The effect of sacral nerve modulation on cerebral evoked potential latency in fecal incontinence and constipation.

Abstract:

OBJECTIVE:Influence of sacral nerve modulation (SNM) on cerebral somatosensory evoked potentials (SEP) was determined in patients with incontinence and constipation. BACKGROUND:Selection of patients with incontinence and constipation for SNM could be improved. METHODS:The latency (ms) of SEP induced by pudendal nerve stimulation was compared before (T0) and at 1 month during peripheral nerve evaluation (PNE) of SNM at frequencies of 21 Hz (T1) and 40 Hz (T2). The results were correlated with clinical outcome at 6 months. RESULTS:In 16 of 23 incontinent patients with clinical "success" from SNM (Wexner incontinence score ≤7), there was a significant difference between P40 latency at T0 and T2 (38.81 vs. 37.49 ms, P = 0.049). In the 7 with "failure," there was no change between T0 and T2. In 12 of 19 constipated patients with "success" (Wexner constipation score ≤15), there was no difference between T0 and T2 P40 latency (39.28 vs. 38.25 ms, P = 0.374). In the 7 with "failure," there was a significant fall in P40 latency (41.20 vs. 39.30 ms, P = 0.047) but not to the normal range. The T0 P40 latency in incontinent patients having "success" was significantly higher than in the normal range (P = 0.044). In constipated patients it was significantly higher than in the normal range in both those with "success" (P = 0.001) and "failure" (P = 0.022). CONCLUSIONS:Measurement of P40 latency of SEP at baseline and at 1 month of SNM at a frequency of 40 Hz may help to predict the outcome of SNM and thus influence the decision for permanent implantation for patients with incontinence and constipation.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Giani I,Novelli E,Martina S,Clerico G,Luc AR,Trompetto M,Malaguti S,Nicholls J,Ganio E

doi

10.1097/SLA.0b013e3182196ff4

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

90-6

issue

1

eissn

0003-4932

issn

1528-1140

journal_volume

254

pub_type

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