Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence

Satish Sanku Chander Rao, Enrique Coss-Adame, Kasaya Tantiphlachiva, Ashok Attaluri, Jose Remes-Troche

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Neurologic dysfunction causes fecal incontinence, but current techniques for its assessment are limited and controversial. OBJECTIVE: The purpose of this work was to investigate spino-rectal and spino-anal motor-evoked potentials simultaneously using lumbar and sacral magneticstimulation in subjects with fecal incontinence and healthy subjects and to compare motor-evoked potentials and pudendal nerve terminal motor latency in subjects with fecal incontinence. DESIGN: This was a prospective, observational study. SETTINGS: The study took place in 2 tertiary care centers. PATIENTS: Subjects included adults with fecal incontinence and healthy subjects. INTERVENTIONS: Translumbar and transsacral magnetic stimulations were performed bilaterally by applying a magnetic coil to the lumbar and sacral regions in 50 subjects with fecal incontinence (1 or more episodes per week) and 20 healthy subjects. Both motor-evoked potentials and pudendal nerve terminal motor latency were assessed in 30 subjects with fecal incontinence. Stimulation-induced, motor-evoked potentials were recorded simultaneously from the rectum and anus with 2 pairs of bipolar ring electrodes. MAIN OUTCOME MEASURES: Latency and amplitude of motor-evoked potentials after lumbosacral magnetic stimulation and agreement with pudendal nerve terminal motor latency were measured. RESULTS: When compared with control subjects, 1 or more lumbo-anal, lumbo-rectal, sacro-anal, or sacrorectal motor-evoked potentials were significantly prolonged (p < 0.01) and were abnormal in 44 (88%) of 50 subjects with fecal incontinence. Positive agreement between abnormal motor-evoked potentials and pudendal nerve terminal motor latency was 63%, whereas negative agreement was 13%. Motor-evoked potentials were abnormal in more (p < 0.05) subjects with fecal incontinence than pudendal nerve terminal motor latency, in 26 (87%) of 30 versus 19 (63%) of 30, and in 24% of subjects with normal pudendal nerve terminal motor latency. There were no adverse events. LIMITATIONS: Anal EMG was not performed. CONCLUSIONS: Translumbar and transsacral magnetic stimulation-induced, motor-evoked potentials provide objective evidence for rectal or anal neuropathy in subjects with fecal incontinence and could be useful. The test was superior to pudendal nerve terminal motor latency and appears to be safe and well tolerated.

Original languageEnglish (US)
Pages (from-to)645-652
Number of pages8
JournalDiseases of the Colon and Rectum
Volume57
Issue number5
DOIs
StatePublished - Jan 1 2014

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Motor Evoked Potentials
Fecal Incontinence
Pudendal Nerve
Healthy Volunteers
Sacrococcygeal Region
Lumbosacral Region
Anal Canal
Neurologic Manifestations
Rectum
Tertiary Care Centers
Observational Studies
Electrodes
Prospective Studies

Keywords

  • Fecal incontinence
  • Motor-evoked potentials
  • Neurophysiologic test
  • Spino-anorectal pathway

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence. / Rao, Satish Sanku Chander; Coss-Adame, Enrique; Tantiphlachiva, Kasaya; Attaluri, Ashok; Remes-Troche, Jose.

In: Diseases of the Colon and Rectum, Vol. 57, No. 5, 01.01.2014, p. 645-652.

Research output: Contribution to journalArticle

Rao, Satish Sanku Chander ; Coss-Adame, Enrique ; Tantiphlachiva, Kasaya ; Attaluri, Ashok ; Remes-Troche, Jose. / Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence. In: Diseases of the Colon and Rectum. 2014 ; Vol. 57, No. 5. pp. 645-652.
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AU - Attaluri, Ashok

AU - Remes-Troche, Jose

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N2 - BACKGROUND: Neurologic dysfunction causes fecal incontinence, but current techniques for its assessment are limited and controversial. OBJECTIVE: The purpose of this work was to investigate spino-rectal and spino-anal motor-evoked potentials simultaneously using lumbar and sacral magneticstimulation in subjects with fecal incontinence and healthy subjects and to compare motor-evoked potentials and pudendal nerve terminal motor latency in subjects with fecal incontinence. DESIGN: This was a prospective, observational study. SETTINGS: The study took place in 2 tertiary care centers. PATIENTS: Subjects included adults with fecal incontinence and healthy subjects. INTERVENTIONS: Translumbar and transsacral magnetic stimulations were performed bilaterally by applying a magnetic coil to the lumbar and sacral regions in 50 subjects with fecal incontinence (1 or more episodes per week) and 20 healthy subjects. Both motor-evoked potentials and pudendal nerve terminal motor latency were assessed in 30 subjects with fecal incontinence. Stimulation-induced, motor-evoked potentials were recorded simultaneously from the rectum and anus with 2 pairs of bipolar ring electrodes. MAIN OUTCOME MEASURES: Latency and amplitude of motor-evoked potentials after lumbosacral magnetic stimulation and agreement with pudendal nerve terminal motor latency were measured. RESULTS: When compared with control subjects, 1 or more lumbo-anal, lumbo-rectal, sacro-anal, or sacrorectal motor-evoked potentials were significantly prolonged (p < 0.01) and were abnormal in 44 (88%) of 50 subjects with fecal incontinence. Positive agreement between abnormal motor-evoked potentials and pudendal nerve terminal motor latency was 63%, whereas negative agreement was 13%. Motor-evoked potentials were abnormal in more (p < 0.05) subjects with fecal incontinence than pudendal nerve terminal motor latency, in 26 (87%) of 30 versus 19 (63%) of 30, and in 24% of subjects with normal pudendal nerve terminal motor latency. There were no adverse events. LIMITATIONS: Anal EMG was not performed. CONCLUSIONS: Translumbar and transsacral magnetic stimulation-induced, motor-evoked potentials provide objective evidence for rectal or anal neuropathy in subjects with fecal incontinence and could be useful. The test was superior to pudendal nerve terminal motor latency and appears to be safe and well tolerated.

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