A new concept in the electrophysiological evaluation of syringomyelia.
OBJECTIVE
The current neurophysiological assessment of syringomyelia is inadequate. Early-stage syringomyelia is anatomically predisposed to affect decussating spinothalamic fibers that convey pain and sensation primarily. Silent periods have been proven to be a sensitive tool for detecting alterations in this pathway.


METHODS
Thirty-seven patients with syringomyelia were included in this prospective study. Routine electrophysiological measurements were applied including somatosensory evoked potential (SSEP) and motor evoked potential (MEP) recordings for all extremities. The silent periods were recorded from the pollicis brevis muscle, and electrical stimuli were applied to the ipsilateral digiti II. To establish baseline values, the authors had 28 healthy controls undergo monitoring. Sensitivity and specificity values were statistically evaluated according to the main clinical symptoms (paresis, dissociative syndrome, and pain).


RESULTS
All control individuals had normal silent periods in voluntarily activated muscle. In syringomyelia patients, the affected limb showed pathological silent periods with all symptoms (sensitivity 30-50%). Pain was the most specific symptom (90%), despite SSEP and MEP values that were within the normal range.


CONCLUSIONS
Silent period testing is a sensitive neurophysiological technique and an invaluable tool for preoperative assessment of syringomyelia. Silent periods are associated with early dysfunction of thin myelinated spinothalamic tract fibers, even when routine electrophysiological measurements still reveal normal values. Conduction abnormalities that selectively abolish the silent periods can distinguish between hydromyelia (a physiologically dilated central canal) and space-occupying syringomyelia.
Department of Neurosurgery, University of Tübingen, Germany. f.roser@gmx.de
Florian
F
Roser
Florian H
FH
Ebner
Marina
M
Liebsch
Klaus
K
Dietz
Marcos
M
Tatagiba
D000293:Adolescent; D000328:Adult; D000368:Aged; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009434:Neural Pathways / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology; D010291:Paresis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011930:Reaction Time / Q000502:physiology; D012680:Sensitivity and Specificity; D013595:Syringomyelia / Q000503:physiopathology*; D013979:Tibial Nerve / Q000503:physiopathology