title: Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence.
abstract: BACKGROUND
  Neurologic dysfunction causes fecal incontinence, but current techniques for its assessment are limited and controversial.
  
  
  OBJECTIVE
  The purpose of this work was to investigate spino-rectal and spino-anal motor-evoked potentials simultaneously using lumbar and sacral magnetic stimulation in subjects with fecal incontinence and healthy subjects and to compare motor-evoked potentials and pudendal nerve terminal motor latency in subjects with fecal incontinence.
  
  
  METHODS
  This was a prospective, observational study.
  
  
  METHODS
  The study took place in 2 tertiary care centers.
  
  
  METHODS
  Subjects included adults with fecal incontinence and healthy subjects.
  
  
  METHODS
  Translumbar and transsacral magnetic stimulations were performed bilaterally by applying a magnetic coil to the lumbar and sacral regions in 50 subjects with fecal incontinence (1 or more episodes per week) and 20 healthy subjects. Both motor-evoked potentials and pudendal nerve terminal motor latency were assessed in 30 subjects with fecal incontinence. Stimulation-induced, motor-evoked potentials were recorded simultaneously from the rectum and anus with 2 pairs of bipolar ring electrodes.
  
  
  METHODS
  Latency and amplitude of motor-evoked potentials after lumbosacral magnetic stimulation and agreement with pudendal nerve terminal motor latency were measured.
  
  
  RESULTS
  When compared with control subjects, 1 or more lumbo-anal, lumbo-rectal, sacro-anal, or sacro-rectal motor-evoked potentials were significantly prolonged (p < 0.01) and were abnormal in 44 (88%) of 50 subjects with fecal incontinence. Positive agreement between abnormal motor-evoked potentials and pudendal nerve terminal motor latency was 63%, whereas negative agreement was 13%. Motor-evoked potentials were abnormal in more (p < 0.05) subjects with fecal incontinence than pudendal nerve terminal motor latency, in 26 (87%) of 30 versus 19 (63%) of 30, and in 24% of subjects with normal pudendal nerve terminal motor latency. There were no adverse events.
  
  
  CONCLUSIONS
  Anal EMG was not performed.
  
  
  CONCLUSIONS
  Translumbar and transsacral magnetic stimulation-induced, motor-evoked potentials provide objective evidence for rectal or anal neuropathy in subjects with fecal incontinence and could be useful. The test was superior to pudendal nerve terminal motor latency and appears to be safe and well tolerated.
authors.affiliation: 1Section of Gastroenterology/Hepatology, Georgia Regents University, Augusta, Georgia 2Division of Neurogastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 3Division of Colorectal Surgery, Department of Surgery, Chulalongkorn University, Bangkok, Thailand 4Digestive Physiology and Motility Department, Medical-Biological Research Institute, University of Veracruz, Veracruz, Mexico.
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
authors.forename: Enrique
authors.initials: E
authors.lastname: Coss-Adame
authors.forename: Kasaya
authors.initials: K
authors.lastname: Tantiphlachiva
authors.forename: Ashok
authors.initials: A
authors.lastname: Attaluri
authors.forename: Jose
authors.initials: J
authors.lastname: Remes-Troche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019054:Evoked Potentials, Motor; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000503:physiopathology*; D008280:Magnetics; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D060525:Pudendal Nerve; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome