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Background: Seizure disorders have been identified in patients suffering from different types of dementia. However, the risks associated with the seizure subtypes have not been characterized., Objective: To compare the occurrence and risk of various seizure subtypes (focal and generalized) between patients with and without a dementia diagnosis., Methods: Data from 40.7 million private insured patient individual electronic health records from the U.S., were utilized. Patients 60 years of age or more from the Optum Insight Clinformatics-data Mart database were included in this study. Using ICD-9 diagnoses, the occurrence of generalized or focal seizure disorders was identified. The risk of new-onset seizures and the types of seizures associated with a dementia diagnosis were estimated in a cohort of 2,885,336 patients followed from 2005 to 2014. Group differences were analyzed using continuity-adjusted chi-square and hazard ratios with 95%confidence intervals calculated after a logistic regression analysisResults:A total of 79,561 patient records had a dementia diagnosis, and 56.38%of them were females. Patients with dementia when compared to those without dementia had higher risk for seizure disorders [Hazard ratio (HR) = 6.5 95%CI = 4.4-9.5]; grand mal status (HR = 6.5, 95%CI = 5.7-7.3); focal seizures (HR = 6.0, 95%CI = 5.5-6.6); motor simple focal status (HR = 5.6, 95%CI = 3.5-9.0); epilepsy (HR = 5.0, 95%CI = 4.8-5.2); generalized convulsive epilepsy (HR = 4.8, 95%CI = 4.5-5.0); localization-related epilepsy (HR = 4.5, 95%CI = 4.1-4.9); focal status (HR = 4.2, 95%CI = 2.9-6.1); and fits convulsions (HR = 3.5, 95%CI = 3.4-3.6)., Conclusion: The study confirms that patients with dementia have higher risks of generalized or focal seizure than patients without dementia.

Introduction: M Scan-Fit, an automated method for motor unit number estimation (MUNE), was assessed in muscles innervated by the facial nerve., Methods: Healthy volunteers were recruited. M Scans were recorded twice from nasalis and depressor anguli oris (DAO) muscles, and then fitted to a probabilistic model., Results: Twenty-one subjects were evaluated; 38% were females and 62% were males, with a mean age of 34.71 years. The average number of MUs was 38.57 on both testing occasions (t ≤ 0.0001; P = 1.0) for the nasalis. For the DAO, results were 20.62 MUs for the first and 23.48 for the second (t = -2.12; P = .04). Pearson's interrater correlation coefficients were 0.96 (P < .0001) for nasalis and 0.87 (P ≤ .01) for DAO. Intraclass correlation coefficients were 0.88 (P ≤ .01) for nasalis and 0.39 (P = .37) for DAO., Discussion: M Scan-Fit MUNE is an automated, accurate, reliable method of estimating MU number and size from facial muscles., (© 2020 Wiley Periodicals LLC.)

Purulent infectious myositis (PIM), formerly known as tropical pyomyositis, is a pyogenic infection of skeletal muscles. Staphylococcus aureus, a normal human skin inhabitant, is the main pathogen involved, but multiple other microorganisms have been implicated. Although usually a progressive febrile disease with pain in the affected muscle(s), severe, life-threatening forms have been described, especially in immunosuppressed patients and children. PIM may elude early diagnosis given the lack of overlying skin changes. Hence, high index of suspicion followed by imaging modalities (ultrasonography when superficial and computed tomography or magnetic resonance imaging with contrast when deep) help confirm the diagnosis. Treatment requires combination of percutaneous or open surgical drainage along with antimicrobial therapy guided by culture results. The rising incidence of cases due to methicillin-resistant Staphylococcus aureus (MRSA) strains, makes the inclusion of vancomycin be recommended. This paper reviews PIM highlighting its global distribution, causative agents, predisposing factors, management, and potential complications., Competing Interests: Declaration of competing interest The authors declare having no conflict of interest in the elaboration or with the publication of this review., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To establish appropriate reference values of upper extremity nerve conduction studies (NCS) at the Del Valle University Hospital, from Colombia., Methods: Two hundred and twenty-two (N = 222) healthy volunteers were recruited. Latencies, amplitudes and conduction velocities from the Median, Ulnar, and Radial nerves were performed following recommendations from Buschbacher and Prahlow. Then, according to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) task force for reference value establishment, analyses of variance were run where each electrophysiological parameter from every nerve tested was used as dependent variable, to define which characteristics have to be kept for the model. Percentiles 3 and 97 from each of the parameters were derived. Finally, a multivariate quantile regression analysis model was tested., Results: Sensory percentiles were 2.8-3.5 ms, 18.9-120.8 μV, and 40.0-50.0 m/s for the Median, 2.1-2.9 ms, 10.4-106.9 μV, and 41.0-58.0 m/s for the Ulnar, while 2.6-3.5 ms, 11.3-69.9 μV, and 39.0-54.0 m/s for the Radial nerve. The same parameters for motor function were 2.8-3.9 ms, 4.6-15.0 mV, and 49.0-68.0 m/s for the Median, while 2.3-3.5 ms, 3.9-11.5 mV and 51.0-70 m/s for the Ulnar nerve., Conclusions: Values of latency, amplitude, and conduction velocity of sensory and motor functions from upper extremity nerves among Colombians are similar to equal parameters, obtained by comparable studies of populations alike., Significance: This is the first study to establish reference values for upper extremity NCS carried out following the AANEM recommendations in a South American population., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology.)

Background: Somatosensory evoked potential (SSEP) monitoring is used extensively for early detection and prevention of neurological complications in patients undergoing many different neurosurgical procedures. However, the predictive ability of SSEP monitoring during endovascular treatment of cerebral aneurysms is not well detailed., Objective: To evaluate the performance of intraoperative SSEP in the prediction postprocedural neurological deficits (PPNDs) after coil embolization of intracranial aneurysms., Methods: This population-based cohort study included patients ≥18 years of age undergoing intracranial aneurysm embolization with concurrent SSEP monitoring between January 2006 and August 2012. The ability of SSEP to predict PPNDs was analyzed by multiple regression analyses and assessed by the area under the receiver operating characteristic curve., Results: In a population of 888 patients, SSEP changes occurred in 8.6% (n = 77). Twenty-eight patients (3.1%) suffered PPNDs. A 50% to 99% loss in SSEP waveform was associated with a 20-fold increase in risk of PPND; a total loss of SSEP waveform, regardless of permanence, was associated with a greater than 200-fold risk of PPND. SSEPs displayed very good predictive ability for PPND, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.92)., Conclusion: This study supports the predictive ability of SSEPs for the detection of PPNDs. The magnitude and persistence of SSEP changes is clearly associated with the development of PPNDs. The utility of SSEP monitoring in detecting ischemia may provide an opportunity for neurointerventionalists to respond to changes intraoperatively to mitigate the potential for PPNDs., (Copyright © 2017 by the Congress of Neurological Surgeons)

Study Design: This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict postoperative neurological deficits after posterior cervical fusions (PCF). Eight hundred forty six eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012., Objective: To assess the specificity and sensitivity of intraoperative monitoring in predicting postoperative neurological deficits during PCF., Summary of Background Data: We calculated the predictive value, including sensitivity and specificity, of changes in SSEPs to identify neurological deficits postoperatively. We used a receiver operating characteristic (ROC) curve with SSEP categories as cutoff values to further evaluate the diagnostic accuracy of change in SSEPs and postoperative neurological deficit., Methods: All patients had preposition baselines and continuous SSEP monitoring throughout the surgery. Statistical analysis was completed using SPSS version 22 (IBM Corp., Armonk, NY)., Results: Age and sex did not influence outcomes. Obesity affected patient outcome. The SSEP categories of significant changes and loss of responses resulted in a sensitivity/specificity of 0.30/0.96 and 0.16/0.98, respectively. The receiver operating characteristic curve has an area under the curve for significant change in/loss of SSEPs of 0.62/0.65 with a 95% confidence interval of 0.525 to 0.714/0.509 to 0.797., Conclusion: Significant SSEP changes during PCF are a very specific but poorly sensitive indicator of postoperative neurological deficits. The odds ratio for significant changes in SSEPs and loss of waveforms was 9.80 and 11.82, respectively, with a 95% confidence interval of 4.695 to 20.46 and 4.45 to 31.41, respectively., Level of Evidence: 1.

Background  Microvascular decompression (MVD) utilizes brainstem auditory evoked potential (BAEP) intraoperative monitoring to reduce the risk of iatrogenic hearing loss. Studies report varying efficacy and hearing loss rates during MVD with intraoperative monitoring. Objectives  This study aims to perform a comprehensive review and study of diagnostic accuracy of BAEPs during MVD to predict hearing loss in studies published from January 1984 to December 2013. Methods  The PubMed/MEDLINE and World Science databases were searched. Studies performed MVD for trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia or geniculate neuralgia and monitored intraoperative BAEPs to prevent hearing loss. Retrospectively, BAEP parameters were compared with postoperative hearing. The diagnostic accuracy of significant change in BAEPs, which includes loss of response, was tested using summary receiver operative curve and diagnostic odds ratio (DOR). Results  A total of 13 studies were included in the analysis with a total of 2,540 cases. Loss of response pooled sensitivity, specificity, and DOR with 95% confidence interval being 74% (60-84%), 98% (88-100%), and 69.3 (18.2-263%), respectively. The similar significant change results were 88% (77-94%), 63% (40-81%), and 9.1 (3.9-21.6%). Conclusion  Patients with hearing loss after MVD are more likely to have shown loss of BAEP responses intraoperatively. Loss of responses has high specificity in evaluating hearing loss. Patients undergoing MVD should have BAEP monitoring to prevent hearing loss.

Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery., (© The Author(s) 2016.)

Background and Purpose: Perioperative stroke risk following carotid endarterectomy (CEA) is reported to be approximately 2-3%. The diagnostic accuracies of intraoperative EEG and SSEP monitoring during CEA have been studied separately. However, to date, the effectiveness of simultaneous EEG and SSEP monitoring during CEA has only been evaluated in small study populations. This study examined the diagnostic accuracy of combined EEG and SSEP monitoring in a large (N = 1165) patient population., Methods: This study included 1165 patients who underwent CEA from 2000 to 2012 at the University of Pittsburgh Medical Center. The sensitivities, specificities, and diagnostic odds ratio of EEG and SSEP monitoring methods were examined separately and together. Receiver operating characteristic curves were plotted to assess sensitivity and specificity of single and combined Intraoperative monitoring (IONM) methods., Results: Maximum sensitivity was obtained with multimodality monitoring with an IONM change in either EEG or SSEP of 50.00 (95% CI, 30.66-69.34). The specificity of simultaneous EEG and SSEP changes was 93.95 (95% CI, 92.28-95.35%). Maximum area under ROC curve obtained for IONM change in either EEG or SSEP was 0.660 (95% CI, 0.547-0.773, p-value 0.004)., Conclusion: The diagnostic accuracy of multimodality IONM during CEA is higher than an approach using single modality IONM. Simultaneous EEG and SSEP monitoring improves the likelihood of detecting periprocedural strokes after CEA. Neuro protective therapies to prevent periprocedural strokes can be based on changes in SSEP and EEG during CEA.

Introduction: Needle stick injuries remain a physical and psychological burden to healthcare workers. Noninvasive surface adhesive stimulating electrodes used to generate somatosensory evoked potentials can help decrease this risk., Methods: We performed a retrospective observational study of patients who underwent anterior cervical discectomy and fusion (ACDF) surgery to determine the utility and variability of using surface adhesive stimulating electrodes. Our analysis for utility compared alarm (significant changes) frequency, defined by established alarm criteria, between subdermal needle (Group I) and surface adhesive electrodes (Group II). We compared the variability by comparing the frequency of alarms based on establishing baselines during various stages of the procedure., Results: Between Group I and Group II, no significant differences were found in demographic, age, number of levels decompressed and fused, and length of surgery variability. However, stimulation intensity was significantly higher in Group II. Significant differences in the mean frequency of alarm of cortical, subcortical, and Erb's somatosensory evoked potential (SSEP) responses for the upper extremities between the two groups were only observed for the upper left Erb's point amplitude (p = 0.03) at retraction and upper right cortical amplitude at incision (p = 0.02). The frequency of alarms of the amplitude of left ulnar cortical responses from SSEPs using surface adhesives when baselines were established at the beginning of the procedure, at the time of incision, and at placement of retractors were 13.83 % (±14.08%), 7.50 % (±7.56%) and 3.42 % (±3.48%), respectively. Comparatively, the frequencies of alarms of the amplitude of left ulnar cortical responses from SSEPs using needle electrodes were 18.07 % (±22.85%), 12.13 % (±17.30%) and 7.37 % (±11.82%), respectively. Similar results were observed from frequency for alarms from the right ulnar SSEPs., Conclusion: This study found little significant difference between the frequencies of alarm in patients who had SSEP responses obtained using surface adhesive electrodes when compared to needle electrodes. This lack of significant difference was observed even when alarms were established at various stages of the surgery before any major manipulation. For short procedures monitoring the upper extremities only, surface adhesive electrodes may provide a reliable alternative to invasive needle electrodes.

Object: Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL., Methods: Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort., Results: The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss., Conclusions: The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

The objective of the study was to compare the presence of comorbid medical conditions between patients with a vascular dementia (VaD) and a control group, from the Integrated Healthcare Information Services (IHCIS) database. VaD was defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 290.40, 290.4, 290.41, 290.42, and, 290.43. An individual matching method was used to select the controls, which were matched to cases on a 15:1 ratio by age, gender, type of health plan, and pharmacy benefits. Alzheimer's disease, any other dementia or cognitive deficits associated were considered exclusion criteria. Among the IHCIS patients 60 years of age or older and full year of eligibility during 2010, there were 898 VaD patients, from which 63.6% were women. Concurrent presence of cerebrovascular disease, atherosclerosis, heart failure, and atrial fibrillation were found at 12.6, 4.6, 2.8, and 1.7 times higher in VaD patients, respectively. Compared to controls, VaD patients had more septicemia, injuries, lung diseases including chronic obstructive pulmonary disease, and urinary diseases (all with df = 897,1; p < 0.0001). The present study confirms that these four medical comorbidities are frequent complications of VaD and physicians should be alert to the presence of them in patients with VaD.

The primary aim of this paper is to study the pre-operative characteristics, intra-operative changes and post-operative hearing outcomes in patients after complete loss of wave V of the brainstem auditory evoked potential. We retrospectively analyzed the brainstem auditory evoked potential data of 94 patients who underwent microvascular decompression for hemifacial spasm at our institute. Patients were divided into two groups - those with and those without loss of wave V. The differences between the two groups and outcomes were assessed using t-test and chi-squared tests. In our study 23 (24%) patients out of 94 had a complete loss of wave V, with 11 (48%) patients experiencing transient loss and 12 (52%) patients experiencing permanent loss. The incidence of hearing loss in patients with no loss of wave V was 5.7% and 26% in patients who did experience wave V loss. The incidence of hearing change in patients with no loss of wave V was 12.6% and 30.43% in patients who did experience wave V loss. Loss of wave V during the procedure or at the end of procedure significantly increases the odds of hearing loss. Hearing change is a significant under-reported clinical condition after microvascular decompression in patients who have loss of wave V., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Cranial nerve deficits during CEA are a known complication. The purpose of this study is to evaluate if significant changes in somatosensory evoked potentials and electroencephalography increase cranial nerve deficits during CEA., Procedures: This is an observational retrospective case-control study analyzed with data collected from patients who underwent CEA at the University of Pittsburgh Medical Center. Five hundred and eighty-seven patients were included in the final analysis. Due to the small number of cranial nerve deficits and the comparatively large number of potential covariates, we used a regression analysis with Bayesian shrinkage., Findings: Analysis was performed on 587 patients, of which a total of 11 (1.8%) cases of cranial nerve deficits were recorded. The marginal mandibular branch of the facial nerve was injured in nine (81%) patients and hypoglossal nerve was injured in two (19%) patients. Of the 11 patients, 9 cases resolved by the time of discharge, the 2 cases that persisted both were injuries to the facial nerve. Multivariate analysis using Bayesian shrinkage showed that after adjusting for all risk factors only IOM changes increased the risk of cranial nerve deficits (OR 38.47, 95% CI 7.73, 191.42)., Conclusions: Cranial nerve injury is 38 times more likely in patients who experienced a change in IOM during CEA shunt. Future studies examining the effect of stretch and the degree of retraction on the CN might be more helpful in reducing cranial nerve deficits., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Importance: Perioperative stroke is a persistent complication of carotid endarterectomy (CEA) for patients with symptomatic carotid stenosis (CS)., Objective: To evaluate whether changes in somatosensory evoked potential (SSEP) during CEA are diagnostic of perioperative stroke in patients with symptomatic CS., Design, Setting, and Participants: We searched PubMed and the World Science Database for reference lists of retrieved studies and/or experiments on SSEP use in postoperative outcomes following CEA in patients with symptomatic CS from January 1, 1950, through January 1, 2013. We independently screened all titles and abstracts to identify studies that met the inclusion criteria and extracted relevant articles in a uniform manner. Inclusion criteria included randomized clinical trials, prospective studies, or retrospective cohort reviews; population of symptomatic CS; use of intraoperative SSEP monitoring during CEA; immediate postoperative assessment and/or as long as a 3-month follow-up; a total sample size of 50 or more patients; studies with adult humans 18 years or older; and studies published in English., Main Outcome and Measure: Whether intraoperative SSEP changes were diagnostic of perioperative stroke indicated by postoperative neurological examination., Results: Four-hundred sixty-four articles were retrieved, and 15 prospective and retrospective cohort studies were included in the data analysis. A 4557-patient cohort composed the total sample population for all the studies, 3899 of whom had symptomatic CS. A change in SSEP exhibited a strong pooled mean specificity of 91% (95% CI, 86-94) but a weaker pooled mean sensitivity of 58% (95% CI, 49-68). A pooled diagnostic odds ratio for individual studies of patients with neurological deficit with changes in SSEPs was 14.39 (95% CI, 8.34-24.82), indicating that the odds of observing an SSEP change among those with neurologic deficits were 14 times higher than in individuals without neurologic deficit., Conclusions and Relevance: Intraoperative SSEP is a highly specific test in predicting neurological outcome following CEA. Patients with perioperative neurological deficits are 14 times more likely to have had changes in SSEPs during the procedure. The use of SSEPs to design prevention strategies is valuable in reducing perioperative cerebral infarctions during CEA.

Objective: The primary aim of the study was to assess the sensitivity and specificity of intraoperative monitoring in predicting postoperative hearing loss during microvascular decompression (MVD)., Methods: The study was designed as an examination of the diagnostic accuracy of brainstem evoked potentials compared with reference standard for nonserviceable hearing loss (Class C/D), which is a change of more than 50 dB on pure tone threshold, and change of speech discrimination score of more than 50. All patients underwent surgery and audiograms at a University of Pittsburgh Medical Center facility in the study period 2005-2012. All participants received a pre- and postaudiogram within 90 days before or after the operation. During the operation, participants received intraoperative monitoring with a supervising physician. A total of 238 patients were selected. Brainstem auditory evoked potentials (BAEPs) were indexed into categories of change based on their maximum change and response at the end of surgery. Differences in hearing outcome by BAEP change were analyzed., Results: Age and sex did not affect outcomes. Patient outcome was affected by condition. The BAEP categories significant changes, transient loss, and persistent loss show a sensitivity/specificity of 0.905/0.701, 0.667/0.903, and 0.429/0.972, respectively. The receiver operating characteristic curve has an area under the curve of 0.870 with a 95% confidence interval of 0.783 to 0.957., Conclusions: Loss of wave V during MVD is a specific indicator of postoperative hearing loss. The current alarm criteria used to warn the surgeon is a sensitive indicator of impending postoperative hearing loss., Classification of Evidence: This study provides Class IV evidence that in patients undergoing MVD, intraoperative BAEPs accurately identifies those who will have postoperative hearing loss., (© 2014 American Academy of Neurology.)

Purpose: To evaluate the appropriate time to establish baseline responses for brain stem auditory evoked potentials (BAEPs) during microvascular decompression for hemifacial spasm and its implications on the alarm criteria and outcomes., Methods: Overall, 61 patients who had intraoperative monitoring with BAEP during microvascular decompression were retrospectively identified. The latencies and amplitudes of wave V before skin incision and at dura opening (before major manipulation) were compared with the latency and amplitude of wave V at change start (first alarm reported to the surgeon). Also, the results with respect to postoperative outcomes were evaluated., Results: More alarms would have been communicated to the surgeon when baseline values were set at the beginning of the procedure, when compared with baseline values reset at dura opening (before major manipulation)., Conclusions: Significant variations in BAEP latency exist before any major manipulations during microvascular decompression. Despite a false-negative case, baselines can be set before any major manipulations (e.g., just before dura opening), with an understanding of the etiology of changes to BAEPs during microvascular decompression., Significance: This is the first study to establish that during intraoperative BAEP monitoring, baselines that are reset before any significant manipulations are performed, rather than at the beginning of the procedure, have a higher level of sensitivity with regards to hearing outcomes.

Background: Intraoperative monitoring (IOM) using somatosensory-evoked potentials (SSEPs) plays an important role in reducing iatrogenic neurologic deficits during corrective pediatric idiopathic procedures for scoliosis. However, for unknown reasons, recent reports have cited that the sensitivity of SSEPs to detect neurologic deficits has decreased, in some to be less than 50%. This current trend, which is coincident with the addition of transcranial motor-evoked potentials, is surprising given that SSEPs are robust, reproducible responses that were previously shown to have sensitivity and specificity of >90%., Purpose: Our primary aim was to assess whether SSEPs alone can detect impending neurologic deficits with similar sensitivity and specificity as originally reported. Our secondary aim was to estimate the potential predictive value of adding transcranial motor-evoked potentials to SSEP monitoring in idiopathic scoliosis procedures., Design: This was a retrospective review to analyze the efficacy of SSEP monitoring in the group of pediatric instrumented scoliosis fusion cases., Patient Sample: We retrospectively reviewed all consecutive cases of patients who underwent idiopathic scoliosis surgery between 1999 and 2009 at Children's Hospital of Pittsburgh. We identified 477 patients who had the surgery with SSEP monitoring alone. Exclusion criteria included any patients with neuromuscular disorders or unreliable SSEP monitoring. Patients who had incomplete neurophysiology data or incomplete postoperative records were also excluded., Outcome Measures: Major outcomes measured were clinically significant postoperative sensory or motor deficits, as well as significant intraoperative SSEP changes., Methods: Continuous interleaved upper- and lower-extremity SSEPs were obtained throughout the duration of all procedures. We considered a persistent 50% reduction in primary somatosensory cortical amplitude or a prolongation of response latency by >10% from baseline to be significant. Persistent changes represent significant deviation in SSEP amplitude or latency in more than two consecutive averaged trials. Patients were classified into one of four categories with respect to SSEP monitoring: true positive, false positive, true negative, and false negative. The sensitivity, specificity, positive predictive value, and negative predictive value were then calculated accordingly., Results: Our review of 477 idiopathic scoliosis surgeries monitored using SSEPs alone revealed a new deficit rate of 0.63% with no cases of permanent injury. Sensitivity = 95.0%, specificity = 99.8%, positive predictive value = 95%, negative predictive value = 99.8%. Using evidence-based epidemiologic measures, we calculated that the number needed to treat was 1,587 patients for one intervention to be performed that would have been missed by SSEP monitoring alone. In addition, the number needed to harm, which represents the increase in false positives with the addition of transcranial electrical motor-evoked potentials, was 200., Conclusion: SSEP monitoring alone during idiopathic scoliosis continues to be a highly reliable method for the detection and prevention of iatrogenic injury. Our results confirm the high sensitivity and specificity of SSEP monitoring alone published in earlier literature. As such, we suggest the continued use of SSEP alone in idiopathic scoliosis surgeries. At this time we do not believe there are sufficient data to support the addition of MEP monitoring, although more studies and revised criteria for the use of MEP may provide added value for its use in the future., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To evaluate if adding cranial nerves (CNs) V and VI to standard intraoperative neurophysiological monitoring (IONM) of microvascular decompressions for glossopharyngeal neuralgia improve its efficacy., Methods: We reviewed all patients who received a microvascular decompression for glossopharyngeal neuralgia at our institution between January 2008 and August 2012. All received upper extremity somatosensory evoked potentials, brainstem auditory evoked potentials, and free-running electromyography of muscles innervated by ipsilateral CNs VII, IX, and X. The sample was divided into 12 patients who received additional monitoring of CNs V and VI and 15 who did not., Results: No difference on neurotonic activity presence was found on CN V (standard IONM: 0% versus additional CNs IONM: 8.33%; p = 0.423), CN VI (never present on the additional CN patients), CN VII (standard IONM: 73.33% versus additional CNs IONM: 66.64%; p = 0.973), CN IX (standard IONM: 40.0% versus additional CNs IONM: 25.0%; p = 0.683), or CN X (standard IONM: 46.67% versus additional CNs IONM: 33.33%; p = 0.701) between groups. Additionally, no differences of brainstem auditory evoked potentials wave V's delay, and amplitude at the end of the decompression, or closing of the case were found between groups., Conclusions: Monitoring free-running electromyography of additional CNs V and VI does not improve the efficacy of IONM of microvascular decompressions for glossopharyngeal neuralgia.

Introduction: Intraoperative monitoring of brain stem auditory evoked potential during microvascular decompression (MVD) prevent hearing loss (HL). Previous studies have shown that changes in wave III (wIII) are an early and sensitive sign of auditory nerve injury., Objective: To evaluate the changes of amplitude and latency of wIII of brain stem auditory evoked potential during MVD and its association with postoperative HL. Hearing loss was classified by American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) criteria, based on changes in pure tone audiometry and speech discrimination score., Methods: Retrospective analysis of wIII in patients who underwent intraoperative monitoring with brain stem auditory evoked potential during MVD was performed. A univariate logistic regression analysis was performed on independent variables amplitude of wIII and latency of wIII at change max and On-Skin, or a final recording at the time of skin closure. A further analysis for the same variables was performed adjusting for the loss of wave., Results: The latency of wIII was not found to be significantly different between groups I and II. The amplitude of wIII was significantly decreased in the group with HL. Regression analysis did not find any increased odds of HL with changes in the amplitude of wIII., Conclusions: Changes in wave III did not increase the odds of HL in patients who underwent brain stem auditory evoked potential s during MVD. This information might be valuable to evaluate the value of wIII as an alarm criterion during MVD to prevent HL.

Objectives: Despite availability of neuroepidemiological data, urban-rural differences on neurological diseases have almost never been considered. Our goal is to identify differences in the frequency of neurological conditions between a rural and an urban sample from central Colombia., Methods: We compared frequencies of neurological encounters of an urban sample from Bogotá (N=2932), to our rural sample from Tunja (N=2664), collected both circa to 2000. The classification of neurological conditions used is based on the 9th revision of the International Classification of Diseases, clinical modification. A clustered sampling was used. Information collection was performed in a format designed for this purpose and already used in Colombia., Results: Highly significant statistical differences (p<0.0001) were found for cerebrovascular diseases, seizure disorder, headache, Parkinson's disease and other movement disorders, and, inflammatory (infectious) conditions. Neurodevelopmental disorders (p=0.0029), dizziness and balance problems (p=0.0018), and neuropathies (p=0.0007), also showed statistically significant differences., Conclusions: Our study showed significant differences on all categories and diagnostics between the samples. Cerebrovascular disease the most frequent reason of neurological consultation in the rural sample could be confounded by sociodemographic (aging of the population, urbanization process), or the concomitant presence of medical (chronic pulmonary) and/or environmental (air pollution) conditions., (Copyright © 2012. Published by Elsevier B.V.)

Introduction: Botulinum neurotoxin (BtNtx) treatment for hemifacial spasm (HFS) prior to microvascular decompression (MVD) is hypothesized to be a factor in the variability of intraoperative neurophysiological monitoring (IONM) during this procedure., Methods: We analyzed 282 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. We retrospectively compared the lateral spread response (LSR) in the mentalis muscle when stimulus-triggered electromyography (EMG) was elicited from the facial nerve. Previous BtNtx treatment was the grouping factor., Results: Baseline LSR amplitudes during MVD (prior BtNtx: mean = 341.47 μV; no BtNtx: mean = 241.81 μV) were significantly different between groups (df = 1,281; t = -2.463; P = 0.014). Comparisons of latency and current threshold at baseline, as well as HFS disappearance or LSR persistence after the procedure, did not achieve statistical significance., Conclusions: HFS patients treated with BtNtx prior to MVD demonstrated higher LSR baseline amplitudes during IONM. This could be related to muscle poly-reinnervation after recovery from repeated BtNtx use., (Copyright © 2011 Wiley Periodicals, Inc.)

Objectives: We compared the prevalence of subtypes of depression in patients with Alzheimer's disease (AD), vascular dementia (VaD), and unspecified dementia (UD)., Methods: Using the Integrated Healthcare Information Services database, we conducted an analysis of subtypes of depression (major depressive disorder, depressive disorder not otherwise specified, dysthymic disorder; depressive psychosis, and adjustment disorder depressive) among patients with AD, VaD, and UD. Six thousand four hundred and forty patients aged 60 years or older with dementia (2947 with AD, 725 with VaD, and 2768 with UD) were identified from January 1 to December 31, 2001. Both subtypes of depression and dementia subgroups were diagnosed using criteria from the International Classification of Diseases, 9th version., Results: The overall prevalence of depressive disorders was 27.41%. The prevalence of depressive disorders was significantly higher in VaD (44.14%) and UD (32.48%) patients compared with AD (18.53%, P < .0001) patients. The AD patients had the lowest prevalence of all subtypes of depression. The VaD patients, compared with both AD and UD (P < .005), had a significantly higher prevalence of: 1) depressive disorder not otherwise specified, 2) major depressive disorder, and 3) dysthymic disorder. Adjustment disorder with depressive symptoms was more common in the UD subgroup, whereas the rate of depressive psychosis was similar in all dementia subgroups, Conclusions: This study supports the view that depressive disorders are more prevalent in VaD compared with UD and AD, and provides indicators to the clinician for further evaluation of depression in dementia subgroups., (2010 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the project was to determine whether children at high risk for alcohol use disorder (AUD) are impaired at performing oculomotor response inhibition tasks sensitive to detecting prefrontal cortex dysfunction., Methods: Three antisaccade tasks were administered to 67 10-12-year-old children having fathers with AUD and 12 children whose fathers had no psychiatric disorder., Results: Children of AUD+ fathers performed similar to children of AUD- fathers on measures of response latency and gain to target. Peak velocity discriminated the two groups on only one task. Children of AUD+ fathers exhibited a higher rate of prosaccade errors on the most difficult antisaccade task. Within the AUD+ group of men, offspring who qualified for attention deficit hyperactivity disorder (ADHD; N = 13) exhibited more response suppression errors than children without ADHD on two of three tasks. No differences were observed between children without ADHD whose fathers either qualified for AUD+ or had no psychiatric disorder., Conclusion: Inhibiting a response to a prepotent stimulus in children of AUD+ fathers is circumscribed to ADHD youths. These findings suggest that frontal-striatal mechanisms may underlie the risk for AUD among ADHD children.

The P300 amplitude of the event-related potential as a mediator of the association between parental substance use disorder (SUD) and child's neurobehavioral disinhibition was assessed. The P300 amplitude was recorded using an oddball task in sons of fathers having either lifetime SUD (n = 105) or no psychiatric disorder (n = 160). Neurobehavioral disinhibition was assessed using measures of affect regulation, behavior control, and executive cognitive function. Parental SUD and child's P300 amplitude accounted for, respectively, 16.6% and 16.8% of neurobehavioral disinhibition variance. Controlling for parental and child psychopathology, an association between parental SUD and child's P300 amplitude was not observed. It was concluded that the P300 amplitude does not mediate the association between parental SUD and child's neurobehavioral disinhibition., (Copyright 2005 APA, all rights reserved.)

Background: Attenuated amplitude of the P300 wave has been frequently documented in youths at high risk for substance use disorders (SUDs). This investigation had two aims: 1) determine whether P300 amplitude in late childhood is a predictor of SUD outcome by age 19; and 2) evaluate whether neurobehavior disinhibition (ND) mediates this association., Methods: Boys (aged 10-12) were recruited through proband biological fathers with either a lifetime DSM-III-R diagnosis of SUD (N = 67) or no adult psychiatric disorder (N = 94). P300 amplitude was recorded during an auditory oddball task. Neurobehavior disinhibition was evaluated using tests of executive cognitive function, behavior under control, and emotion dysregulation. The relationship is assessed using multiple and logistic regressions., Results: Substance use disorder by age 19 was significantly predicted by P300 amplitude (odds ratio [OR] = .958; 95% confidence interval [CI] = .918-.999; Wald chi (2) = 3.992; df = 1; p = .045) and ND score (OR = 1.060; 95% CI = 1.023-1.098; Wald chi (2) = 10.267; df = 1; p = .0014) measured at age 10 to 12. P300 amplitude also significantly correlated with ND severity (beta = -.217; t = -2.412; df = 6,160; p = .017). Low P300 amplitudes were observed in children who succumbed to SUD by age 19., Conclusions: These results indicate that ND mediates the association between attenuated P300 amplitude in childhood and SUD at age 19; however, P300 amplitude is not a specific childhood marker of SUD.