title: Improved diagnosis of spinal cord disorders with contact heat evoked potentials.
abstract: OBJECTIVE
  To evaluate the sensitivity of contact heat evoked potentials (CHEPs) compared with dermatomal somatosensory evoked potentials (dSSEPs) and clinical sensory testing in myelopathic spinal cord disorders (SCDs).
  
  
  METHODS
  In a prospective cohort study, light-touch (LT) and pinprick (PP) testing was complemented by dermatomal CHEPs and dSSEPs in patients with a confirmed SCD as defined by MRI. Patients with different etiologies (i.e., traumatic and nontraumatic) and varying degrees of spinal cord damage (i.e., completeness) were included. SCD was distinguished into 3 categories according to MRI pattern and neurologic examination: a) complete, b) incomplete-diffuse, and c) central or anterior cord damage.
  
  
  RESULTS
  Seventy-five patients were included (complete n = 7, incomplete-diffuse n = 33, central/anterior n = 35). In total, 319 dermatomes were tested with combined CHEPs and dSSEPs. CHEPs, dSSEPs, and clinical sensory testing were comparably sensitive to detect the myelopathy in complete (CHEPs 100%, dSSEPs 91%, PP and LT 82%) and incomplete-diffuse (CHEPs 92%, dSSEPs and PP 86%, LT 81%, p > 0.05 for all comparisons) cord damage. In central/anterior cord damage, CHEPs showed a significantly higher sensitivity than dSSEPs (89% compared with 24%, p < 0.001) and clinical sensory testing (PP 62%, LT 57%, p < 0.05). A subclinical sensory impairment was detected more frequently by CHEPs than dSSEPs (60% compared with 29%, p = 0.001).
  
  
  CONCLUSIONS
  Assessment of spinothalamic pathways with CHEPs is reliable and revealed the highest sensitivity in all SCDs. Specifically in incomplete lesions that spare dorsal pathways, CHEPs are sensitive to complement the clinical diagnosis.
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. anett.ulrich@balgrist.ch
authors.forename: Anett
authors.initials: A
authors.lastname: Ulrich
authors.forename: Jenny
authors.initials: J
authors.lastname: Haefeli
authors.forename: Julia
authors.initials: J
authors.lastname: Blum
authors.forename: Kan
authors.initials: K
authors.lastname: Min
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010812:Physical Stimulation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000503:physiopathology*