Correction to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary.

The article Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary, written by Stanley A. Skinner, Elif Ilgaz Aydinlar, Lawrence F. Borges, Bob S. Carter, Bradford L. Currier, Vedran Deletis, Charles Dong, John Paul Dormans, Gea Drost, Isabel Fernandez­Conejero, E. Matthew Hoffman, Robert N. Holdefer, Paulo Andre Teixeira Kimaid, Antoun Koht, Karl F. Kothbauer, David B. MacDonald, John J. McAuliffe III, David E. Morledge, Susan H. Morris, Jonathan Norton, Klaus Novak, Kyung Seok Park, Joseph H. Perra, Julian Prell, David M. Rippe, Francesco Sala, Daniel M. Schwartz, Martín J. Segura, Kathleen Seidel, Christoph Seubert, Mirela V. Simon, Francisco Soto, Jeffrey A. Strommen, Andrea Szelenyi, Armando Tello, Sedat Ulkatan, Javier Urriza and Marshall Wilkinson, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 05 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 30 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The original article has been corrected.

Neurophysiological Monitoring in Radiofrequency Ablation of Spinal Osteoid Osteoma With a Progressive Time and Temperature Protocol in Children.

STUDY DESIGN: Retrospective. Level IV Evidence. OBJECTIVE: To assess the utility of intraoperative neurophysiological monitoring (IONM) to detect and eventually prevent impending neurovascular damage during computed tomography (CT)-guided radiofrequency ablation (RFA) of spinal osteoid osteoma (OO) in children. SUMMARY AND BACKGROUND DATA: To our knowledge, this is the first case series of spinal OO in pediatric patients treated at a single center employing IONM during RFA. METHODS: This is a retrospective study of seven consecutive patients (3 girls and 4 boys, mean age: 9 years 4 months) with imaging and clinical signs compatible with spinal OO who underwent CT-guided RFA, under general anesthesia, and IONM in a single center between 2011 and 2015. Before the RFA procedure, a CT-guided percutaneous biopsy of the nidus was performed in the same setting. RFA was divided into four cycles of increasing time and temperature and performed under IONM in every patient. RESULTS: Two patients had lesions located in the thoracic spine and five patients had lumbar involvement. The RFA technical and clinical success was 85.7%. Six patients presented with reversible neurophysiological changes either during biopsy needle positioning or RFA cycles. In the remaining case, as IONM changes did not improve after several minutes of neuroprotective hypertension, the procedure was interrupted. Neither neurologic nor vascular complications were observed after RFA treatment. In only one biopsy sample, OO was confirmed by histopathologic studies. CONCLUSION: CT-guided RFA is an accepted minimally invasive technique for the treatment of spinal OO in children. IONM may be a helpful tool that requires minimal additional time and provides feedback on the state of the spinal cord and nerves at risk during the procedure. We promote the use of IONM during these procedures to detect and possibly prevent impending neurologic damage. LEVEL OF EVIDENCE: Level IV.

A Multiparametric Alarm Criterion for Motor Evoked Potential Monitoring During Spine Deformity Surgery.

PURPOSE: This is a pilot study to compare changes in the amplitude, area below the curve, number of phases, duration, and latency of the intraoperative transcranial motor evoked potentials (TcMEP) for early detection of impending spinal cord injury. An empirical ratio calculated by a combination of the above-mentioned parameters was also assessed. METHODS: Intraoperative TcMEP recordings from five patients presenting with neuromuscular kyphoscoliosis, idiopathic scoliosis, achondroplasia and lumbar kyphosis, congenital kyphosis, and achondroplasia with cervical instability were reviewed. Anesthesia was sustained with propofol or sevoflurane plus remifentanil, no muscle relaxants were used after intubation. The TcMEPs to multipulse electrical stimulation were recorded from upper-limb and lower-limb muscles. To be worthy of analyses, changes should include TcMEP disappearance or amplitude decrease >-65% during surgical/force maneuverings. RESULTS: Transient TcMEP changes related to surgical/force maneuvering were observed in all five patients consisting of a decrease in the empirical ratio value (>-95%), followed in magnitude by a drop in the area below the curve, amplitude (>-80%), duration, and number of phases, whereas latency increased. Changes returned to baseline when maneuverings were reverted. No hemodynamic/anesthetic factors were present during these events. After surgeries, no new neurological deficits were detected. CONCLUSIONS: An empirical ratio accounting for all TcMEP parameters seems to drop more than the amplitude during an intraoperative event. As few cases were analyzed, further studies in larger series of patients will be necessary to assess empirical ratio sensitivity/specificity and to determine whether this may be a useful monitoring warning criterion not leading to unnecessary interference with surgical treatment.

Interferon beta-1a treatment in childhood and juvenile-onset multiple sclerosis.

The authors studied the safety and tolerability of subcutaneous interferon beta-1a at different doses in 24 children with clinically definite multiple sclerosis. After a mean treatment period of 44 months, interferon beta-1a was well tolerated in 22 patients, although two experienced possible serious adverse events. Although effectiveness cannot be inferred from this study, the authors did observe a significant reduction in the relapse rate at 22 mug, three times weekly, in the relapsing-remitting subgroup.

Motor activation time in Parkinson 's disease

Se estudió el tiempo de activación motora (TAM), considerando para el presente trabajo como el intervalo de procesamiento intracerebral durante una prueba de Tiempo de Reacción (TR), en 17 pacientes con enfermedad de Parkinson y en 7 voluntarios sanos. El TAM fue calculado substrayendo al TR premotor los tiempos de conducción aferente y eferente obtenidos por medio de potenciales evocados somatosensitivos y motores. Comparados con los voluntarios sanos los pacientes con enfermedad de Parkinson presentaron valores de TAM significativamente prolongados (p < 0,02). En un grupo menor de 9 pacientes se estudiaron el TAM y el potencial cognitivo P300 mientras se encontraban bajo tratamiento antiparkinsoniano y también luego de un período de 12 horas de supresión medicamentosa. Durante el período de supresión los pacientes exhibieron un importante incremento en el TAM (P < 0,01) sin cambios significativos en la latencia o amplitud del potencial P300. Estos resultados sugieren que el enlentecimiento del TAM corresponde a un funcionamiento anormal de los circuitos dopaminérgicos involucrados en la iniciación del movimiento y no esté relacionado a cambios en la reactividad o en el estado cognitivo