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 Volume 63, Number 12, December 28, 2004
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NEUROLOGY 2004;63:2266-2271
© 2004 American Academy of Neurology

Role of motor evoked potentials in diagnosis of cauda equina and lumbosacral cord lesions

V. Di Lazzaro, MD, F. Pilato, MD, A. Oliviero, MD, E. Saturno, MD, M. Dileone, MD and P. A. Tonali, MD

From the Institute of Neurology (Drs. Di Lazzaro, Pilato, Oliviero, Saturno, Dileone, and Tonali), Università Cattolica, Rome, Italy; and Unidad de Neurologia Funcional (Dr. Oliviero), Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain.

Address correspondence and reprint requests to Dr. V. Di Lazzaro, Istituto di Neurologia, Universitá Cattolica, L.go A. Gemelli 8, 00168 Rome, Italy; e-mail: vdilazzaro{at}rm.unicatt.it

Objective: To determine the diagnostic value of motor evoked potentials (MEPs) in the diagnosis of lumbosacral cord disorders.

Methods: MEPs in 37 patients with sensory and motor deficits in the lower limbs were studied. MRI demonstrated spinal cord involvement in 10 patients and cauda equina lesions in 27 patients. A double determination of central motor conduction time (CMCT), calculated as the difference between the latencies of responses evoked by cortical and paravertebral magnetic stimulation and as the difference between the latency of cortical MEP and the total peripheral conduction time calculated from the F-wave latency, enabled discrimination between a delay along the proximal root and a delay along the corticospinal tract. An abnormality of the CMCT calculated with both techniques is indicative of central motor pathway damage, whereas an abnormality of the CMCT calculated from the latency of responses evoked by paravertebral magnetic stimulation associated with a normal CMCT calculated from the F-wave latency suggests a cauda equina lesion.

Results: Neurophysiologic findings strongly correlated with the lesion site documented by MRI (cauda equina or lumbosacral cord). All patients with MR evidence of cord involvement had an abnormality of CMCT calculated with both methods, suggesting a lesion of central motor pathways. Clinical examination often failed to document a spinal cord lesion, suggesting pure peripheral involvement in 5 of the 10 patients with MR evidence of cord lesion.

Conclusion: Motor evoked potential recording is an accurate and easily applicable test for the diagnosis of lumbosacral spinal cord lesions.

Received March 23, 2004. Accepted in final form August 2, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 28 issue to find the title link for this article.






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