Comparison of the prognostic utility of VEPs and SEPs in comatose children
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Somatosensory evoked potential
Coma (optics)
Visual evoked potentials
Evoked potential
The early recognition of comatose patients with a hopeless prognosis--regardless of how aggressively they are managed--is of utmost importance. Median somatosensory evoked potentials (SSEP) supplement and enhance neurological examination findings in anoxic-ischemic coma and are useful as an early guide in predicting outcome. The key finding is that bilateral absence of cortical evoked potentials reliably predicts unfavorable outcome in comatose patients after cardiac arrest. The author studied 50 comatose patients with preserved brainstem function after cardiac arrest. All 23 patients with bilateral absence of cortical evoked potentials died without awakening. Neuropathological study in seven patients disclosed widespread ischemic changes or frank cortical laminar necrosis. The remaining 27 patients with normal or delayed central conduction times had an uncertain prognosis because some died without awakening or entered a persistent vegetative state. The majority of patients with normal central conduction times had a good outcome, whereas a delay in central conduction times increased the likelihood of neurological deficit or death. Greater use of SSEP in anoxic-ischemic coma would identify those patients unlikely to recover and would avoid costly medical care that is to no avail.
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Persistent coma after global cerebral ischemia is a serious clinical disorder with uncertain neurologic recovery. The decision whether or not to continue treatment and defining objective criteria for this decision are difficult. More data are available on the outcome from postanoxic coma than from hypoglycemic coma. In a meta-analysis,1 the most reliable predictors of poor outcome in postanoxic–ischemic coma included absent pupillary responses, absent motor response to pain, bilateral absence of N20 components of the median nerve somatosensory evoked potentials (SSEP), and burst suppression or isoelectric EEG patterns (the first two variables on day 3 and the other two within the first week of coma). It was concluded that the absence of early cortical SSEP is the most discriminating predictor of poor outcome in patients with anoxic–ischemic coma.
In hypoglycemic coma in rats, ATP production is reduced in proportion to the duration of hypoglycemia.2 The short-term recovery of EEG changes and SSEP is …
Coma (optics)
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Somatosensory evoked potential
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Visual evoked potentials
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Somatosensory evoked potential
Coma (optics)
Visual evoked potentials
Evoked potential
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The long-term effects for the neural activities on somatosensory area caused by transcranial direct current stimulation (tDCS) have been showed with somatosensory evoked potentials (SEPs) and high frequency oscillations (HFOs) in animals and humans. This study investigates the relationship of SEPs with HFOs before and after applying cathodal tDCS (0, 15, 30, 45, 60 min) to human left somatosensory cortex for 15 min at 2 mA. The amplitudes of N20 and P30 evoked by right median nerve stimulation were slightly decreased after cathodal tDCS. Likewise, HFOs were affected by cathodal tDCS but there weren't steadily decrement during the entire HFO, the effects were oscillating depending on the peak of HFOs or the elapse time after tDCS. tDCS may leave the different influences between time- and location-dependent somatosensory processing.
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Somatosensory evoked potentials (SEPs) reflect the activity of somatosensory pathways mediated through the dorsal columns of the spinal cord and the specific somatosensory cortex. In this study we aimed to demonstrate the effects of physiologic parameters such as height, age and gender on N9, N13, N20 SEP components and the central conduction time (CCT) to median nerve stimulation in Turkish population. The results revealed a statistically significant correlation between height, gender and SEP latencies (p < 0.05 and p < 0.0005 respectively) whereas no significant age related changes was found in SEPs. In all groups CCT was not influenced by these parameters.
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Visual, spinal and somatosensory evoked potentials were performed on 56 patients with clinically definite multiple sclerosis at the beginning and end of a 2 1/2 year follow-up period. At the initial examination one or both visual evoked potentials were abnormal in all but nine patients (84%), five of whom had abnormalities of either spinal or somatosensory evoked responses; that is, one or more abnormal results were obtained from 52 of 56 (91%) patients. At the final examination there were abnormalities of one or more evoked potentials in 55 of the 56 (98%) patients. There was an increase in latency of the components of the evoked responses over the period; reduction in latency in individual patients was exceptional. The change in these electrophysiological measurements correlated with the increase in clinical disability of the group of patients over the period of study.
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