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Spinal Cord Monitoring During Scoliosis Surgery in Children with Spastic Cerebral Palsy: Is it Feasible and Safe Even with an Active Seizure Disorder?: PAPER #60

Shah, Suken A. MD; Wiggins, Cheryl R. AuD; Schwartz, Daniel M. PhD; Sestokas, Anthony K. PhD; Rogers, Kenneth J. PhD; Gabos, Peter G. MD; Dabney, Kirk W. MD; Miller, Freeman MD

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Spine Journal Meeting Abstracts: 2011 - Volume - Issue - p 85–85
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Summary: tceMEP monitoring was attempted in 138 consecutive patients; 63 (46%) had an active seizure disorder. There was no physical or EEG manifestation of seizure elicitation in any of the 138 children who received RTES for motor evoked potential monitoring, nor was there evidence of increased frequency of post‐operative seizures. Surgeon concerns that transcranial electric stimulation for tceMEP monitoring can elicit intraop seizures during correction of NMS in children with CP, with or without active seizure disorder, appears unsubstantiated and hence, should not preclude its routine use.

Introduction: Spinal cord monitoring in children with severe spastic quadriplegia (SSQ) and neuromuscular scoliosis (NMS) is both challenging and controversial. Is repetitive high voltage transcranial electric stimulation (RTES) for motor evoked potential monitoring contraindicated in the presence of active seizure disorder? This study sought to assess the safety and feasibility of RTES for MEP monitoring in patients with NMS due to CP.

Methods: The medical charts of 261 children with CP and SSQ who underwent correction of NMS from 2001‐2009 were analyzed. 158 (61%) showed sufficient purposeful lower extremity motor function to warrant neuromonitoring for preservation of residual spinal cord function. 74 (47%) of these had active seizure disorder, while the remaining 84 (53%) were seizure‐free.

Results: tceMEP monitoring was attempted in 138 (87%) patients; 63 (46%) had active seizure disorder. There was no physical or EEG manifestation of seizure elicitation in any of the 138 children who received RTES for MEP monitoring, nor was there evidence of increased frequency of post‐opseizures.

For the 63 children in the active seizure group, lower extremity tceMEPs were monitorable in 30/63 (48%). Parenthetically, SSEP monitoring was attempted in 60/63 of these same children and was successful in 31/60 (52%). For the seizure‐free group, lower extremity tceMEPs and SSEPs were each recorded successfully in 47/75 (63%) children.

Conclusion: Contrary to conventional opinion, RTES for eliciting MEP is not contraindicated in CP children with SSQ and NMS who present with active seizure disorder. This special population of NMS patients presents a unique challenge for reliable and valid spinal cord monitoring, even in the absence of seizure disorder. These results demonstrate that spinal cord monitoring with tceMEPs is both safe and feasible, and do not support the oft‐held opinion that it is contraindicated in children with active seizure disorder.

Significance: Surgeon concerns that repetitive transcranial electric stimulation for tceMEP monitoring can elicit intraoperative seizures during correction of NMS in children with SSQ, with or without active seizure disorder, appears unsubstantiated and hence, should not preclude its routine use.

© 2011 Lippincott Williams & Wilkins, Inc.