Matthew Stevenson, Kelly Baylor, Brett L Netherton, Mark M Stecker
Electrical stimulation can cause significant damage to clinical electrodes as well as patient injury. In this study, the effects of stimulation on pure metal electrodes were investigated without the complexities introduced by the multiple elements that make up the clinical electrode. As with the clinical electrodes, there was significant decomposition of pure stainless steel anodes with no associated significant changes in the cathodes when stimulation employed long pulse durations. Effects of stimulation were greater when the anode and cathode were closer under constant voltage stimulation but were distance independent under constant current stimulation. High ionic content of the solution also increased the degree of damage to the anode as did the presence of chloride in the solution. Electrode composition also influenced the amount damage to the anode. Platinum and platinum-iridium electrodes showed no damage with any stimulus while stainless steel showed the lowest resistance to corrosion for direct current (DC) stimulation. Tungsten electrodes behaved very differently than stainless steel, decomposing with pulse stimulation and resisting decomposition during DC stimulation because of the formation of surface protective layers. Because platinum was able to maintain high levels of current over time, prolonged stimulation produced dramatic increases in the temperature of the solution; however, even short periods of stimulation were sufficient to produce dramatic changes in pH in the neighborhood of the electrode.
{"title":"Electrical stimulation and electrode properties. Part 2: pure metal electrodes.","authors":"Matthew Stevenson, Kelly Baylor, Brett L Netherton, Mark M Stecker","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Electrical stimulation can cause significant damage to clinical electrodes as well as patient injury. In this study, the effects of stimulation on pure metal electrodes were investigated without the complexities introduced by the multiple elements that make up the clinical electrode. As with the clinical electrodes, there was significant decomposition of pure stainless steel anodes with no associated significant changes in the cathodes when stimulation employed long pulse durations. Effects of stimulation were greater when the anode and cathode were closer under constant voltage stimulation but were distance independent under constant current stimulation. High ionic content of the solution also increased the degree of damage to the anode as did the presence of chloride in the solution. Electrode composition also influenced the amount damage to the anode. Platinum and platinum-iridium electrodes showed no damage with any stimulus while stainless steel showed the lowest resistance to corrosion for direct current (DC) stimulation. Tungsten electrodes behaved very differently than stainless steel, decomposing with pulse stimulation and resisting decomposition during DC stimulation because of the formation of surface protective layers. Because platinum was able to maintain high levels of current over time, prolonged stimulation produced dramatic increases in the temperature of the solution; however, even short periods of stimulation were sufficient to produce dramatic changes in pH in the neighborhood of the electrode.</p>","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"50 4","pages":"263-96"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29666497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia A Lordeon, Bilal Sitwat, Donna Brehm, Deborah Holder
Dravet Syndrome (DS), also known as Severe Myoclonic Epilepsy in Infancy (SMEI) is a rare, primarily genetic disorder which develops in infancy. The characteristics of DS are frequent, prolonged, primarily generalized seizures which occur initially with fever and eventually evolve to multiple afebrile seizure types such as myoclonic, atypical absence, and complex partial seizures. Patients, who are initially developmentally normal, will experience concomitant developmental regression as the syndrome progresses. Because it is a childhood disorder, DS is not well known outside the realm of pediatrics. An astute EEG technologist should be able to recognize key factors both clinically and electrographically which point suspicion to the diagnosis of Dravet Syndrome.
{"title":"Dravet syndrome: a technologist's perspective.","authors":"Patricia A Lordeon, Bilal Sitwat, Donna Brehm, Deborah Holder","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dravet Syndrome (DS), also known as Severe Myoclonic Epilepsy in Infancy (SMEI) is a rare, primarily genetic disorder which develops in infancy. The characteristics of DS are frequent, prolonged, primarily generalized seizures which occur initially with fever and eventually evolve to multiple afebrile seizure types such as myoclonic, atypical absence, and complex partial seizures. Patients, who are initially developmentally normal, will experience concomitant developmental regression as the syndrome progresses. Because it is a childhood disorder, DS is not well known outside the realm of pediatrics. An astute EEG technologist should be able to recognize key factors both clinically and electrographically which point suspicion to the diagnosis of Dravet Syndrome.</p>","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"50 4","pages":"297-312"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29666498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-12-01DOI: 10.1080/1086508X.2010.11079786
F. Jahangiri, Andrea Holmberg, J. Sherman, R. Louis, J. Elias, F. Vega–Bermudez
ABSTRACT. A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe “burning” in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3–L4 and L4–L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 μsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1–L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF, thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain.
{"title":"Protecting the Genitofemoral Nerve during Direct/Extreme Lateral Interbody Fusion (DLIF/XLIF) Procedures","authors":"F. Jahangiri, Andrea Holmberg, J. Sherman, R. Louis, J. Elias, F. Vega–Bermudez","doi":"10.1080/1086508X.2010.11079786","DOIUrl":"https://doi.org/10.1080/1086508X.2010.11079786","url":null,"abstract":"ABSTRACT. A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe “burning” in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3–L4 and L4–L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 μsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1–L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF, thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"15 1","pages":"321 - 335"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89987165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-12-01DOI: 10.1080/1086508X.2010.11079784
P. Lordeon, Bilal Sitwat, D. Holder, D. Brehm
ABSTRACT. Dravet Syndrome (DS), also known as Severe Myoclonic Epilepsy in Infancy (SMEI) is a rare, primarily genetic disorder which develops in infancy. The characteristics of DS are frequent, prolonged, primarily generalized seizures which occur initially with fever, and eventually evolve to multiple afebrile seizure types such as myoclonic, atypical absence, and complex partial seizures. Patients, who are initially developmentally normal, will experience concomitant developmental regression as the syndrome progresses. Because it is a childhood disorder, DS is not well known outside the realm of pediatrics. An astute EEG technologist should be able to recognize key factors both clinically and electrographically which point suspicion to the diagnosis of Dravet Syndrome.
{"title":"Dravet Syndrome: A Technologist's Perspective","authors":"P. Lordeon, Bilal Sitwat, D. Holder, D. Brehm","doi":"10.1080/1086508X.2010.11079784","DOIUrl":"https://doi.org/10.1080/1086508X.2010.11079784","url":null,"abstract":"ABSTRACT. Dravet Syndrome (DS), also known as Severe Myoclonic Epilepsy in Infancy (SMEI) is a rare, primarily genetic disorder which develops in infancy. The characteristics of DS are frequent, prolonged, primarily generalized seizures which occur initially with fever, and eventually evolve to multiple afebrile seizure types such as myoclonic, atypical absence, and complex partial seizures. Patients, who are initially developmentally normal, will experience concomitant developmental regression as the syndrome progresses. Because it is a childhood disorder, DS is not well known outside the realm of pediatrics. An astute EEG technologist should be able to recognize key factors both clinically and electrographically which point suspicion to the diagnosis of Dravet Syndrome.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"11 1","pages":"297 - 312"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86487618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcranial electric motor evoked potentials (TCeMEPs) are routinely used intraoperatively to detect and prevent iatrogenic injury to the spinal cord, specifically the corticospinal tract. Complications related to TCeMEP testing include the potential for seizure induction, cardiac arrhythmia, scalp burns, infection, and tongue or lip laceration. Among this list of potential complications, tongue and lip lacerations are the most common and most directly attributable to transcranial stimulation. The technique of low voltage stimulation and the correct placement of oral bite blocks is successful in preventing patient bite injuries. We report two cases of patient bite injuries following TCeMEPs and discuss potential mechanisms of injury and prevention.
{"title":"A report of two cases of lip and tongue bite injury associated with transcranial motor evoked potentials.","authors":"Scott F Davis, Philip Kalarickal, Ted Strickland","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transcranial electric motor evoked potentials (TCeMEPs) are routinely used intraoperatively to detect and prevent iatrogenic injury to the spinal cord, specifically the corticospinal tract. Complications related to TCeMEP testing include the potential for seizure induction, cardiac arrhythmia, scalp burns, infection, and tongue or lip laceration. Among this list of potential complications, tongue and lip lacerations are the most common and most directly attributable to transcranial stimulation. The technique of low voltage stimulation and the correct placement of oral bite blocks is successful in preventing patient bite injuries. We report two cases of patient bite injuries following TCeMEPs and discuss potential mechanisms of injury and prevention.</p>","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"50 4","pages":"313-20"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29666499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-12-01DOI: 10.1080/1086508X.2010.11079783
M. Stevenson, K. Baylor, M. Stecker, B. Netherton
ABSTRACT. Electrical stimulation can cause significant damage to clinical electrodes as well as patient injury. In this study, the effects of stimulation on pure metal electrodes were investigated without the complexities introduced by the multiple elements that make up the clinical electrode. As with the clinical electrodes, there was significant decomposition of pure stainless steel anodes with no associated significant changes in the cathodes when stimulation employed long pulse durations. Effects of stimulation were greater when the anode and cathode were closer under constant voltage stimulation but were distance independent under constant current stimulation. High ionic content of the solution also increased the degree of damage to the anode as did the presence of chloride in the solution. Electrode composition also influenced the amount damage to the anode. Platinum and platinum-iridium electrodes showed no damage with any stimulus while stainless steel showed the lowest resistance to corrosion for direct current (DC) stimulation. Tungsten electrodes behaved very differently than stainless steel, decomposing with pulse stimulation and resisting decomposition during DC stimulation because of the formation of surface protective layers. Because platinum was able to maintain high levels of current over time, prolonged stimulation produced dramatic increases in the temperature of the solution; however, even short periods of stimulation were sufficient to produce dramatic changes in pH in the neighborhood of the electrode.
{"title":"Electrical Stimulation and Electrode Properties. Part 2: Pure Metal Electrodes","authors":"M. Stevenson, K. Baylor, M. Stecker, B. Netherton","doi":"10.1080/1086508X.2010.11079783","DOIUrl":"https://doi.org/10.1080/1086508X.2010.11079783","url":null,"abstract":"ABSTRACT. Electrical stimulation can cause significant damage to clinical electrodes as well as patient injury. In this study, the effects of stimulation on pure metal electrodes were investigated without the complexities introduced by the multiple elements that make up the clinical electrode. As with the clinical electrodes, there was significant decomposition of pure stainless steel anodes with no associated significant changes in the cathodes when stimulation employed long pulse durations. Effects of stimulation were greater when the anode and cathode were closer under constant voltage stimulation but were distance independent under constant current stimulation. High ionic content of the solution also increased the degree of damage to the anode as did the presence of chloride in the solution. Electrode composition also influenced the amount damage to the anode. Platinum and platinum-iridium electrodes showed no damage with any stimulus while stainless steel showed the lowest resistance to corrosion for direct current (DC) stimulation. Tungsten electrodes behaved very differently than stainless steel, decomposing with pulse stimulation and resisting decomposition during DC stimulation because of the formation of surface protective layers. Because platinum was able to maintain high levels of current over time, prolonged stimulation produced dramatic increases in the temperature of the solution; however, even short periods of stimulation were sufficient to produce dramatic changes in pH in the neighborhood of the electrode.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"35 1","pages":"263 - 296"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90620855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-12-01DOI: 10.1080/1086508X.2010.11079787
L. Kull, Ryan R. Lau, Leisha L. Osburn
Dr. Ritaccio is currently involved in research to connect the human brain to a computer using surface or indwelling electrodes. By interfacing the mind with a computer, it is possible for the brain to control devices, even as complicated as the controls of an airplane, allowing thoughts alone to complete tasks. Dr. Ritaccio is working on a computer program that monitors the brain for gamma frequency EEG which can be used to map cortical functions in an entirely new way. Applications of this technology range from medical and military use to virtual gaming devices.
{"title":"American Society of Electroneurodiagnostic Technologists 51st Annual Conference Proceedings","authors":"L. Kull, Ryan R. Lau, Leisha L. Osburn","doi":"10.1080/1086508X.2010.11079787","DOIUrl":"https://doi.org/10.1080/1086508X.2010.11079787","url":null,"abstract":"Dr. Ritaccio is currently involved in research to connect the human brain to a computer using surface or indwelling electrodes. By interfacing the mind with a computer, it is possible for the brain to control devices, even as complicated as the controls of an airplane, allowing thoughts alone to complete tasks. Dr. Ritaccio is working on a computer program that monitors the brain for gamma frequency EEG which can be used to map cortical functions in an entirely new way. Applications of this technology range from medical and military use to virtual gaming devices.","PeriodicalId":7480,"journal":{"name":"American Journal of Electroneurodiagnostic Technology","volume":"2 1","pages":"336 - 350"},"PeriodicalIF":0.0,"publicationDate":"2010-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75103268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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