PURPOSE: To evaluate the prognostic value of multimodal evoked potentials in predicting both awakening and failure to awake from coma due to cardiac arrest. METHODS: Multimodal evoked potentials composed of somatosensory evoked potentials (SEPs), visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) were recorded for 46 patients with anoxicischemic encephalopathy who had coma duration>24 h. Patients with trauma, stroke, malignancy, or age<14 y were excluded. Outcomes were categorized as awakening (GOS 3-5) vs. vegetative state or death (GOS 1-2). RESULTS: Forty-one percent of patients regained consciousness, and 59% died or remained vegetative. Bilaterally absent SEP N20 peaks predicted non-awakening with a sensitivity of 52% and a specificity of 100%. Unilaterally or bilaterally absent BAEP III-V predicted non-awakening with a sensitivity of 12% and a specificity of 100%. Using bilaterally absent SEP N20 peaks, unilaterally or bilaterally absent BAEP III-V, or both of the above predicted non-awakening with a sensitivity of 56% and a specificity of 100%. Bilaterally present SEP N20 peaks predicted awakening with a sensitivity of 100% and a specificity of 63%. However, the combination of bilateral presence of SEP N20 and VEP P100 in predicting awakening increased the specificity to 74%, reaching a sensitivity of 89%, a PPV of 71% and a NPV of 91%. CONCLUSION: Non-awakening in postanoxic coma can be reliably predicted with SEPs and BAEPs. Bilaterally preserved SEPs and VEPs predicted awakening with an accuracy of 80% at 1~4 days after cardiopulmonary resuscitation.
Coma ; Consciousness ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Heart Arrest ; Humans ; Persistent Vegetative State ; Prognosis ; Sensitivity and Specificity ; Stroke ; Survivors

OBJECTIVE: The present study was undertaken to determine the value of developmental assessment, multimodality evoked potentials, brain magnetic resonance image (MRI) and electroencephalography (EEG) and to identify correlations between each evaluation. METHOD: Developmental assessments such as Bayley scales of infant development and Vineland social maturity scale, brain MRI, EEG and evoked potentials findings were evaluated in 45 children with spastic cerebral palsy to assess the developmental level and abnormalities of the anatomical structure of the brain and to elucidate the relationship between the test methods. RESULTS: 1) Mean mental developmental index (MDI) and psychomotor developmental index (PDI) were 69.6 and 68.6, respectively and mean Vineland social maturity quotient (SQ) was 76.1 and there was a significant correlation between the MDI, PDI, and SQ in cerebral palsied children. 2) Abnormal findings of brain MRI and EEG were found in 73.3% and 44.4% of the cases, respectively. 3) There was significant correlation between findings of brain MRI, auditory evoked potentials, visual evoked potentials, median somatosensory evoked potentials and social quotient. CONCLUSION: Developmental assessment, multimodality evoked potentials, EEG, and brain MRI would be a useful method to evaluate the maturity of brain and estimate the level of development.
Brain* ; Cerebral Palsy* ; Child Development ; Child* ; Electroencephalography* ; Evoked Potentials* ; Evoked Potentials, Auditory ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Humans ; Magnetic Resonance Imaging* ; Weights and Measures

OBJECTIVETo investigate the variations of sensory evoked potentials (SEPs) in patients with affective disorders accompanying suicidal behavior.

METHODS39 depressive patients, 22 manic patients and 33 normal controls were included in the study. Visual, auditory and somatosensory evoked potentials (VEP, AEP & SSEP) were recorded from every subject using a Nicolet Spirit Instrument.

RESULTSBoth the depressive and manic groups presented prolonged latencies and decreased amplitudes of major components of SEPs as compared to that of normal controls. Depressive patients with suicidal behavior had decreased P(3) amplitude of VEP (P < 0.05), while maniacs with suicidal behavior had decreased P(2) amplitudes of VEP & AEP (P < 0.05 or 0.01). Compared with patients without suicidal behavior, patients with suicidal behavior had significantly decreased P(3) amplitudes of VEP & SSEP.

CONCLUSIONSThe variations of SEPs in patients with affective disorders is closely associated with a history of suicidal behavior. Their clinical significance and biological correlates with suicidal behavior need further study.

Adult ; Bipolar Disorder ; physiopathology ; Depressive Disorder ; physiopathology ; Evoked Potentials, Auditory ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Female ; Humans ; Male ; Middle Aged ; Suicide, Attempted

PURPOSE: Cerebral palsy is a group of conditions characterized by nonprogressive motor and posture dysfunction developing during perinatal period due to brain damage. Combined sensory and cognitive disorders can evolve the secondary mental retardation or speech disorder. Brain evoked potential can evaluate the visual, auditory, somatosensory neuropathway, and the response of frontal, temporal, occipital lobe. We studied the usefulness of brain pvoked votential as a tool in the early diagnosis and treatment of sensory disorders in cerebral palsy. METHODS: We retrospectively reviewed the records of 86 cerebral palsy patients who were practiced brain evoked potential study in Chungnam National University Hospital from July, 1995 to June, 1999. We analyzed the visual, auditory, somatosensory evoked potential result and the correlations between the electroencephalography, radiologic brain imaging study and the brain evoked potential. RESULTS: 1) Clinical types of cerebral palsy were spastic type(85.0%), athetoid type(3.5%), mixed type(3.5%) and the remaining cases did not manifest any one the types above. 2) Abnormal evoked potential fingings were 25 cases(29.4%) in visual evoked potential, 16 cases(18.8%) in auditory evoked potential, 28 cases(37.8%) in median nerve evoked potential, 39 cases(52.7%) in tibial nerve evoked potential. 3) Electroencephalography, radiologic brain imaging study manifested no statistically significant correlations with the brain evoked potential result(P>0.05). CONCLUSION: As a noninnvasive neurophysiologic study, Brain evoked potential is a useful method predicting neurologic developmental progress and helpful to early diagnosis of sensory disorder in cerebral palsy patients.
Brain* ; Cerebral Palsy* ; Chungcheongnam-do ; Early Diagnosis ; Electroencephalography ; Evoked Potentials* ; Evoked Potentials, Auditory ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Humans ; Intellectual Disability ; Median Nerve ; Muscle Spasticity ; Neuroimaging ; Occipital Lobe ; Posture ; Retrospective Studies ; Sensation Disorders ; Tibial Nerve

OBJECTIVE: This study was performed to investigate the prognostic value of multi-sensory evoked potentials (MSEPs) in neonatal period for the early diagnosis of delayed motor development, especially cerebral palsy. METHOD: The MSEPs studies composed of auditory brainstem evoked potentials (AEPs), visual evoked potentials (VEPs) and somatosensory evoked potentials were taken on 237 neonates, 136 boys and 101 girls, using Viking IV machine. Follow up MSEPs were repeated in every 4 or more weeks for those who showed abnormal responses in any of the MSEPs. Each neonate was also evaluated for motor development as an outpatient or by telephone interview. RESULTS: Among 237 neonates, 6.4% showed delayed development, and 4.6% were cerebral palsy: 3.8%, spastic type; 0.8%, athetoid type, and the others revealed normal motor development. AEP was useful method to predict motor development when this was done at 39.7 0.4 weeks of postmenstrual age (PMA). VEPs failed to show the validity, but there was the typical waveform change in accordance with increase of the postmenstrual age. Median nerve SEPs were valuable for prediction of motor development which were taken at PMA 40.7 0.6 weeks. After 45.3 1.5 weeks of PMA, median nerve SEPs did not reflect motor development outcome significantly. However, posterior tibial SEPs significantly reflect motor outcome regardless of the time of examination. CONCLUSION: Median and posterior tibial SEPs done before 40weeks of PMA are useful tool to predict motor development outcome. When any of these tests showed abnormal findings, follow up study is recommended and posterior tibial SEP study is thought to be the most useful for its predictability. It is necessary to correlate the AEPs and VEPs with hearing and vision whenever abnormal findings are found.
Brain Stem ; Cerebral Palsy ; Early Diagnosis ; Evoked Potentials* ; Evoked Potentials, Auditory ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Female ; Follow-Up Studies ; Hearing ; Humans ; Infant, Newborn* ; Interviews as Topic ; Median Nerve ; Muscle Spasticity ; Outpatients

Rett syndrome is a progressive encephalopathy in females that appears during the first 18 months of the life. A few neurophysiologic investigations of peripheral nerve and electrodiagnostic studies in Rett syndrome has proposed mild distal axonopathy. However, the electrodiagnostic study shows demyelination rather than axonopathy in presenting patient with Rett syndrome. An 11-year-old female had normal birth history, no perinatal problems and normal development until age of 18 months. Developmental regression was recognized by her parent and slowly progressed. At physical examination at her age of 7 years, stereotypic hand movements was present and she could walk with frequent fall. Brain Computed Tomography was not specific and electrodiagnostic study revealed slow conduction velocity in all nerves tested. After follow-up for 4 years, hand wringling was remained and she became to be unable to walk alone. Electrodiagnostic study revealed as follows; 1) Compound muscle action potentials and sensory nerve action potentials in all the nerves tested revealed prolonged distal latency with normal amplitude. 2) F waves were evoked with prolonged latency in the all the nerves tested. 3) H-reflex were absent, bilaterally. 4) Facial motor conduction study and blink reflex showed normal findings. 5) Auditory evoked potential and visual evoked potential studies showed normal findings. These electrodiagnostic study indicates demyelinating neuropathy.
Action Potentials ; Blinking ; Brain ; Child ; Demyelinating Diseases ; Electromyography ; Evoked Potentials, Auditory ; Evoked Potentials, Visual ; Female ; Follow-Up Studies ; H-Reflex ; Hand ; Humans ; Parents ; Peripheral Nerves ; Physical Examination ; Reproductive History ; Rett Syndrome

While it has been reported previously that the loudness dependence of auditory evoked potentials (LDAEP) is a putative biological marker or a predictor of treatment response, there have been few studies of LDAEP in bipolar disorder. However, a recent study by Park and colleagues raised the possibility that the LDAEP could be useful as a biological marker of bipolar disorder. They found that the LDAEP was significantly higher in normal controls than in patients with either bipolar disorder or schizophrenia. Lee and colleagues also examined the LDAEP in bipolar disorder and normal controls, and found that it differed according to the bipolar phase, being significantly higher in cases of euthymic bipolar disorder, bipolar depression, and bipolar mania. With regard to treatment response, early clinical findings were that a higher LDAEP and a stronger intensity dependence of visual evoked potentials were related to a favorable response to lithium treatment. Juckel and colleagues recently demonstrated that the pretreatment LDAEP could be a predictor of successful prophylactic lithium treatment. The present article reviews the literature in order to determine whether the LDAEP can be used as a biological marker or a predictor of treatment response in patients with bipolar disorder and of manic switch or treatment resistance in patients with major depressive episode(s).
Biomarkers ; Bipolar Disorder* ; Evoked Potentials, Auditory* ; Evoked Potentials, Visual ; Humans ; Lithium

OBJECTIVE: Maturation of the acoustic and visual pathways in brainstem can be reflected by the brainstem auditory evoked potential(BAEP) and visual evoked potential(VEP) response studies. The purpose of this study was to evaluate the high-risk infants by the BAEP and VEP studies as a screening test for Their brainstem maturities. METHOD: The BAEP and VEP studies were used as a screening test in 142 high-risk infants with 31 to 42 weeks of conceptional age. Further follow-up data were obtained within 1 year in the same infants who showed the abnormal findings in BAEP and VEP at an initial screening test. RESULTS: On an initial BAEP and VEP study, the proportion of the abnormal findings was significantly higher among infants with below 36weeks(53.8%, 28.2%) of conceptional age than above 36 weeks(27.2%, 3.9%). At the follow-up study, 3 of 21 infants with no responses in BAEP and 1 of 6 infants with no responses in VEP on an initial test showed the persistent abnormal findings. However, normal configurations of BAEP and VEP were observed in infants with prolonged latencies or with distorted waveforms of BAEP and VEP at the first examination. CONCLUSIONS: These results suggest that the BAEP and VEP studies on the useful screening tests in infants above 36weeks of conceptional age. Because of the risk of persistent abnormal results, infants with no responses on an initial screening test need a follow-up study.
Acoustics ; Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Evoked Potentials, Visual* ; Follow-Up Studies ; Humans ; Infant* ; Mass Screening ; Visual Pathways

BACKGROUND AND OBJECTIVES: Cochlear microphonic (CM) is an electrical potential generated by outer hair cells in response to acoustic stimulation. The aim of this study is to evaluate the significance of CM in neonatal hearing loss. SUBJECTS AND METHOD: From April 2013 to April 2014, 64 neonates hospitalized in neonatal intensive care unit were enrolled. Subjects underwent transient evoked otoacoustic emission (TEOAE), auditory brain stem response (ABR) and CM. We analyzed the results of hearing tests and the correlation between CM and the other test modalities. RESULTS: Ninety two ears showed normal ABR waves whereas the other 36 ears had abnormal ABR. There were two neonates who were suspected of auditory neuropathy because of the presence of TEOAE and CM. Among 14 ears who showed abnormal OAE results, 12 ears (86%) were identified as having CM. The amplitudes of CMs were correlated with the reproducibility of TEOAE (p<0.005). Between the ears with positive TEOAE and others with negative TEOAE, the amplitudes of CMs were significantly different (p<0.005). CONCLUSION: Many ears were identified with the presence of CM without TEOAE response because of the the vulnerability of OAE from middle ear status and environment. We suppose that CM might provide information on outer hair cell function to complement the OAE in neonatal hearing test.
Acoustic Stimulation ; Cochlear Microphonic Potentials ; Complement System Proteins ; Ear ; Ear, Middle ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Hearing Loss ; Hearing Tests* ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Neonatal Screening

OBJECTIVE: To investigate incidents and clinical features of auditory neuropathy in Nanjing deaf school students. METHOD: Three hundred and fifty-eight deaf students in the school accepted the first examination including otoscopic examination, tympanometry and transiently evoked otoacoustic emissions (TEOAE) screening. Detailed audiological and vestibular evaluations including pure-tone audiometry, immittance audiometry and acoustic reflex measures, transiently evoked otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE), auditory brain stem response (ABR), electronystagmography (ENG) and vestibular evoked myogenic potential (VEMP) were given to whom had positive TEOAE screening. RESULT: Three hundred and twenty-three students entered the program of screening for auditory neuropathy. One student had positive TEOAE in single ear while the other two had positive TEOAE in both ears. In the screening stage,there were strong evidences in these three students with auditory neuropathy in the detailed audiological procedures. CONCLUSION Auditory neuropathy, which can also be found in deaf schools, is not as rare as we thought before. Early identification and intervention may help those children to avoid entering the deaf school and to return to normal society.
Adolescent ; Adult ; Audiometry, Pure-Tone ; Child ; China ; epidemiology ; Cochlear Microphonic Potentials ; Deafness ; epidemiology ; physiopathology ; Evoked Potentials, Auditory, Brain Stem ; Female ; Hearing Loss, Central ; epidemiology ; physiopathology ; Humans ; Male ; Otoacoustic Emissions, Spontaneous ; Students ; Young Adult