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Transcranial electric motor evoked potential monitoring during scoliosis surgery in children with cerebral palsy and active seizure disorder: is it feasible and safe?

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Abstract

Purpose

Use of spinal cord monitoring in children with cerebral palsy (CP) and neuromuscular scoliosis is challenging. The previous reports suggest low success rates in the setting of CP, and it is unclear if transcranial electric motor evoked potentials (TcMEP) monitoring is contraindicated in patients with an active seizure disorder. The purpose of this study was to determine (1) are patients with CP able to be appropriately monitored with TcMEP? and (2) does TcMEP cause an increase in seizure activity?

Methods

This was an institutional review board-approved retrospective cohort study observing 304 patients from 2011 to 2020. Inclusion criteria included all patients with CP undergoing posterior spinal fusion during this time. Intraoperative data were examined for the ability to obtain monitoring and any intraoperative events. Patients were followed for 3 months postoperatively to determine any increase in seizure activity that could have been attributed to the TcMEP monitoring.

Results

Of the 304 patients who were observed, 21% (20.8%) were unable to be monitored due to lacking baseline signals from the extremities. Seventy-seven percent (77.5%) were successfully monitored with TcMEP. For these patients, no increased seizure activity was documented either intra- or postoperatively.

Conclusion

A high percentage of children (77.5%) with CP were able to be successfully monitored with TcMEP during posterior spinal fusion. Furthermore, the concerns about increased seizure activity after TcMEP were not supported by the data from this cohort. Technical details of successful neuromonitoring in these patients are important and included increased stimulation voltage requirements and latency times.

Level of evidence

III retrospective comparative study.

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Availability of data and material

Data are available upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to acknowledge the contributions of Ali Fuat Karatas and Brian Burke.

Funding

The authors received no external financial support for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedics, Nemours Children’s Health, 1600 Rockland Road, Wilmington, DE, 19803, USA

    M. Wade Shrader, Ran Zhang, Mary C. Theroux, Kenneth J. Rogers & Suken A. Shah

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Sabina DiCindio

  3. University of South Carolina, Columbia, SC, USA

    Katherine G. Kenny

  4. Greater Delaware Valley Specialty Care, Philadelphia, PA, USA

    Alier J. Franco

Authors
  1. M. Wade Shrader
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  2. Sabina DiCindio
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  3. Katherine G. Kenny
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  4. Alier J. Franco
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  5. Ran Zhang
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  6. Mary C. Theroux
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  7. Kenneth J. Rogers
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  8. Suken A. Shah
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Contributions

Conception or design of the work: MWS, SD, KGK, AJF, MCT, KJR, SAS. Acquisition, analysis, or interpretation of data for the work: MWS, SD, KGK, AJF, RZ, KJR, SAS. Drafting the work: MWS, SD, KGK, KJR. Revising the work critically for important intellectual content: MWS, SD, KGK, AJF, RZ, MCT, KJR, SAS. Final approval of the version to be published: MWS, SD, KGK, AJF, RZ, MCT, KJR, SAS. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MWS, SD, KGK, AJF, RZ, MCT, KJR, SAS.

Corresponding author

Correspondence to M. Wade Shrader.

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All authors have no relevant financial or non-financial interests to disclose.

Ethics approval

Approval was obtained from the Nemours Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Shrader, M.W., DiCindio, S., Kenny, K.G. et al. Transcranial electric motor evoked potential monitoring during scoliosis surgery in children with cerebral palsy and active seizure disorder: is it feasible and safe?. Spine Deform 11, 1461–1466 (2023). https://doi.org/10.1007/s43390-023-00730-w

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