Intra-operative recording of motor tract potentials at the cervico-medullary junction following scalp electrical and magnetic stimulation of the motor cortex

J Neurol Neurosurg Psychiatry. 1991 Jul;54(7):618-23. doi: 10.1136/jnnp.54.7.618.

Abstract

Activity in descending motor pathways after scalp electrical and magnetic brain stimulation of the motor cortex was recorded from the exposed cervico-medullary junction in six patients having trans-oral surgery of the upper cervical spine. Recordings during deep anaesthesia without muscle paralysis revealed an initial negative potential (D wave) at about 2 ms with electrical stimulation in five of the six patients. This was followed by a muscle potential which obscured any later waveforms. Magnetic stimulation produced clear potentials in only one patient. The earliest wave to magnetic stimulation during deep anaesthesia was 1-2 ms later than the earliest potential to electrical stimulation. Following lightening of the anaesthetic and the administration of muscle relaxants a series of later negative potentials (I waves) were more clearly seen to both electrical and magnetic stimulation. More I waves were recorded to magnetic stimulation during light anaesthesia than during deep anaesthesia. Increasing the intensity of electrical stimulation also produced an extra late I wave. At the highest intensity of magnetic stimulation the latency of the earliest potential was comparable to the D wave to electrical stimulation. The intervals between these various D and I waves corresponded to those previously described for the timing of single motor unit discharge after cortical stimulation.

MeSH terms

  • Adult
  • Aged
  • Cervical Vertebrae / physiopathology
  • Cervical Vertebrae / surgery*
  • Efferent Pathways / physiopathology
  • Electric Stimulation / instrumentation
  • Electromagnetic Fields*
  • Evoked Potentials, Somatosensory / physiology
  • Female
  • Hand / innervation
  • Humans
  • Male
  • Medulla Oblongata / physiopathology
  • Middle Aged
  • Monitoring, Intraoperative / instrumentation*
  • Motor Cortex / physiopathology*
  • Motor Neurons / physiology*
  • Muscle Contraction / physiology
  • Muscles / innervation
  • Pons / physiopathology
  • Spinal Cord / physiopathology*
  • Spinal Cord Compression / physiopathology
  • Spinal Cord Compression / surgery*
  • Spinal Diseases / physiopathology
  • Spinal Diseases / surgery*
  • Synaptic Transmission / physiology