What is the role of somatosensory evoked potential (SSEP) studies in electrodiagnosis?

Answer

SSEP studies are the most widely used EP tests. Stimulation occurs at the extremity, and recordings are made on the scalp, near the sensory cortex. This technique may be used to locate the level of the injury in the nerve root, spinal cord, or brain. In CNS insults, such as spinal cord trauma and stroke, SSEP testing has been helpful in establishing the degree of insult and in determining its prognosis.

SSEPs can also be used to localize demyelinating diseases, such as multiple sclerosis, and root level injuries in cervical and lumbar radiculopathies.^[24]

A retrospective study by Devic et al indicated that SSEPs can aid in the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) when nerve conduction studies (NCSs) fail to reveal peripheral demyelination in patients with other signs of the disease. The study involved 26 patients with clinical signs of CIDP, with SSEPs in 22 of the patients (85%) demonstrating abnormal proximal conduction in sensory fibers; this included 16 of 20 patients (80%) who responded to immunotherapy, considered to be confirmation of CIDP.^[25]

In addition, SSEPs can be used to determine the level of coma and to evaluate for brain death.^[26]SSEPs are also useful for intraoperative monitoring of patients undergoing neurosurgical procedures.

In 2018, the International Society of Intraoperative Neurophysiology published recommendations regarding the intraoperative monitoring of SSEPs. These included the recommendation that propofol and opioid total intravenous anesthesia be used during surgery to avoid the dose-dependent suppression of polysynaptic cortical SSEPs found with inhalation anesthetics such as nitrous oxide and to facilitate a higher signal-to-noise ratio. The recommendations also specified the use of an adaptive warning criterion consisting of “visually obvious amplitude reduction from recent pre-change values” that clearly exceeds variability, “particularly when abrupt and focal.”^[27]

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Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am. 2013 Feb. 24(1):49-66. [Medline].
Joyce NC, Carter GT. Electrodiagnosis in persons with amyotrophic lateral sclerosis. PM R. 2013 May. 5(5 Suppl):S89-95. [Medline].
Nguyen BN, Vingrys AJ, McKendrick AM. The effect of duration post-migraine on visual electrophysiology and visual field performance in people with migraine. Cephalalgia. 2013 Aug 22. [Medline].
Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 2nd ed. Philadelphia, Pa: Davis; 1989.
Delagi EF, Perotto A. Anatomic Guide for the Electromyographer: The Limbs. 2nd ed. Springfield, Ill: Thomas; 1980.
Gonzales E, Myers SJ, et al, eds. Downey and Darling's Physiological Basis of Rehabilitation Medicine. 3rd ed. Boston, Mass: Butterworth-Heinemann; 2001.
Impastato DM, Impastato KA, Dabestani P, Ko JH, Bunnell AE. Prognostic value of needle electromyography in traumatic brachial plexus injury. Muscle Nerve. 2019 Nov. 60 (5):595-7. [Medline].
Lorin S, Nierman DM. Critical illness neuromuscular abnormalities. Crit Care Clin. 2002 Jul. 18(3):553-68. [Medline].
Gutmann L, Pawar GV. An approach to electrodiagnosis of peripheral neuropathies. Semin Neurol. 2005 Jun. 25(2):160-7. [Medline].
Smorto MP, Basmajian JV. Clinical Electroneurography: An Introduction to Nerve Conduction Tests. 2nd ed. Baltimore, Md: Williams & Wilkins; 1979.
Murashima H, Sonoo M, Tsukamoto H, et al. Spread to the dorsal ulnar cutaneous branch: A pitfall during the routine antidromic sensory nerve conduction study of the ulnar nerve. Clin Neurophysiol. 2011 Oct 14. [Medline].
Jarvik JG, Yuen E. Diagnosis of carpal tunnel syndrome: electrodiagnostic and magnetic resonance imaging evaluation. Neurosurg Clin N Am. 2001 Apr. 12(2):241-53. [Medline].
Alanazy MH. Clinical and electrophysiological evaluation of carpal tunnel syndrome: approach and pitfalls. Neurosciences (Riyadh). 2017 Jul. 22 (3):169-80. [Medline].
Li Pi Shan R, Nicolle M, Chan M, et al. Electrodiagnostic Testing and Treatment for Carpal Tunnel Syndrome in Canada. Can J Neurol Sci. 2016 Jan. 43 (1):178-82. [Medline].
Spinner M. Injuries to the Major Branches of Peripheral Nerves of the Forearm. Philadelphia, Pa: WB Saunders; 1978.
Goodgold J, Kopell HP, Spielholz NI. The tarsal-tunnel syndrome. Objective diagnostic criteria. N Engl J Med. 1965 Sep 30. 273(14):742-5. [Medline].
Ross MA. Electrodiagnosis of peripheral neuropathy. Neurol Clin. 2012 May. 30(2):529-49. [Medline].
Park JH, Won JC. Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold. Diabetes Metab J. 2018 Oct 24. [Medline]. [Full Text].
Omejec G, Podnar S. Proposal for electrodiagnostic evaluation of patients with suspected ulnar neuropathy at the elbow. Clin Neurophysiol. 2016 Apr. 127 (4):1961-7. [Medline].
Zanette G, Lauriola MF, Tamburin S. Electrodiagnosis of Lesions of Median and Ulnar Nerve Hand Sensory Branches: A Case Series. J Clin Neurophysiol. 2016 Oct. 33 (5):454-7. [Medline].
Fowler JR, Byrne K, Pan T, Goitz RJ. False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome. J Hand Surg Am. 2019 Mar. 44 (3):181-5. [Medline].
Chiappa KH, ed. Evoked Potentials in Clinical Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1997.
Pitzalis S, Spinelli D, Vallar G, Di Russo F. Transcutaneous electrical nerve stimulation effects on neglect: a visual-evoked potential study. Front Hum Neurosci. 2013 Aug 19. 7:111. [Medline].
Kim CT, Strommen JA, Johns JS, et al. Neuromuscular rehabilitation and electrodiagnosis. 4. Pediatric issues. Arch Phys Med Rehabil. Mar 2005. 86(3 Suppl 1):S28-32. [Medline].
Devic P, Petiot P, Mauguiere F. Diagnostic utility of somatosensory evoked potentials in chronic polyradiculopathy without electrodiagnostic signs of peripheral demyelination. Muscle Nerve. 2015 Apr 23. [Medline].
Amantini A, Amadori A, Fossi S. Evoked potentials in the ICU. Eur J Anaesthesiol Suppl. 2008. 42:196-202. [Medline].
[Guideline] MacDonald DB, Dong C, Quatrale R, et al. Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials. Clin Neurophysiol. 2019 Jan. 130 (1):161-79. [Medline]. [Full Text].
Holder GE, Gale RP, Acheson JF, et al. Electrodiagnostic assessment in optic nerve disease. Curr Opin Neurol. 2009 Feb. 22(1):3-10. [Medline].
Lieberman JA, Lyon R, Feiner J, et al. The efficacy of motor evoked potentials in fixed sagittal imbalance deformity correction surgery. Spine. Jun 1 2008. 33(13):E414-24. [Medline].
Cheh G, Lenke LG, Padberg AM, et al. Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do?. Spine. May 1 2008. 33(10):1093-9. [Medline].
Kelleher MO, Tan G, Sarjeant R, et al. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine. Mar 2008. 8(3):215-21. [Medline].
Kim DH, Zaremski J, Kwon B, et al. Risk factors for false positive transcranial motor evoked potential monitoring alerts during surgical treatment of cervical myelopathy. Spine. 2007 Dec 15. 32(26):3041-6. [Medline].
Rosenberg J. Spinal cord monitoring. Morris PJ, Wood WC, eds. Oxford Textbook of Surgery. 2nd ed. New York, NY: Oxford University Press; 2000. 3133.
Matsuoka R, Takeshima Y, Hayashi H, et al. Feasibility of adjunct facial motor evoked potential monitoring to reduce the number of false-positive results during cervical spine surgery. J Neurosurg Spine. 2019 Dec 13. 1-8. [Medline].

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Sensory nerve action potential.
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Adam B Agranoff, MD Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital

Adam B Agranoff, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Elizabeth A Moberg-Wolff, MD Associate Professor and Pediatric PM&R Fellowship Director, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin; Program Director, Tone Management and Mobility, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Medtronic Neurological Grant/research funds Speaking and teaching

Jerrold N Rosenberg, MD Director of Rehabilitation Services, Providence Veterans Hospital; Clinical Assistant Professor, Departments of Orthopedics and Rehabilitation, Rhode Island Hospital, Brown University

Jerrold N Rosenberg, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Congress of Rehabilitation Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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