Magnetic stimulation as a diagnostic tool in cervical nerve root compression and compression-induced neuropathy

Original Surgical Treatment and Long-term Follow-up for Chronic Inflammatory Demyelinating Polyradiculoneuropathy Causing A Compressive Cervical Myelopathy

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic relapsing disease of unknown aetiology. The diagnosis of this disease is still very complicated. The treatment is medical but, in some cases, a surgical decompression might be required. In rare cases it develops a radicular hypertrophy that can cause a cervical myelopathy; this pathology should be put in differential diagnosis with neurofibromatosis 1 (NF-1) and Charcot Marie Tooth (CMT) syndromes. The cases of CIDP cervical myelopathy reported in the literature are rare and even more rarely a surgical decompression was described. Here we report a first and unique case of CIDP cervical myelopathy treated with an open-door laminoplasty technique with 10-years post-operative follow-up (FU). The surgical decompression revealed to be effective in stopping the progression of myelopathy without destabilizing the spine. The patient that before surgery presented a severe tetra-paresis could return to walk and gained back his self-care autonomy. At 10-years FU he didn't complain of neck pain and didn't develop a cervical kyphosis. In case of cervical myelopathy caused by radicular hypertrophy CIDP should be kept in mind in the differential diagnosis and an open-door laminoplasty is indicated to stop myelopathy progression.

Transcranial magnetic stimulation: normal values of magnetic motor evoked potentials in 84 normal horses and influence of height, weight, age and sex

REASONS FOR PERFORMING STUDY

Cervical spinal cord dysfunction is a common problem in equine medicine and the currently available tests give no objective information about the functionality of the nervous tracts. Therefore, transcranial magnetic stimulation (TMS) was performed in 84 healthy horses of different height in order to have an objective measure for the integrity of the descending motor tracts in normal horses.

OBJECTIVES

To obtain reference values for onset latency and peak-to-peak amplitude of magnetic motor evoked potentials (MMEPs) and to evaluate the possible effect of height, age and gender on the neurophysiological measures.

METHODS

All horses were sedated and stimulated transcranially by using a magnetic coil placed on the forehead. The stimulator triggered the sweep of an electromyogram machine that recorded MMEPs bilaterally from needle electrodes in the extensor carpi radialis and cranial tibial muscles. In that way, it was possible to measure latency between stimulus and onset of response.

RESULTS

A significant difference was found between recordings made in the fore- and hindlimbs; MMEPs recorded in the front legs had a shorter onset latency and higher peak-to-peak amplitude. Mean +/- s.d. normal values for onset latency of 19.32 +/- 2.50 and 30.54 +/- 5.28 msecs and peak-to-peak amplitude values of 9.54 +/- 3.73 and 6.62 +/- 3.62 mV were obtained for extensor carpi radialis and cranial tibial muscles, respectively. The left-to-right difference in onset latency and peak-to-peak amplitude was not significant. In the same horse, differences up to 0.82 and 1.53 msecs for the extensor carpi radialis and cranial tibial muscles, respectively, lie within the 95% confidence limit and are considered normal. In contrast to onset latency, peak-to-peak amplitude showed a very large intra- and interindividual variability, even in the same muscle. To reduce the variability and predict normal values of new individual cases, influence of height, weight, age and sex on the MMEPs were determined. No significant effects of sex were observed on onset latency and peak-to-peak amplitude. The age of the horse had only a small but significant effect on peak-to-peak amplitude, with larger responses in older horses. Height at the withers and weight of the horse, parameters that strongly correlate with the size of the horse, had an important significant influence on onset latency but not on peak-to-peak amplitude. The age of the horse and height at the withers were used to predict peak-to-peak amplitude and onset latency, respectively, in normal horses.

CONCLUSIONS AND POTENTIAL RELEVANCE

TMS is an excellent addition to the few tools we have for noninvasive imaging of the equine nervous system. Magnetically evoked potentials are highly reproducible and recent advances suggest that the applications of TMS in horses will continue to grow rapidly.