The value of motor and somatosensory evoked potentials in evaluation of cervical myelopathy in the presence of peripheral neuropathy.
METHODS
Patterns and rates of motor-evoked potential (MEP) and somatosensory-evoked potential (SEP) abnormalities were evaluated in 9 patients with combined cervical cord compression and diabetic neuropathy and 15 patients with asymptomatic cervical cord compression. The results were compared with those of 8 patients with pure cervical myelopathy and 7 patients with pure diabetic neuropathy.


OBJECTIVE
To assess the efficacy of MEPs and SEPs in the evaluation of cervical myelopathy in the presence of peripheral neuropathy.


BACKGROUND
Previous studies have demonstrated a high sensitivity of MEPs and SEPs in documenting a functional involvement of motor and somatosensory pathways in pure or preclinical cervical myelopathy. However, there have been no detailed reports on MEPs and SEPs in cervical cord compression associated with peripheral neuropathy.


METHODS
Central somatosensory conduction was assessed by median and tibial SEPs using peak-to-peak and onset-to-onset methods. Central motor conduction was measured by MEPs and F-waves elicited from upper and lower limb muscles in response to transcranial magnetic stimulation, magnetic stimulation of cervical motor roots, and electrical stimulation of peripheral nerves.


RESULTS
MEPs were more sensitive than SEPs in detecting central conduction impairments in patients with either pure or preclinical or combined forms of cervical myelopathy. The rate of MEP abnormalities suggesting the corticospinal tract involvement in the combined cervical cord compression-neuropathy group did not differ significantly from that in the asymptomatic cervical cord compression group but was lower than in the pure cervical myelopathy group. Combined MEP and SEP analysis improved the test sensitivity in detecting clinically "silent" cervical cord dysfunctions.


CONCLUSIONS
MEPs associated with SEPs are a valuable tool for assessing the presence and severity of cervical cord involvement in combined cervical cord compression and peripheral neuropathy lesions.
Chistyakov
Andrei V
AV
Division of Clinical Neurosciences, Department of Neurosurgery, Rambam (Maimonides) Medical Center, B. Rappaport Faculty of Medicine, the Technion, Israel Institute of Technology, Haifa, Israel. a_chistyakov@rambam.health.gov.il
Soustiel
Jean F
JF
Hafner
Hava
H
Kaplan
Boris
B
Feinsod
Moshe
M
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D003929:Diabetic Neuropathies / Q000150:complications*; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000150:complications / Q000175:diagnosis*