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Walter Paulus - One of the best experts on this subject based on the ideXlab platform.

  • Transcranial Electrical Stimulation of the occipital cortex during visual perception modifies the magnitude of bold activity a combined tes fmri approach
    NeuroImage, 2016
    Co-Authors: Ivan Alekseichuk, Walter Paulus, Kersten Diers, Andrea Antal
    Abstract:

    The aim of this study was to investigate if the blood oxygenation level-dependent (BOLD) changes in the visual cortex can be used as biomarkers reflecting the online and offline effects of Transcranial Electrical Stimulation (tES). Anodal Transcranial direct current Stimulation (tDCS) and 10Hz Transcranial alternating current Stimulation (tACS) were applied for 10min duration over the occipital cortex of healthy adults during the presentation of different visual stimuli, using a crossover, double-blinded design. Control experiments were also performed, in which sham Stimulation as well as another electrode montage were used. Anodal tDCS over the visual cortex induced a small but significant further increase in BOLD response evoked by a visual stimulus; however, no aftereffect was observed. Ten hertz of tACS did not result in an online effect, but in a widespread offline BOLD decrease over the occipital, temporal, and frontal areas. These findings demonstrate that tES during visual perception affects the neuronal metabolism, which can be detected with functional magnetic resonance imaging (fMRI).

  • imaging artifacts induced by Electrical Stimulation during conventional fmri of the brain
    NeuroImage, 2014
    Co-Authors: Andrea Antal, Marom Bikson, Abhishek Datta, Lucas C Parra, Belen Lafon, Peter Dechent, Walter Paulus
    Abstract:

    Functional magnetic resonance imaging (fMRI) of brain activation during Transcranial Electrical Stimulation is used to provide insight into the mechanisms of neuromodulation and targeting of particular brain structures. However, the passage of current through the body may interfere with the concurrent detection of blood oxygen level-dependent (BOLD) signal, which is sensitive to local magnetic fields. To test whether these currents can affect concurrent fMRI recordings we performed conventional gradient echo-planar imaging (EPI) during Transcranial direct current (tDCS) and alternating current Stimulation (tACS) on two post-mortem subjects. tDCS induced signals in both superficial and deep structures. The signal was specific to the electrode montage, with the strongest signal near cerebrospinal fluid (CSF) and scalp. The direction of change relative to non-Stimulation reversed with tDCS Stimulation polarity. For tACS there was no net effect of the MRI signal. High-resolution individualized modeling of current flow and induced static magnetic fields suggested a strong coincidence of the change EPI signal with regions of large current density and magnetic fields. These initial results indicate that (1) fMRI studies of tDCS must consider this potentially confounding interference from current flow and (2) conventional MRI imaging protocols can be potentially used to measure current flow during Transcranial Electrical Stimulation. The optimization of current measurement and artifact correction techniques, including consideration of the underlying physics, remains to be addressed.

  • close to threshold Transcranial Electrical Stimulation preferentially activates inhibitory networks before switching to excitation with higher intensities
    Brain Stimulation, 2012
    Co-Authors: Vera Moliadze, Andrea Antal, Deniz Atalay, Walter Paulus
    Abstract:

    Background: Recently we have shown that Transcranial random noise (tRNS) and 140 Hz Transcranial alternating current Stimulations (tACS), applied over the primary motor cortex (M1) and using 10 min Stimulation duration and 1 mA intensity, significantly increases cortical excitability as measured by motor evoked potentials at rest before and after Stimulation. Objective/hypothesis: Here, by decreasing the Stimulation intensity in 0.2 mA steps from 1.0 mA, we investigate to what extent intensity depends on the induced after-effects. Methods: All twenty-five subjects participated in two different experimental sessions each. They received tACS using 140 Hz frequency and full spectrum tRNS at five different intensities on separate days. Sham Stimulation was used as a control. Results: Instead of receiving a simple threshold, unexpectedly, in these two independent data sets at threshold intensities of 0.4 mA we found a switch of the already known excitation achieved with an intensity of 1 mA to inhibition. The intermediate intensity ranges of 0.6 and 0.8 mA had no effect at all. Interestingly, the inhibition produced by 140 Hz tACS was stronger than that induced by tRNS. Conclusions: In summary, we have shown here the possibility of selectively controlling the enhancement or reduction of M1 excitability by applying different intensities of high frequency Transcranial Electrical Stimulation.

  • Transcranial Electrical Stimulation tes tdcs trns tacs methods
    Neuropsychological Rehabilitation, 2011
    Co-Authors: Walter Paulus
    Abstract:

    Weak Transcranial direct current Stimulation (tDCS) with a homogenous DC field at intensities of around 1 mA induces long-lasting changes in the brain. tDCS can be used to manipulate brain excitability via membrane polarisation: cathodal Stimulation hyperpolarises, while anodal Stimulation depolarises the resting membrane potential, whereby the induced after-effects depend on polarity, duration and intensity of the Stimulation. A variety of other parameters influence tDCS effects; co-application of neuropharmacologically active drugs may most impressively prolong or even reverse Stimulation effects. Transcranial alternating Stimulation (tACS) and random noise Stimulation (tRNS) are used to interfere with ongoing neuronal oscillations and also finally produce neuroplastic effects if applied with appropriate parameters.

  • level of action of cathodal dc polarisation induced inhibition of the human motor cortex
    Clinical Neurophysiology, 2003
    Co-Authors: Michael A Nitsche, M Nitsche, C Klein, Frithjof Tergau, John C Rothwell, Walter Paulus
    Abstract:

    Abstract Objective : To induce prolonged motor cortical excitability reductions by Transcranial direct current Stimulation in the human. Methods : Cathodal direct current Stimulation was applied Transcranially to the hand area of the human primary motor cortex from 5 to 9min in separate sessions in twelve healthy subjects. Cortico-spinal excitability was tested by single pulse Transcranial magnetic Stimulation. Transcranial Electrical Stimulation and H-reflexes were used to learn about the origin of the excitability changes. Neurone specific enolase was measured before and after the Stimulation to prove the safety of the Stimulation protocol. Results : Five and 7min direct current Stimulation resulted in motor cortical excitability reductions, which lasted for minutes after the end of Stimulation, 9min Stimulation induced after-effects for up to an hour after the end of Stimulation, as revealed by Transcranial magnetic Stimulation. Muscle evoked potentials elicited by Transcranial electric Stimulation and H-reflexes did not change. Neurone specific enolase concentrations remained stable throughout the experiments. Conclusions : Cathodal Transcranial direct current Stimulation is capable of inducing prolonged excitability reductions in the human motor cortex non-invasively. These changes are most probabely localised intracortically.

Roi Cohen Kadosh - One of the best experts on this subject based on the ideXlab platform.

  • Transcranial Electrical Stimulation tes mechanisms and its effects on cortical excitability and connectivity
    Journal of Inherited Metabolic Disease, 2018
    Co-Authors: Thomas Reed, Roi Cohen Kadosh
    Abstract:

    In this review, we describe Transcranial Electrical Stimulation (tES) techniques currently being used in neuroscientific research, including Transcranial direct current (tDCS), alternating current (tACS) and random noise (tRNS) Stimulation techniques. We explain how these techniques are used and summarise the proposed mechanisms of action for each technique. We continue by describing how each method has been used to alter endogenous neuronal oscillations and connectivity between brain regions, and we conclude by highlighting the varying effects of Stimulation and discussing the future direction of these Stimulation techniques in research.

  • Transcranial Electrical Stimulation and numerical cognition
    Canadian Journal of Experimental Psychology, 2016
    Co-Authors: Amar Sarkar, Roi Cohen Kadosh
    Abstract:

    Processing, representing, and manipulating numbers and quantities is one of the most advanced cognitive abilities humans possess. This ability is becoming increasingly important with the rising dependence of society on technology, and rising educational and occupational focus on quantitative aptitude. Moreover, deficits in numerical cognition may impair both individual and societal achievement (Beddington et al., 2008; Duncan et al., 2007; Parsons & Bynner, 2005).Recently, there has been increasing academic and public attention on the applications of Transcranial Electrical Stimulation (tES) for cognitive enhancement. Improvements have been observed in a range of psychological variables in healthy populations, including high-level cognition such as visual short term memory (Tseng et al., 2012), working memory (Fregni et al., 2005; Richmond et al., 2014), planning (Dockery et al., 2009), language learning (Floel et al., 2008; Meinzer et al., 2014), analogical reasoning (Santarnecchi et al., 2013), and numerical cognition. The application of tES to numerical cognition is the focus of this review.Research on the use of tES for cognitive enhancement is very new, and within this emerging field, tES for enhancing numerical cognition is itself a nascent field of enquiry. The use of tES is both of scientific importance in understanding numerical cognition, and also of immense practical importance in the enhancement of typical and atypical numerical cognition. There are as yet no reviews on the use of tES for enhancing numerical cognition, though there are several on tES and general cognitive enhancement (e.g., Cohen Kadosh, 2013, in press; Jacobson, Koslowsky, & Lavidor, 2012; Krause & Cohen Kadosh, 2013; Kuo & Nitsche, 2012). An area of particular interest is the combination of tES and cognitive training, which seems to produce long-lived effects that are apparent even up to 6 months after the last Stimulation session (e.g., Cappelletti et al., 2013; Cohen Kadosh et al., 2010; Looi et al., 2015; Reis et al., 2009; Snowball et al., 2013). Cognitive training leads to particular neuroanatomical and neurophysiological changes (Boyke et al., 2008; Draganski et al., 2004; Klingberg, 2010; Slagter et al., 2007). tES is combined with training to facilitate these neural changes, acting as an ingredient to sensitize the neural environment to the effects of training, thereby facilitating the acquisition of the practice effects to a greater degree than training by itself (Cohen Kadosh et al., 2012).This article attempts to bring together several important findings in this (small) body of research to provide a general picture of this emerging field. The material is divided into three sections: (a) A short overview of two relevant forms of tES; (b) the application of tES in the enhancement of three aspects of numerical cognition: numerosity, magnitude processing, and arithmetic operations; and (c) an agenda for future research.Principles of tESThe technology is portable, painless, easy to use, and safe when appropriate screening procedures are conducted (e.g., excluding participants with a personal or family history of epilepsy). The impact of the Stimulation on neuronal activity depends on the shape of the current, and in this regard, there are several forms of tES that produce different effects based on the nature of the current. All the forms of tES can be accompanied by appropriate placebo conditions, in which the current is simply turned off after a brief period (e.g., 30 s), which serves as an effective placebo by generating physical sensations indistinguishable from real Stimulation (Gandiga, Hummel, & Cohen, 2006), but no neural changes (Fritsch et al., 2010).Two forms of tES have been used in numerical cognition research, Transcranial direction current Stimulation (tDCS), and Transcranial random noise Stimulation (tRNS), and some of their features are described below.tDCSThis is the most well-known and most frequently used form of tES. …

  • Transcranial Electrical Stimulation and the enhancement of numerical cognition
    Development of Mathematical Cognition#R##N#Volume 2: Neural Substrates and Genetic Influences, 2016
    Co-Authors: Amar Sarkar, Roi Cohen Kadosh
    Abstract:

    Transcranial Electrical Stimulation (tES) is being employed as a tool for cognitive enhancement in an increasing number of research studies. Its effects have been noted in a range of psychological functions, including numerical cognition and learning. This chapter first presents the historical background, technical principles, and limitations that contextualize modern tES experiments, and then considers how this technology has been applied in the enhancement of numerical cognition. The populations considered here include individuals with normal numerical abilities, such as judging numerosity, perceiving and comparing magnitudes, and carrying out more advanced arithmetic operations, as well as individuals with serious difficulties in working with numbers, as seen in mathematics anxiety and developmental dyscalculia. The chapter concludes with a consideration of important directions that research may take in the future. The emphasis throughout is the need to test the ecological validity of tES-induced cognitive benefits, which is particularly important in the context of an ever-increasing number of positive reports, both in the media and in academia. However, enhancements in healthy individuals have been restricted entirely to controlled laboratory settings. The essential bridge between using tES to enhance numerical cognition in the laboratory and the enhancement of mathematical achievement in educational or occupational settings has yet to be built. As this chapter illustrates, the steady accumulation of evidence is providing firmer ground to begin explorations of the ecological validity of tES interventions.

  • not all brains are created equal the relevance of individual differences in responsiveness to Transcranial Electrical Stimulation
    Frontiers in Systems Neuroscience, 2014
    Co-Authors: Beatrix Krause, Roi Cohen Kadosh
    Abstract:

    A current issue in the research of augmentation of brain functions using Transcranial Electrical Stimulation (tES) is the diversity and inconsistency in outcome results. Similar studies often report different results, depending on the parameters and tasks used. Such inconsistencies have led to significant doubts about the efficacy of the method in the broader scientific community, despite its promising potential for patient recovery and treatment. Evidence on the large variability in individual cortical excitability and response to tES suggests that Stimulation may affect individuals differently, depending on the subject’s age, gender, brain state, hormonal levels, and pre-existing regional excitability. Certain factors might even lead to the reversal of polarity-dependent effects, and therefore have crucial implications for neurorehabilitation and cognitive enhancement. Research paradigms may have to be refined in the future to avoid the confounding effects of such factors.

  • can Transcranial Electrical Stimulation improve learning difficulties in atypical brain development a future possibility for cognitive training
    Developmental Cognitive Neuroscience, 2013
    Co-Authors: Beatrix Krause, Roi Cohen Kadosh
    Abstract:

    Learning difficulties in atypical brain development represent serious obstacles to an individual's future achievements and can have broad societal consequences. Cognitive training can improve learning impairments only to a certain degree. Recent evidence from normal and clinical adult populations suggests that Transcranial Electrical Stimulation (TES), a portable, painless, inexpensive, and relatively safe neuroenhancement tool, applied in conjunction with cognitive training can enhance cognitive intervention outcomes. This includes, for instance, numerical processing, language skills and response inhibition deficits commonly associated with profound learning difficulties and attention-deficit hyperactivity disorder (ADHD). The current review introduces the functional principles, current applications and promising results, and potential pitfalls of TES. Unfortunately, research in child populations is limited at present. We suggest that TES has considerable promise as a tool for increasing neuroplasticity in atypically developing children and may be an effective adjunct to cognitive training in clinical settings if it proves safe. The efficacy and both short- and long-term effects of TES on the developing brain need to be critically assessed before it can be recommended for clinical settings.

Marom Bikson - One of the best experts on this subject based on the ideXlab platform.

  • Neurovascular-modulation: A review of primary vascular responses to Transcranial Electrical Stimulation as a mechanism of action
    'Elsevier BV', 2021
    Co-Authors: Mersedeh Bahr-hosseini, Marom Bikson
    Abstract:

    Background: The ubiquitous vascular response to Transcranial Electrical Stimulation (tES) has been attributed to the secondary effect of neuronal activity forming the classic neurovascular coupling. However, the current density delivered Transcranially concentrates in: A) the cerebrospinal fluid of subarachnoid space where cerebral vasculature resides after reaching the dural and pial surfaces and B) across the blood-brain-barrier after reaching the brain parenchyma. Therefore, it is anticipated that tES has a primary vascular influence. Objectives: Focused review of studies that demonstrated the direct vascular response to Electrical Stimulation and studies demonstrating evidence for tES-induced vascular effect in coupled neurovascular systems. Results: tES induces both primary and secondary vascular phenomena originating from four cellular elements; the first two mediating a primary vascular phenomenon mainly in the form of an immediate vasodilatory response and the latter two leading to secondary vascular effects and as parts of classic neurovascular coupling: 1) The perivascular nerves of more superficially located dural and pial arteries and medium-sized arterioles with multilayered smooth muscle cells; and 2) The endothelial lining of all vessels including microvasculature of blood-brain barrier; 3) Astrocytes; and 4) Neurons of neurovascular units. Conclusion: A primary vascular effect of tES is highly suggested based on various preclinical and clinical studies. We explain how the nature of vascular response can depend on vessel anatomy (size) and physiology and be controlled by Stimulation waveform. Further studies are warranted to investigate the mechanisms underlying the vascular response and its contribution to neural activity in both healthy brain and pathological conditions – recognizing many brain diseases are associated with alteration of cerebral hemodynamics and decoupling of neurovascular units

  • adaptive current flow models of ect explaining individual static impedance dynamic impedance and brain current delivery
    bioRxiv, 2020
    Co-Authors: G Unal, Jaiti Swami, C Canela, Sarah M Cohen, N Khadka, M Rad, B Short, Miklos Argyelan, H Sackeim, Marom Bikson
    Abstract:

    The physical properties of the Electroconvulsive Therapy (ECT) stimulus markedly effect both efficacy and cognitive side effects. Combining records of clinical ECT, device measurements, and MRI-derived FEM computational head models, we consider the sources and relationship between static impedance, dynamic impedance, and current delivered to the brain. To this end, we develop the first adaptive models of Transcranial Electrical Stimulation, where local tissue conductivity is modulated by electric field. The models predict subject-specific static impedance and dynamic impedance, provide insight into their relationship, and predicts how ECT shapes tissue conductance and so how current reaches the brain.

  • limited output Transcranial Electrical Stimulation lotes 2017 engineering principles regulatory statutes and industry standards for wellness over the counter or prescription devices with low risk
    Brain Stimulation, 2018
    Co-Authors: Marom Bikson, Zeinab Esmaeilpour, Bhaskar Paneri, Andoni Mourdoukoutas, Bashar W Badran, Robin Azzam, Devin Adair, Abhishek Datta, Xiao Hui Fang
    Abstract:

    We present device standards for low-power non-invasive Electrical brain Stimulation devices classified as limited output Transcranial Electrical Stimulation (tES). Emerging applications of limited output tES to modulate brain function span techniques to stimulate brain or nerve structures, including Transcranial direct current Stimulation (tDCS), Transcranial alternating current Stimulation (tACS), and Transcranial pulsed current Stimulation (tPCS), have engendered discussion on how access to technology should be regulated. In regards to legal regulations and manufacturing standards for comparable technologies, a comprehensive framework already exists, including quality systems (QS), risk management, and (inter)national electrotechnical standards (IEC). In Part 1, relevant statutes are described for medical and wellness application. While agencies overseeing medical devices have broad jurisdiction, enforcement typically focuses on those devices with medical claims or posing significant risk. Consumer protections regarding responsible marketing and manufacture apply regardless. In Part 2 of this paper, we classify the Electrical output performance of devices cleared by the United States Food and Drug Administration (FDA) including over-the-counter (OTC) and prescription electroStimulation devices, devices available for therapeutic or cosmetic purposes, and devices indicated for Stimulation of the body or head. Examples include iontophoresis devices, powered muscle stimulators (PMS), cranial electrotherapy Stimulation (CES), and transcutaneous Electrical nerve Stimulation (TENS) devices. Spanning over 13 FDA product codes, more than 1200 Electrical stimulators have been cleared for marketing since 1977. The output characteristics of conventional tDCS, tACS, and tPCS techniques are well below those of most FDA cleared devices, including devices that are available OTC and those intended for Stimulation on the head. This engineering analysis demonstrates that with regard to output performance and standing regulation, the availability of tDCS, tACS, or tPCS to the public would not introduce risk, provided such devices are responsibly manufactured and legally marketed. In Part 3, we develop voluntary manufacturer guidance for limited output tES that is aligned with current regulatory standards. Based on established medical engineering and scientific principles, we outline a robust and transparent technical framework for ensuring limited output tES devices are designed to minimize risks, while also supporting access and innovation. Alongside applicable medical and government activities, this voluntary industry standard (LOTES-2017) further serves an important role in supporting informed decisions by the public.

  • rigor and reproducibility in research with Transcranial Electrical Stimulation an nimh sponsored workshop
    Brain Stimulation, 2017
    Co-Authors: Marom Bikson, Leonardo G Cohen, Flavio Frohlich, Andre R Brunoni, Leigh Charvet, Vincent P Clark, Zhide Deng, Jacek P Dmochowski, Dylan J Edwards, Emily S Kappenman
    Abstract:

    Abstract Background Neuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity Transcranial Electrical Stimulation (tES) with direct currents (Transcranial direct current Stimulation, tDCS) or alternating currents (Transcranial alternating current Stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities. Objective This report seeks to promote the science, technology and effective clinical applications of these modalities, identify research challenges, and suggest approaches for addressing these needs in order to achieve rigorous, reproducible findings that can advance clinical treatment. Methods The National Institute of Mental Health (NIMH) convened a workshop in September 2016 that brought together experts in basic and human neuroscience, Electrical Stimulation biophysics and devices, and clinical trial methods to examine the physiological mechanisms underlying tDCS/tACS, technologies and technical strategies for optimizing Stimulation protocols, and the state of the science with respect to therapeutic applications and trial designs. Results Advances in understanding mechanisms, methodological and technological improvements (e.g., electronics, computational models to facilitate proper dosing), and improved clinical trial designs are poised to advance rigorous, reproducible therapeutic applications of these techniques. A number of challenges were identified and meeting participants made recommendations made to address them. Conclusions These recommendations align with requirements in NIMH funding opportunity announcements to, among other needs, define dosimetry, demonstrate dose/response relationships, implement rigorous blinded trial designs, employ computational modeling, and demonstrate target engagement when testing Stimulation-based interventions for the treatment of mental disorders.

  • Optimal use of EEG recordings to target active brain areas with Transcranial Electrical Stimulation
    NeuroImage, 2017
    Co-Authors: Jacek P Dmochowski, Marom Bikson, Laurent Koessler, Anthony M Norcia, Lucas Parra
    Abstract:

    To demonstrate causal relationships between brain and behavior, investigators would like to guide brain Stimulation using measurements of neural activity. Particularly promising in this context are electroencephalography (EEG) and Transcranial Electrical Stimulation (TES), as they are linked by a reciprocity principle which, despite being known for decades, has not led to a formalism for relating EEG recordings to optimal Stimulation parameters. Here we derive a closed-form expression for the TES configuration that optimally stimulates (i.e., targets) the sources of recorded EEG, without making assumptions about source location or distribution. We also derive a duality between TES targeting and EEG source localization, and demonstrate that in cases where source localization fails, so does the proposed targeting. Numerical simulations with multiple head models confirm these theoretical predictions and quantify the achieved Stimulation in terms of focality and intensity. We show that constraining the Stimulation currents automatically selects optimal montages that involve only a few (4−7) electrodes, with only incremental loss in performance when targeting focal activations. The proposed technique allows brain scientists and clinicians to rationally target the sources of observed EEG and thus overcomes a major obstacle to the realization of individualized or closed-loop brain Stimulation.

David Burke - One of the best experts on this subject based on the ideXlab platform.

  • depression of i waves in corticospinal volleys by sevoflurane thiopental and propofol
    Anesthesia & Analgesia, 1999
    Co-Authors: Ian J Woodforth, R Hicks, J Stephen, M Crawford, David Burke
    Abstract:

    UNLABELLED Isoflurane depresses the number and amplitude of I waves of the motor-evoked potential produced by Transcranial Electrical Stimulation of the motor cortex and thus affects components of the corticospinal volley that are believed to arise from Laminae III and V. This study extends these observations to sevoflurane (9 patients) and the two IV anesthetics, thiopental and propofol (10 sets of observations in 10 and 6 patients, respectively). The patients' ages ranged from 10 to 17 yr. Sevoflurane was administered to achieve end-tidal concentrations of 0.5%-3%. Thiopental and propofol were given as boluses of 5 mg/kg and 2 mg/kg, respectively, to patients anesthetized with nitrous oxide, fentanyl, midazolam, and a muscle relaxant. Sevoflurane had a depressant effect on I waves essentially similar to that of isoflurane; thiopental depressed I wave activity by an average of 33% (95% confidence interval: 20%-46%, P < 0.001) and propofol by 39% (95% confidence interval: 20%-40%, P < 0.001). With all three anesthetics, later I waves showed the most amplitude depression. The three anesthetics had qualitatively similar effects on I waves. IMPLICATIONS Sevoflurane, thiopental, and propofol depress components of the corticospinal volley produced by Transcranial Electrical Stimulation of motor cortex in a manner qualitatively similar to isoflurane. The findings indicate that anesthetics with primarily hypnotic actions suppress interneuronal activity in cerebral cortex.

  • variability of motor evoked potentials recorded during nitrous oxide anesthesia from the tibialis anterior muscle after Transcranial Electrical Stimulation
    Anesthesia & Analgesia, 1996
    Co-Authors: Ian J Woodforth, R Hicks, Matthew R Crawford, J Stephen, David Burke
    Abstract:

    When recorded as a compound muscle action potential (CMAP), the motor-evoked potential (MEP) is affected by volatile anesthetics and nitrous oxide. However, MEPs recorded using epidural electrodes in the presence of nitrous oxide are highly reproducible from trial to trial. We wished to establish th

Akio Muramoto - One of the best experts on this subject based on the ideXlab platform.

  • a new alarm point of Transcranial Electrical Stimulation motor evoked potentials for intraoperative spinal cord monitoring a prospective multicenter study from the spinal cord monitoring working group of the japanese society for spine surgery and rel
    Journal of Neurosurgery, 2014
    Co-Authors: Sho Kobayashi, Yukihiro Matsuyama, Kenichi Shinomiya, Shigenori Kawabata, Muneharu Ando, Tsukasa Kanchiku, Takanori Saito, Masahito Takahashi, Zenya Ito, Akio Muramoto
    Abstract:

    Object Although multimodal intraoperative spinal cord monitoring provides greater accuracy, Transcranial Electrical Stimulation motor evoked potential (TcMEP) monitoring became the gold standard for intraoperative spinal cord monitoring. However, there is no definite alarm point for TcMEPs because a multicenter study is lacking. Thus, based on their experience with 48 true-positive cases (that is, a decrease in potentials followed by a new neurological motor deficit postoperatively) encountered between 2007 and 2009, the authors set a 70% decrease in amplitude as the alarm point for TcMEPs. Methods A total of 959 cases of spinal deformity, spinal cord tumor, and ossification of the posterior longitudinal ligament (OPLL) treated between 2010 and 2012 are included in this prospective multicenter study (18 institutions). These institutions are part of the Japanese Society for Spine Surgery and Related Research monitoring working group and the study group on spinal ligament ossification. The authors prospecti...