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Somatosensory cortical potentials evoked by stimulation of leg nerves: analysis of normal values and variability; diagnostic significance

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Summary

An attempt was undertaken to assess the diagnostic value of sensory potentials evoked by stimulation of leg nerves. Findings in normal persons were as follows. First, stimulation of the sural nerve was superior to other methods, especially stimulation of the tibial nerve. Second, variations in latency were considerable and not attributable to age, height, or skin temperature. In many normal persons latency was not stable in either short-time or long-time trials. Amplitudes varied to such an extent that they could not help in diagnosis with the possible exception of extreme side-to-side differences. Finally, both amplitudes and latencies varied in relation to stimulus intensity, repetition rate, and filtering.

Since sensory potentials from the leg nerves varied considerably, normal values must extend over a range that is wide enough to avoid mistaken diagnosis of abnormality. Hence, slight disturbances of nerve conduction such as those found in certain neuropathies, root damage and many extramedullary intraspinal space-occupying lesions could not be identified, whereas extensive demyelination in all parts of the sensory neuronal chain was readily discovered.

Zusammenfassung

Es wurde versucht, die diagnostische Wertigkeit der SEP nach Reizung von Beinnerven (SEPL) abzustecken. Die Untersuchung von Normalpersonen ergab folgendes:

  1. 1.

    Die Reizung des N. suralis ist den anderen Methoden — vor allem auch der Stimulation des N. tibialis — überlegen.

  2. 2.

    Die Latenzzeit zeigt eine beträchtliche Streuung, die sich auch durch Berücksichtigung von Alter, Körpergröße und Hauttemperatur nicht wesentlich einengen läßt. Zudem ist sie sowohl im Kurzzeit- als auch im Langzeit-Versuch bei vielen Gesunden nicht stabil. Bei den Amplituden sollten nur extreme Rechts-Links-Differenzen verwertet werden.

  3. 3.

    Amplituden und Latenzzeiten variieren in Abhängigkeit von Reizintensität und -frequenz sowie von der Filterung.

Angesichts der beträchtlichen Variabilität sollte man — um falsch positive Befunde zu vermeiden — die Grenzen der Normalwerte hinreichend weit abstecken. Daraus folgt, daß sich diskrete Leistungsstörungen — wie man sie bei bestimmten Polyneuropathien, Wurzelschäden und vielen intraspinalen raumfordernden Prozessen erwarten kann — dem Nachweis entziehen, während sich ausgedehnte Demyelinisierungen in jedwedem Abschnitt der sensiblen Neuronenkette gut aufdecken lassen.

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  1. Department of Neurology, Allgemeines Krankenhaus St. Georg, Hamburg, Federal Republic of Germany

    P. Vogel & H. Vogel

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Vogel, P., Vogel, H. Somatosensory cortical potentials evoked by stimulation of leg nerves: analysis of normal values and variability; diagnostic significance. J Neurol 228, 97–111 (1982). https://doi.org/10.1007/BF00313755

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