August 23 2021 IONM & Neurophysiology, Neurosurgery Related Articles of Interest!.

Median nerve SSEPs waves N20-P25 amplitudes were increased in Amyotrophic Lateral Sclerosis, suggested to be associated with Survival in ALS cases!?. 

A total of 145 patients with ALS and 57 healthy subjects were studied. We recorded the median nerve SEP and measured the onset-to-peak amplitude of N20 (N20o-p), and peak-to-peak amplitude between N20 and P25 (N20p-P25p). We obtained early and late HFO potentials by filtering SEP between 500 and 1 kHz, and measured the peak-to-peak amplitude. We followed up patients until endpoints (death or tracheostomy) and analyzed the relationship between SEP or HFO amplitudes and survival using a Cox analysis.

Bulbocavernex reflex? stimulus response curve used to assess spinal reflex in bladder filling condition, wherein Amplification of reflex is associated with bladder filling, in Upper motor neuron lesions such a Sacral spinal reflex is amplified.

 Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BC

 Latest Neurophysiology In Neurosurgery book, renewed Edition:

The purpose of this book is to describe the integration of neuromonitoring with surgical procedures. Each methodology is discussed in detail as well as chapters describing how those methodologies are applied to multiple surgical procedures and the evidence used to support those uses.

NEP, what is NEP potentials: Early Nociceptive Evoked potentials, these are recorded at C3'-Fz and Cz-Au1 in response to a stimulus placed on dorsum of right hand, where Adelta fibers that respond to mechanical stimulus!. Check out the three different Nociceptivr fibers diagram below (image courtesy online). Repeated Stimulation of Ad fibers with at the rate of .83/sec 250-500 averages -N40 wave form occurred at 40ms on contralateral scalp recording electrode site.Authors conclude the N40 as early response and as per the paper, their result is the first of its kind to record early response to A d nociceptive fiber stimulation.

Can you diagnose Dilirium using cEEG?,  Yes ofcourse. What is cEEG, oh well, it is done in "Critical Care Units" contineous EEG Monitoring and automatic storage for analysis!, it is done in 102 patients, septic patients in critical care, about 1252 cEEG blocks were monitored visually, about 805 blocks were analayzed automatically?. Results and conclusion appear to promote more automatic recording analysis, which is not much different than the visual as per their percentage difference!. As a Neurophysiologist, I personally find it odd to rely on machines, human observation and analysis is more important, one can supplement it with automated data, that is my conclusion contrary to this report.

Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury, this work discusses Electrical Epidural Stimulation (EES) of spinal cord at the lumbosacral area to promote loctomotor function following Traumatic Cervical Spinal Cord injuries (cSCI). The reality of SCI is the damage to bulbospinal pathway, thereby creating debilitating respiratory neurons failure to elicit response, and therby respiratory failure quite a life threatening condition, if one can use epidural stimulation of lumbosacral spinal cord to promote locomotor neural plasticity that would be benefitial to the injured and to enable some movements (neural plasticity, or regeneration, huge topic in itself, someday I will review it?). This is not a well developed surgical procedure or stimulation paradigm yet, the authors are working around phrenic motor neurons and improvising the EES stim methods, Interesting work considering the implication in critical care patients recovery.