• lateral corticospinal tract
  
• generalized current spread during stimulation
  
• significantly less stimulus intensity to the diffuse current spread
  
• measuring and using modified 10-20 system for optimization
  
• lqp technique is using C1-C4 for electrode placement; C1-3 connected and C2-4 connected
  
• Cadwell system uses an extension cable, 2 on the right and three on the left, they do not use the middle one
  
• you can also use jumper cables
  
• central sulcus has more csf which has less resistant to current
  
• bone is going to be the biggest part of stopping
  
• csf will help activate those fibers
  
• no csf in superior, middle and inferior frontal gyrus, it's in between where the csf concentration is
  
• with lqp you have more chance of recruiting areas with csf in them
  
• internal capsule anatomy; tiny arteries supplying the blood for the internal capsule, sensory could be normal, but could wake up with deficit
  
• basal ganglia tumor; would be great to do an awake craniotomy as 80 volts at 50 pulse width!
  
• they always use corkscrews because it has less impedance than a needle, needles you may have to have higher stimulus
  
• suggest TIVA as the best option, half of MAC of gas sometimes, they used train of 4, ISI 1.5, sometimes go to 1.2 or 1.3, use a pulse width of 75, can activate at 100V for UE and 140 for LE
  
• with longer needles may get better responses!
  
• trauma
  
• has a video that showed him getting responses at 50 volts and then disconnected the electrodes, probably what was going to happen was that the responses went away and then came back when he plugged the two electrodes back in
  
• don't want to place a screw too large for the pedicle
  
• MCA upper extremities, ACA lower extremities
  
• WHEN STIMULATING TCEMEP AT 250V YOU ARE ACTIVATING THE ANTERIOR LIMB OF THE INTERNAL CAPSULE