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Prognostic Use of Somatosensory Evoked Potentials in Acute Consciousness Impairment

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Clinical Neurophysiology in Disorders of Consciousness

Abstract

Predicting the fate of ICU patients who are in coma is extremely challenging. In this context, somatosensory evoked potential (SSEP) can assist the multimodal neurological evaluation. In this chapter, we discuss the principles, applications and limitations of the SSEP in the ICU, with a focus on prognostication in comatose patients. Registration of the SSEP is a very reliable and reproducible method, if performed and interpreted correctly. During recordings, great care should be taken in improving the signal-to-noise ratio: if the noise level is too high, the peripheral responses are abnormal, or the response is not reproducible in a second set of stimuli; in these cases, interpretation of the SSEP cannot be done reliably. A bilaterally absent cortical response is a reliable predictor for poor neurological outcome in patients with a postanoxic coma, but not in patients with traumatic brain injury or stroke.

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References

  • Allison T, McCarthy G, Wood CC, Jones SJ (1991) Potentials evoked in human and monkey cerebral cortex by stimulation of the median nerve. A review of scalp and intracranial recordings. Brain 114(Pt 6):2465–2503

    Article  PubMed  Google Scholar 

  • Amantini A, Fossi S, Grippo A, Innocenti P, Amadori A, Bucciardini L, Cossu C, Nardini C, Scarpelli S, Roma V, Pinto F (2009) Continuous EEG-SEP monitoring in severe brain injury. Neurophysiol Clin 39:85–93

    Article  CAS  PubMed  Google Scholar 

  • Asouhidou I, Katsaridis V, Vaidis G, Ioannou P, Givissis P, Christodoulou A, Georgiadis G (2010) Somatosensory Evoked Potentials suppression due to remifentanil during spinal operations; a prospective clinical study. Scoliosis 5:8

    Article  PubMed Central  PubMed  Google Scholar 

  • Bosco E, Marton E, Feletti A, Scarpa B, Longatti P, Zanatta P, Giorgi E, Sorbara C (2011) Dynamic monitors of brain function: a new target in neurointensive care unit. Crit Care 15:R170

    Article  PubMed Central  PubMed  Google Scholar 

  • Bouwes A, Binnekade JM, Zandstra DF, Koelman JH, van Schaik IN, Hijdra A, Horn J (2009) Somatosensory evoked potentials during mild hypothermia after cardiopulmonary resuscitation. Neurology 73:1457–1461

    Article  CAS  PubMed  Google Scholar 

  • Bouwes A, Binnekade JM, Kuiper MA, Bosch FH, Zandstra DF, Toornvliet AC, Biemond HS, Kors BM, Koelman JH, Verbeek MM, Weinstein HC, Hijdra A, Horn J (2012) Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol 71:206–212

    Article  PubMed  Google Scholar 

  • Cloostermans MC, van Meulen FB, Eertman CJ, Hom HW, van Putten MJ (2012) Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: a prospective cohort study. Crit Care Med 40:2867–2875

    Article  PubMed  Google Scholar 

  • Cruccu G, Aminoff MJ, Curio G, Guerit JM, Kakigi R, Mauguiere F, Rossini PM, Treede RD, Garcia-Larrea L (2008) Recommendations for the clinical use of somatosensory-evoked potentials. Clin Neurophysiol 119:1705–1719

    Article  CAS  PubMed  Google Scholar 

  • Drummond JC, Todd MM, U HS (1985) The effect of high dose sodium thiopental on brain stem auditory and median nerve somatosensory evoked responses in humans. Anesthesiology 63:249–254

    Google Scholar 

  • Kamps MJ, Horn J, Oddo M, Fugate JE, Storm C, Cronberg T, Wijman CA, Wu O, Binnekade JM, Hoedemaekers CW (2013) Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med 39:1671–1682

    Article  CAS  PubMed  Google Scholar 

  • Langeron O, Vivien B, Paqueron X, Saillant G, Riou B, Coriat P, Lille F (1999) Effects of propofol, propofol-nitrous oxide and midazolam on cortical somatosensory evoked potentials during sufentanil anaesthesia for major spinal surgery. Br J Anaesth 82:340–345

    Article  CAS  PubMed  Google Scholar 

  • Laureau E, Marciniak B, Hebrard A, Herbaux B, Guieu JD (1999) Comparative study of propofol and midazolam effects on somatosensory evoked potentials during surgical treatment of scoliosis. Neurosurgery 45:69–74

    Article  CAS  PubMed  Google Scholar 

  • Pfeifer R, Weitzel S, Gunther A, Berrouschot J, Fischer M, Isenmann S, Figulla HR (2013) Investigation of the inter-observer variability effect on the prognostic value of somatosensory evoked potentials of the median nerve (SSEP) in cardiac arrest survivors using an SSEP classification. Resuscitation 84:1375–1381

    Article  PubMed  Google Scholar 

  • Robe PA, Dubuisson A, Bartsch S, Damas P, Laureys S (2003) Favourable outcome of a brain trauma patient despite bilateral loss of cortical somatosensory evoked potential during thiopental sedation. J Neurol Neurosurg Psychiatry 74:1157–1158

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Robinson LR, Micklesen PJ (2010) Does stimulus rate matter when performing somatosensory evoked potentials for coma patients? Neurocrit Care 12:69–73

    Article  PubMed  Google Scholar 

  • Rossetti AO, Oddo M, Logroscino G, Kaplan PW (2010) Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 67:301–307

    PubMed  Google Scholar 

  • Rothstein TL (2004) Recovery from near death following cerebral anoxia: a case report demonstrating superiority of median somatosensory evoked potentials over EEG in predicting a favorable outcome after cardiopulmonary resuscitation. Resuscitation 60:335–341

    Article  PubMed  Google Scholar 

  • Su YY, Xiao SY, Haupt WF, Zhang Y, Zhao H, Pang Y, Wang L, Ding JP, Zhao JW (2010) Parameters and grading of evoked potentials: prediction of unfavorable outcome in patients with severe stroke. J Clin Neurophysiol 27:25–29

    Article  PubMed  Google Scholar 

  • Taniguchi M, Nadstawek J, Pechstein U, Schramm J (1992) Total intravenous anesthesia for improvement of intraoperative monitoring of somatosensory evoked potentials during aneurysm surgery. Neurosurgery 31:891–897

    Article  CAS  PubMed  Google Scholar 

  • Tiainen M, Kovala TT, Takkunen OS, Roine RO (2005) Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia. Crit Care Med 33:1736–1740

    Article  PubMed  Google Scholar 

  • van Putten MJ (2012) The N20 in post-anoxic coma: are you listening? Clin Neurophysiol 123:1460–1464

    Article  PubMed  Google Scholar 

  • Wachter D, Christophis P, Stein M, Oertel MF (2011) Use of multimodal electrophysiological monitoring to predict outcome after subarachnoid hemorrhage? A prospective series. J Neurosurg Sci 55:179–187

    CAS  PubMed  Google Scholar 

  • Zandbergen EG, Hijdra A, de Haan RJ, van Dijk JG, de Visser Ongerboer BW, Spaans F, Tavy DL, Koelman JH (2006a) Interobserver variation in the interpretation of SSEPs in anoxic-ischaemic coma. Clin Neurophysiol 117:1529–1535

    Article  CAS  PubMed  Google Scholar 

  • Zandbergen EGJ, Hijdra A, Koelman JHTM, Hart AAM, Vos PE, Verbeek MM, de Haan RJ, PROPAC Study Group (2006b) Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 66:62–68

    Article  CAS  PubMed  Google Scholar 

  • Zandbergen EG, Koelman JH, de Haan RJ, Hijdra A (2006c) SSEPs and prognosis in postanoxic coma: only short or also long latency responses? Neurology 67:583–586

    Article  CAS  PubMed  Google Scholar 

  • Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30:1136–1139

    Article  PubMed  Google Scholar 

  • Zhang Y, Su YY, Ye H, Xiao SY, Chen WB, Zhao JW (2011) Predicting comatose patients with acute stroke outcome using middle-latency somatosensory evoked potentials. Clin Neurophysiol 122:1645–1649

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical Neurophysiology, MIRA – Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands

    Marleen C. Tjepkema-Cloostermans MD, PhD & Michel J. A. M. van Putten MD, PhD

  2. Departments of Clinical Neurophysiology and Neurology, Medisch Spectrum Twente, Enschede, The Netherlands

    Marleen C. Tjepkema-Cloostermans MD, PhD & Michel J. A. M. van Putten MD, PhD

  3. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Janneke Horn MD, PhD

Authors
  1. Marleen C. Tjepkema-Cloostermans MD, PhD
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  2. Michel J. A. M. van Putten MD, PhD
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  3. Janneke Horn MD, PhD
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Correspondence to Janneke Horn MD, PhD .

Editor information

Editors and Affiliations

  1. Service de Neurologie CHUV BH-07, Lausanne, Switzerland

    Andrea O. Rossetti

  2. Cyclotron Research Centre Coma Science Group, University of Liège, Liège, Belgium

    Steven Laureys

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Tjepkema-Cloostermans, M.C., van Putten, M.J.A.M., Horn, J. (2015). Prognostic Use of Somatosensory Evoked Potentials in Acute Consciousness Impairment. In: Rossetti, A., Laureys, S. (eds) Clinical Neurophysiology in Disorders of Consciousness. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1634-0_6

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  • DOI: https://doi.org/10.1007/978-3-7091-1634-0_6

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1633-3

  • Online ISBN: 978-3-7091-1634-0

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