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Tetanic stimulation of the peripheral nerve augments motor evoked potentials by re-exciting spinal anterior horn cells

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Abstract

Tetanic stimulation of the peripheral nerve, immediately prior to conducting transcranial electrical stimulation motor evoked potential (TES-MEP), increases MEP amplitudes in both innervated and uninnervated muscles by the stimulated peripheral nerve; this is known as the remote augmentation of MEPs. Nevertheless, the mechanisms underlying the remote augmentation of MEPs remain unclear. Although one hypothesis was that remote augmentation of MEPs results from increased motoneuronal excitability at the spinal cord level, the effect of spinal anterior horn cells has not yet been investigated. We aimed to investigate the effect of tetanic stimulation of the peripheral nerve on spinal cord anterior horn cells by analyzing the F-wave. We included 34 patients who underwent elective spinal surgeries and compared the changes in F-waves and TES-MEPs pre- and post-tetanic stimulation of the median nerve. F-wave analyses were recorded by stimulating the median and tibial nerves. TES-MEPs and F-wave analyses were compared between baseline and post-tetanic stimulation time periods using Wilcoxon signed-rank tests. A significant augmentation of MEPs, independent of the level corresponding to the median nerve, was demonstrated. Furthermore, F-wave persistence was significantly increased not only in the median nerve but also in the tibial nerve after tetanic stimulation of the median nerve. The increased F-wave persistence indicates an increase of re-excited motor units in spinal anterior horn cells. These results confirm the hypothesis that tetanic stimulation of the peripheral nerve may cause remote augmentation of MEPs, primarily by increasing the excitability of the anterior horn cells.

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Data availability

The datasets during and/or analysed during the current study available from the first author, Yusuke Yamamoto on reasonable request.

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Acknowledgements

The authors thank Sayomi Yamamoto, Junko Kato, Shinobu Tado, Tomoshige Miyabayashi, and Ryohei Mizobata for their technical assistance with the TES-MEPs and F-wave trial.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nara Medical University, Shijocho 840, Kashihara, Nara, 634-8521, Japan

    Yusuke Yamamoto, Hideki Shigematsu, Masato Tanaka, Akinori Okuda, Sachiko Kawasaki, Keisuke Masuda, Yuma Suga & Yasuhito Tanaka

  2. Department of Anesthesia, Nara Medical University, Nara, Japan

    Masahiko Kawaguchi & Hironobu Hayashi

  3. Division of Central Clinical Laboratory, Nara Medical University, Nara, Japan

    Tsunenori Takatani

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  1. Yusuke Yamamoto
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Contributions

YY: designed the study, collected the data, performed the statistical analysis, and wrote the manuscript. HS: designed the study, collected the data, performed the statistical analysis, and wrote and edited the manuscript. MK: collected patients’ data and reviewed and approved the manuscript. HH: Collected patients’ data and reviewed and approved the manuscript. TT: collected patients’ data and reviewed and approved the manuscript. MT: collected patients’ data and reviewed and approved the manuscript. AO: collected patients’ data and reviewed and approved the manuscript. SK: collected patients’ data and reviewed and approved the manuscript. KM: collected patients’ data and reviewed and approved the manuscript. YS: collected patients’ data and reviewed and approved the manuscript. YT: collected patients’ data, provided critical feedback on the study, and reviewed and approved the manuscript.

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Correspondence to Hideki Shigematsu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional review board of Nara Medical University; Reference Number: 1915.

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Yamamoto, Y., Shigematsu, H., Kawaguchi, M. et al. Tetanic stimulation of the peripheral nerve augments motor evoked potentials by re-exciting spinal anterior horn cells. J Clin Monit Comput 36, 259–270 (2022). https://doi.org/10.1007/s10877-020-00647-z

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