- •Middle-latency evoked potentials predict the outcomes of comatose patients.
- •Middle-latency somatosensory evoked potential (MLSEP) improves outcome prediction.
- •MLSEP is valuable when used within the first week after ischemic brain injuries.
To explore the role of middle latency evoked potentials (EPs) as predictors for favorable outcome in patients with severe ischemic brain injuries by comparing the prognostic ability of short latency somatosensory and auditory evoked potentials (SLSEP and BAEP) with middle latency somatosensory and auditory evoked potentials (MLSEP and MLAEP).
MLSEP, MLAEP, SLSEP and BAEP were recorded in 112 patients with severe ischemic brain injuries (Glasgow Coma Scale ≤ 8). Among them, 83 patients suffered from cerebral ischemic stroke and 29 suffered from anoxic–ischemic encephalopathy after cardiopulmonary resuscitation between 1 and 7 days after the onset of stroke. Outcomes were reviewed 6 months later using the Glasgow Outcome Scale (GOS). A GOS score of 4–5 was considered as a good outcome while a score of 1–3 was considered as poor.
By using the prognostic authenticity analysis of predictors for good outcome, at least unilateral N20 of the SLSEP exit and at least unilateral N60 of the MLSEP exit showed the highest sensitivity which was 100% (95% CI: 86.7%–100%). The bilateral normal N60 showed a high specificity of 97.5% (95% CI: 90.4%–99.6%). It also showed the highest positive likelihood ratio of 6.25% (95% CI: 1.28%–30.59%), which was superior to N20 of SLSEP, V of BAEP, and Pa of MLAEP. The analysis demonstrated that the area under the curve for MLSEP grading was the highest (0.838) compared to that of SLSEP grading (0.784), MLAEP grading (0.659) and BAEP grading (0.621).
Compared with using N20 of SLSEP analysis alone, adding MLSEP improves the outcome prediction in patients with severe ischemic brain injuries. When an outcome is uncertain after initial evaluation using short-latency EPs, MLSEP is valuable to be used from the first week to further improve prognostication in these patients.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the Neurological Sciences
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology. 2006; 67: 203-210
- Parameters and grading of evoked potentials: prediction of unfavorable outcome in patients with severe stroke.J Clin Neurophysiol. 2010; 27: 25-29
- Predictive value of somatosensory evoked potentials for awakening from coma.Crit Care Med. 2003; 31: 960-967
- Clinical practice. Neurologic prognosis after cardiac arrest.N Engl J Med. 2009; 361: 605-611
- Prediction of poor outcome within the first 3 days of postanoxic coma.Neurology. 2006; 66: 62-68
- Anoxic–ischemic encephalopathy: clinical and electrophysiological associations with outcome.Neurocrit Care. 2005; 2: 159-164
- The prognostic value of evoked responses from primary somatosensory and auditory cortex in comatose patients.Clin Neurophysiol. 2003; 114: 1615-1627
- Time-dependency of sensory evoked potentials in comatose cardiac arrest survivors.Intensive Care Med. 2001; 27: 1305-1311
- Multimodality evoked potentials (auditory, somatosensory and motor) in coma.Neurophysiol Clin. 1993; 23: 237-258
- Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest.Neurology. 2000; 54: 889-894
- Predicting comatose patients with acute stroke outcome using middle-latency somatosensory evoked potentials.Clin Neurophysiol. 2011; 122: 1645-1649
- Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment.Crit Care Med. 2000; 28: 721-726
- SSEPs and prognosis in postanoxic coma: only short or also long latency responses?.Neurology. 2006; 67: 583-586
- Long-term outcomes of chronic minimally conscious and vegetative states.Neurology. 2010; 75: 246-252
- Early change detection in humans as revealed by auditory brainstem and middle-latency evoked potentials.Eur J Neurosci. 2010; 32: 859-865
- Application of electrophysiologic techniques in poor outcome prediction among patients with severe focal and diffuse ischemic brain injury.J Clin Neurophysiol. 2011; 28: 497-503
- Assessment of outcome after severe brain damage.Lancet. 1975; 1: 480-484
- Regularity increases middle latency evoked and late induced beta brain response following proprioceptive stimulation.Brain Res. 2008; 1218: 114-131
- Pain-related middle-latency somatosensory evoked potentials in the prognosis of post anoxic coma: a preliminary report.Minerva Anestesiol. 2012; 78: 749-756
- The N20 in post-anoxic coma: are you listening?.Clin Neurophysiol. 2012; 123: 1460-1464
- Clinical relevance of long-latency SEPs and VEPs during coma and emergence from coma.Electroencephalogr Clin Neurophysiol. 1985; 62: 88-98
- Whiplash and concussion: similar acute changes in middle-latency SEPs.Can J Neurol Sci. 2006; 33: 379-386
- Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations.Crit Care Med. 2007; 35: 1230-1237
- Prediction of short- and long-term outcomes by electrocardiography in survivors of out-of-hospital cardiac arrest.Resuscitation. 2004; 63: 137-143
- Middle latency auditory evoked potentials in intensive care patients and normal controls.Int J Neurosci. 1995; 83: 253-267
- Prognostic value of electroencephalography and evoked potentials in the early course of malignant middle cerebral artery infarction.Neurol Sci. 2013; 34: 671-678
- Late auditory and event-related potentials can be useful to predict good functional outcome after coma.Arch Phys Med Rehabil. 2005; 86: 917-923
- Quality of perioperative AEP—variability of expert ratings.Br J Anaesth. 2003; 91: 905-908
Published online: July 17, 2014
Accepted: July 10, 2014
Received in revised form: July 7, 2014
Received: March 10, 2014
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.