Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery Dong-Gun Kim, Seong-Rae Jo, Minjung Youn, Seung-Jae.

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Corticobulbar motor evoked potentials from tongue muscles used as a control in cervical spinal surgery Dong-Gun Kim, Seong-Rae Jo, Minjung Youn, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Hyun-Jib Kim, Kyung Seok Park Clinical Neurophysiology Practice Volume 2, Pages 124-129 (January 2017) DOI: 10.1016/j.cnp.2017.05.003 Copyright © 2017 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 1 Photograph of needle electrodes inserted bilaterally in the tongue. A: Needle inserted bilaterally in the anteriolateral portion of the tongue. B: Image taken after a piece of rolled gauze was inserted to prevent tongue bite injury. Clinical Neurophysiology Practice 2017 2, 124-129DOI: (10.1016/j.cnp.2017.05.003) Copyright © 2017 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 2 A case with positive single-pulse stimulation indicative of peripheral conduction. A: There was a recognizable waveform in corticobulbar MEPs from tongue muscle at 5-pulse stimulation. B: The waveform of the hypoglossal nerve MEPs was also elicited by single-pulse stimulation. Note that there was no recognizable waveform of the limbs. DD, deltoid; APB, abductor pollicis brevis; TA, tibialis anterior; AH, abductor halluces muscles. Note that each muscle has different gain per division. Clinical Neurophysiology Practice 2017 2, 124-129DOI: (10.1016/j.cnp.2017.05.003) Copyright © 2017 International Federation of Clinical Neurophysiology Terms and Conditions

Fig. 3 Stable corticobulbar MEPs (C-MEPs) from tongue muscle despite deteriorating limb MEPs (L-MEPs) recorded caudally to the deltoid muscle. A: Baseline MEPs with 5-pulse stimulation were clearly identifiable in recordings from tongue, deltoid, abductor pollicis brevis, tibialis anterior, and abductor hallucis muscles. B: Single pulse stimulation was performed to rule out peripheral conduction. C, D: Note that C-MEPs from tongue muscle remained stable when the L-MEPs caudally to deltoid muscle deteriorated (C). Gradual recovery of the L-MEPs was shown with stable C-MEPs (D). Gain (amplification intensity) is the same for each muscle. DD, deltoid; APB, abductor pollicis brevis; TA, tibialis anterior; AH, abductor halluces muscles. Note that each muscle has different gain per division. Clinical Neurophysiology Practice 2017 2, 124-129DOI: (10.1016/j.cnp.2017.05.003) Copyright © 2017 International Federation of Clinical Neurophysiology Terms and Conditions