Maximilian Schwendner , Marianne Kanaris , Anthony M. DiGiorgio , Michael C. Huang , Geoffrey T. Manley , Phiroz E. Tarapore
{"title":"导航经颅磁刺激对评估急性创伤性脊髓损伤患者运动功能的诊断和预后价值","authors":"Maximilian Schwendner , Marianne Kanaris , Anthony M. DiGiorgio , Michael C. Huang , Geoffrey T. Manley , Phiroz E. Tarapore","doi":"10.1016/j.bas.2025.104229","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic spinal cord injuries (SCI) represent a profoundly life-altering diagnosis.</div></div><div><h3>Research question</h3><div>The aim of this study was to evaluate the diagnostic and prognostic value of navigated transcranial magnetic stimulation (nTMS) in assessing motor function in the management of patients with acute SCI.</div></div><div><h3>Material and methods</h3><div>nTMS motor mapping of both upper extremities (UE) and lower extremities (LE) was performed in patients suffering from acute traumatic SCI. Data from intraoperative neuromonitoring (IONM) and patient outcomes, including American Spinal Injury Association Impairment Scale (AISA) scores, were analyzed.</div></div><div><h3>Results</h3><div>The patients had a mean age of 68.9 ± 15.6 years (range: 28–94 years). Preoperatively, 7 patients (35.0%) were classified as AISA A or B, and 13 (65.0%) were classified as AISA C or D. At follow-up, 5 patients (25.0%) had improved.</div><div>In all patients motor evoked potentials (MEPs) were elicited. MEPs of UE muscles were observed in 38 (61.3%) muscles in IONM and 41 (66.1%) muscles in TMS. MEPs of LE muscles were observed in 5 (19.2%) and 7 (26.9%) muscles, respectively. e</div><div>Combining the results of IONM and nTMS, a sensitivity of 0.852 and a specificity of 0.889 for motor function of the tested muscle at follow-up was achieved for upper extremity muscles. For lower extremity muscles, a sensitivity of 0.571 and a specificity of 1.00 was achieved.</div></div><div><h3>Discussion and conclusion</h3><div>nTMS in patients with acute SCI provides an objective assessment of motor system integrity. Despite a relatively low sensitivity, potentially due to decreased excitability, this technique exhibited excellent specificity in predicting short-term and long-term motor outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104229"},"PeriodicalIF":1.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic and prognostic value of navigated transcranial magnetic stimulation to assess motor function in patients with acute traumatic spinal cord injury\",\"authors\":\"Maximilian Schwendner , Marianne Kanaris , Anthony M. DiGiorgio , Michael C. Huang , Geoffrey T. Manley , Phiroz E. Tarapore\",\"doi\":\"10.1016/j.bas.2025.104229\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Traumatic spinal cord injuries (SCI) represent a profoundly life-altering diagnosis.</div></div><div><h3>Research question</h3><div>The aim of this study was to evaluate the diagnostic and prognostic value of navigated transcranial magnetic stimulation (nTMS) in assessing motor function in the management of patients with acute SCI.</div></div><div><h3>Material and methods</h3><div>nTMS motor mapping of both upper extremities (UE) and lower extremities (LE) was performed in patients suffering from acute traumatic SCI. Data from intraoperative neuromonitoring (IONM) and patient outcomes, including American Spinal Injury Association Impairment Scale (AISA) scores, were analyzed.</div></div><div><h3>Results</h3><div>The patients had a mean age of 68.9 ± 15.6 years (range: 28–94 years). Preoperatively, 7 patients (35.0%) were classified as AISA A or B, and 13 (65.0%) were classified as AISA C or D. At follow-up, 5 patients (25.0%) had improved.</div><div>In all patients motor evoked potentials (MEPs) were elicited. MEPs of UE muscles were observed in 38 (61.3%) muscles in IONM and 41 (66.1%) muscles in TMS. MEPs of LE muscles were observed in 5 (19.2%) and 7 (26.9%) muscles, respectively. e</div><div>Combining the results of IONM and nTMS, a sensitivity of 0.852 and a specificity of 0.889 for motor function of the tested muscle at follow-up was achieved for upper extremity muscles. For lower extremity muscles, a sensitivity of 0.571 and a specificity of 1.00 was achieved.</div></div><div><h3>Discussion and conclusion</h3><div>nTMS in patients with acute SCI provides an objective assessment of motor system integrity. Despite a relatively low sensitivity, potentially due to decreased excitability, this technique exhibited excellent specificity in predicting short-term and long-term motor outcomes.</div></div>\",\"PeriodicalId\":72443,\"journal\":{\"name\":\"Brain & spine\",\"volume\":\"5 \",\"pages\":\"Article 104229\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brain & spine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772529425000487\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brain & spine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772529425000487","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Diagnostic and prognostic value of navigated transcranial magnetic stimulation to assess motor function in patients with acute traumatic spinal cord injury
Introduction
Traumatic spinal cord injuries (SCI) represent a profoundly life-altering diagnosis.
Research question
The aim of this study was to evaluate the diagnostic and prognostic value of navigated transcranial magnetic stimulation (nTMS) in assessing motor function in the management of patients with acute SCI.
Material and methods
nTMS motor mapping of both upper extremities (UE) and lower extremities (LE) was performed in patients suffering from acute traumatic SCI. Data from intraoperative neuromonitoring (IONM) and patient outcomes, including American Spinal Injury Association Impairment Scale (AISA) scores, were analyzed.
Results
The patients had a mean age of 68.9 ± 15.6 years (range: 28–94 years). Preoperatively, 7 patients (35.0%) were classified as AISA A or B, and 13 (65.0%) were classified as AISA C or D. At follow-up, 5 patients (25.0%) had improved.
In all patients motor evoked potentials (MEPs) were elicited. MEPs of UE muscles were observed in 38 (61.3%) muscles in IONM and 41 (66.1%) muscles in TMS. MEPs of LE muscles were observed in 5 (19.2%) and 7 (26.9%) muscles, respectively. e
Combining the results of IONM and nTMS, a sensitivity of 0.852 and a specificity of 0.889 for motor function of the tested muscle at follow-up was achieved for upper extremity muscles. For lower extremity muscles, a sensitivity of 0.571 and a specificity of 1.00 was achieved.
Discussion and conclusion
nTMS in patients with acute SCI provides an objective assessment of motor system integrity. Despite a relatively low sensitivity, potentially due to decreased excitability, this technique exhibited excellent specificity in predicting short-term and long-term motor outcomes.
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