Current practice of motor evoked potential monitoring: Results of a survey

Centers responding to a survey of MEP monitoring practices predominantly used transcranial electrical brain stimulation (TCES) with brief pulse trains and/or spinal cord stimulation (SCS) to elicit MEPs; transcranial magnetic stimulation and single-pulse TCES were not techniques of choice. Most centers using TCES had patient exclusion criteria (e.g., cochlear implants, cardiac pacemakers, prior craniotomy or skull fracture, history of seizures). Adverse effects included rare tongue injuries or seizures from TCES, and minor bleeding from needle electrodes in muscle. Spinal cord, peripheral nerve, and muscle recording sites were all employed. TCES with recording of muscle responses was the preferred MEP monitoring technique at the plurality of the centers. MEPs suitable for monitoring were obtained in about 91.6% of patients overall. Most of the failures were attributed to technical factors; preexisting neurologic dysfunction precluded MEP monitoring in approximately 1.7% of patients. Almost all centers monitored SEPs concurrently with MEPs. Overall, both measures remained stable during about 90.2% of cases. Adverse MEP changes occurred in about 8.3%; a little over half of these were accompanied by SEP changes. Adverse SEP changes without MEP changes occurred in about 1.5% of cases. SEPs and MEPs should be used together to optimally monitor the spinal cord.