch my today's column info?.

Animal Recordings:- How animal studies/research can lead to Intraoperative Human recordings?

Can you record Cerebellar Evoked potentials, oh why not?.

I have not done any cerebellar evoked potentials, neither I met someone who has done it in humans. But, I came across this study might be of great interest to develop it in Humans.

Evoked potentials elicited on the cerebellar cortex by electrical stimulation of the rat spinocerebellar tract

Surgical Neurology, Volume 72, Issue 4, Pages 395-400H. Muramatsu, K. Suzuki, T. Sasaki, M. Matsumoto, J. Sakuma, M. Oinuma, T. Itakura, N. Kodama

The experimental study was performed on rats. Unilateral muscular contractions of quadriceps femoris muscle were elicited by electrical stimulation. The evoked potentials were recorded from the surface of the ipsilateral cerebellum and the contralateral primary sensory cortex.

703.9 Million to Poor Patients who cannot afford to Pay!!:

About Ascension Health

Consistent with its mission to serve all people with special attention to those who are poor and vulnerable

, Ascension Health (www.ascensionhealth.org) is an innovative leader in transforming healthcare through patient-centered, holistic care of the highest clinical quality,

and provided $703.9 million in care of persons who are poor and community benefit last year.

Ascension Health is the nation’s largest Catholic and nonprofit health system, with more than 100,000 associates serving in 20 states and the District of Columbia.

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Thursday, August 16, 2007

Patient Experience

Neurophysiological Architecture of Functional Magnetic Resonance Images of Human Brain

The Course and Prognostic Factors of Symptomatic Cervical Disc Herniation with Radiculopathy: A Systematic Review of the Literature

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