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  • Title: Cortical localization of external urethral sphincter activation by transcranial electrical stimulation.
    Author: Haghighi SS, Agrawal S.
    Journal: Electromyogr Clin Neurophysiol; 2006 Nov; 46(6):343-8. PubMed ID: 17147076.
    Abstract:
    PURPOSE: Repetitive transcranial electrical stimulation (rTES) was used to activate descending output to the external urethral sphincter muscle. METHODS: Motor evoked potentials (MEPs) were recorded from external urethral sphincter (EUS), and anterior tibial (TA) muscles following high voltage rTES in 9 consecutive patients undergoing spine surgery. Anesthesia was achieved by continuous propofol/narcotic infusion without paralytic agents. Anodal cortical stimulation was delivered at C4/C3, C2/C1, and Cz/Fz locations in each patient. Latency and amplitude of the MEP was measured and compared for each bipolar stimulation montage. RESULTS: The mean latency was 20.24 +/- 1.3 msec. for Cz/Fz; 20.19 +/- 1.1 msec. for C4/C3 and 20.19 +/- 1.1 msec. for C2/C1. Statistical analysis showed no significant difference in latency between the three sites (F(2,15) = 0.004; p > 0.05). The mean amplitude was 37.14 +/- 24.3 microV for Cz/Fz; 113.33 +/- 100.6 microV for C4/C3; and 85 +/- 73.9 microV for C2/C1. A significant difference between the amplitudes at three sites was observed (F(2,8) = 5.2; p < 0.05). The amplitude at C4/C3 was significantly greater than amplitude at CzlFz (t (8) = 3.08; p < 0.05), but data did not give enough evidence to believe that difference between amplitudes for site C4/C3 & C2/C1 was significant (p > 0.05). CONCLUSIONS: This study shows that the intraoperative MEP monitoring of the EUS is a feasible method. Furthermore, activation of descending axonal outflow to the EUS muscle is best achieved by cortical stimulation directed from C4 to C3 or C2 to C1 points.
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