Prognostic value of motor evoked potentials elicited by multipulse magnetic stimulation in a surgically induced transitory lesion of the supplementary motor area: A case report

F. Sala, M. J. Krzan, G. Jallo, F. J. Epstein, V. Deletis

Research output: Contribution to journalArticle

Abstract

Surgery involving the supplementary motor area (SMA) places the patient at risk of transient motor deficit. To predict outcome in patients with early postoperative hypokinesis would be relevant to both the patient and the surgical team. A 15 year old girl with a large left thalamic tumour removed through a left transcallosal approach is described. Despite intra-operatively preserved muscle motor evoked potentials (mMEPs) from all limbs, elicited by multipulse electrical stimulation, she awoke with a right hemiplegia and mutism. On the first postoperative day, neurophysiological evaluation using a multipulse magnetic stimulation technique, with a train of four magnetic stimuli, confirmed the presence of mMEPs from the hemiplegic right limbs. Slight spontaneous motor activity of the right limbs and initial speech were seen later on the same day with dramatic improvement over subsequent days. It is concluded that multiple rather than single magnetic stimulation techniques may be needed to elicit mMEPs for an early postoperative differential diagnosis of SMA damage versus injury to the primary motor cortex or the corticospinal tract.

Original languageEnglish (US)
Pages (from-to)828-831
Number of pages4
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume69
Issue number6
DOIs
StatePublished - 2000

Keywords

  • Brain tumour
  • Motor evoked potentials
  • Multipulse magnetic stimulation
  • Neurophysiological monitoring
  • Supplementary motor area

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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