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Europa Medicophysica 1999 March;35(1):27-34

Copyright © 1999 EDIZIONI MINERVA MEDICA

Prognostic value of multimodal evoked potentials in patients in a persistent vegetative state

Monitillo V. 1, Margari L. 3, Nardulli R. 1, Franchino G. 1, Calabrese S. 1, Multari V. 1, Colucci F. 1, Losurdo M. 3, De Iaco M. 3, Megna M. 1, Megna G. 2

1 Division of Neurology, “Salvatore Maugeri” Foundation, IRCCS, Rehabilitation Institute of Cassano Murge, Italy; 2 Department of Physical Medicine and Rehabilitation, University of Bari, Italy; 3 I Neurological Clinic


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BACKGROUND: Numerous stud­ies ­have dem­on­strat­ed the use­ful­ness of neu­ro­phys­io­log­i­cal inves­ti­ga­tions ­with somat­o­sen­so­ri­al, brain­steim audi­to­ry and vis­u­al ­evoked poten­tials (SEPs, BAEPs, VEPs) for com­plet­ing the clin­i­cal exam­ina­tion and eval­u­a­tion of ­coma ­patients. Recently, new non­in­va­sive tech­niques for trans­cra­ni­al stim­u­la­tion of the ­motor cor­tex ­have ­been util­ised ­with electri­cal or mag­net­ic stim­u­la­tion, ­which ­allow the record­ing of ­motor ­evoked poten­tials (MEPs) in the cor­re­spond­ing mus­cles of the stim­u­lat­ed ­area. This pro­vides infor­ma­tion on the integ­rity of the cor­ti­co-spi­nal ­motor path­ways. Few neu­ro­phys­io­log­i­cal stud­ies ­have ­been car­ried out in ­patients in a per­sis­tent veg­e­ta­tive ­state (PVS).
METHODS: A per­spec­tive neu­ro­phys­io­log­i­cal ­study was per­formed in 8 ­patients in a per­sis­tent veg­e­ta­tive ­state (PVS). The clin­i­cal pat­tern was eval­u­at­ed ­using the Glasgow Outcome Scale at 4, 7 and 10 ­months ­after the path­o­log­i­cal ­event. Neurophysiological inves­ti­ga­tions includ­ing brain­stem audi­to­ry ­evoked poten­tials (BAEPs), ­median ­nerve som­a­tos­en­so­ry ­evoked poten­tials (MN-SEPs) and ­motor ­evoked poten­tials (MEPs) ­were car­ried out at 4 ­months, ­with fol­low-up at 7 ­months.
RESULTS: At the ­first assess­ment and fol­low-up, BAEPs ­were nor­mal in all but one of the ­patients (mono­lat­er­al ­absence of all ­waves due to a periph­er­al ­lesion). SEPs ­were nor­mal in ­only 1 ­patient in ­whom the clin­i­cal sit­u­a­tion ­evolved to ­severe dis­abil­ity; in the remain­ing ­patients SEPs ­revealed dif­fer­ent ­degrees of alter­a­tion. At fol­low-up, SEP record­ings had ­improved in 3 ­patients: 2 ­evolved to ­severe dis­abil­ity and 1 to mod­er­ate dis­abil­ity.
CONCLUSIONS: Our ­study sug­gests ­that SEPs ­could ­have a prog­nos­tic val­ue for the clin­i­cal evo­lu­tion of ­patients in a PVS.

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