SSEP Test help?

[bchenaille]

In March of 2010, I noticed my calves twitching like mad.  Soon it had ascended up throughout my entire body including scalp & tongue.  Recently I have noticed my gums and certain parts of my body (including anus, sorry) seem to be slowly feeling numb to the touch.  A brain MRI in October of 2010 was normal.  A cervical spine MRI showed moderate congenital stenosis with buldging disc at C5 C6.  The neurologist has concluded that all of my neurological issues consisting of full-body & constant fasciculations, dizziness & numbness is solely related to my stenosis.  I guess I am having a problem with this conclusion because I can not find ANY sites that correlate cervical stenosis with the multitude of neurological issues going on in my body.  The only test that seems to be inconclusive according to my neurologist is the SSEP test which again I am having a problem with the conclusions.

Could you kindly review my results and give me your honest opinion & whether I should seek another opinion?

I had my SSEP test on 3/31/2011 which shows the following results and conclusion from the hospital.

EP TECHNIQUE: This is a somatosensory evoked response study for the bilateral median nerves and the bilateral tibial nerves.  Four hundred or more stimulus evoked responses at a frequency of 4.3 Hz were averaged, and the two trials were compared.

Lef Side Absolute Latencies:
N10: 11.5 msec
N13: 15.4 msec
N19: 21.0 msec

Interpeak Intervals:
N10 to N13: 3.9 msec
N13 to N19: 5.6 msec
N10 to N19: 9.5 msec

Right Side Absolute Latencies:
N10: 11.7 msec
N13: 15.6 msec
N19: 21.0 msec

Interpeak Intervals:
N10 to N13: 3.9 msec
N13 to N19: 5.4 msec
N10 to N19: 9.3 msec

BILATERAL TIBIAL NERVE SSEP STUDIES:
Left Side Popliteal Fossa Latency: 11.2 msec
Lumbar Potential: Not clearly identifiable
P37: 43.9 msec.
Central Conduction Time: Cannot be calculated.

Right Side Popliteal Fossa Latency: 12.4 msec.
Lumbar Potential: Not clearly identifiable.

SSEP IMPRESSION:  The bilateral median nerve SSEP studies were within normal limits.  For the bilateral tibial nerve SSEP studies, the P37 bilateral studies showed prolonged latencies.  The lumbar potentials were not well identified on either side.  Please correlate clinically and rule out a lesion distal to the mid cervical spine.

[COBOB]

Not in the nose and tongue.  They are innervated by Cranial Nerves.  The back 1/2 of the head is innervated by the occipital nerve that comes out of the cervical spine.

Bob

[bchenaille]

Thank you COBOB.  I appreciate your feedback, however the part that has the docs stumped is the fasciculations above the cervical spine in my head, nose, tongue, etc...  Could this be cause by the cervical stenosis as well?

[COBOB]

C5-C6 disk bulge would fit as a lesion distal to the Mid C-Spine.  Sensory issues and any related spasticity could be a result of the bulge impinging on the posterior sensory tracts of the spinal cord.  Direct motor deficits could be the result of a disk impinging on the anterior motor tracts of the spinal cord.

Since the arm EPs seemed to be pretty normal, they were looking for something below the mid C-Spine level.

Bob