Myogenic transcranial motor evoked potentials monitoring cannot always predict neurologic outcome after spinal cord ischemia in rats Manabu Kakinohana,

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Manuel J. Antunes, MD, PhD, DSc

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Myogenic transcranial motor evoked potentials monitoring cannot always predict neurologic outcome after spinal cord ischemia in rats Manabu Kakinohana, MD, PhD, Tetsuya Kawabata, MD, Yuji Miyata, MD, Kazuhiro Sugahara, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 129, Issue 1, Pages 46-52 (January 2005) DOI: 10.1016/j.jtcvs.2004.05.007

Figure 1 Changes in neurologic function after spinal cord ischemia, as assessed by the motor deficit index. Data were expressed as medians. A significant motor dysfunction induced by 10 minutes of spinal cord ischemia (group B) can be seen (**P < .01 compared with group A). R-2, Two hours of reperfusion; R-24, 24 hours of reperfusion; R-72, 72 hours of reperfusion. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)

Figure 2 Myogenic tc-MEPs recorded from the right soleus muscle. Tc-MEPs in group A (almost normal motor function during reperfusion) appeared at 30 minutes of reperfusion. In group B (10 minutes of spinal cord ischemia) tc-MEPs appeared consistently in a paraplegic rat. In group C (sham operation) tc-MEPs did not change throughout the experiment. I-2, Two minutes of spinal cord ischemia; I-6, 6 minutes of spinal cord ischemia; R-0.5, 30 minutes of reperfusion; R-24, 24 hours of reperfusion; R-72, 72 hours of reperfusion. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)

Figure 3 Time course changes in the amplitude of myogenic tc-MEPs. Data were expressed as means ± SD. The amplitudes of tc-MEPs decreased significantly and disappeared during spinal cord ischemia. Disappearance reversed to baseline level at 30 minutes of reperfusion in both groups. Note that tc-MEPs can be seen during reperfusion in group B (spastic paraplegia after 10 minutes of spinal cord ischemia). The amplitudes in group B were significantly higher than in group A at 24 and 72 hours of reperfusion (**,##P < .01, **compared with group A, ##compared with baseline level.). I-2, Two minutes of spinal cord ischemia; I-6, 6 minutes of spinal cord ischemia; R-0.5, 30 minutes of reperfusion; R-24, 24 hours of reperfusion; R-72, 72 hours of reperfusion. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)

Figure 4 Light microphotograph of transverse sections. A and B, Transverse section of spinal cord taken from the lumbar spinal segment from an animal that underwent 6 minutes of spinal cord ischemia, with normal motor function at 72 hours of reperfusion. Normal appearance of α motor neurons and medium-size interneurons can be seen. C and D, Transverse section of spinal cord taken from the lumbar spinal segment from a rat subjected to 10 minutes of spinal cord ischemia with spastic paraplegia at 72 hours of reperfusion. Although α motor neurons appeared nearly normal, complete loss of medium-size interneurons in the intermediate zone (laminae VII) can be seen. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)

Appendix Figure MEPs evoked by means of transcranial electrical stimulation recorded from the left anterior tibial muscle in a patient with spastic paraplegia a day after thoracic aortic surgery. This MEP showed amplitude of 1023 μV. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)

The Journal of Thoracic and Cardiovascular Surgery 2005 129, 46-52DOI: (10.1016/j.jtcvs.2004.05.007)