EEG and evoked potentials in comatose patients with severe brain damage

doi:10.1016/0013-4694(88)90030-2

Electroencephalography and Clinical Neurophysiology

Volume 69, Issue 1, January 1988, Pages 6-13

https://doi.org/10.1016/0013-4694(88)90030-2 Get rights and content

Abstract

EEGs and evoked potentials were recorded in 76 deeply comatose and unresponsive patients with traumatic or non-traumatic cerebral damage.

Spontaneous EEG activity was absent in 37 of the patients on the initial examination. The cortical somatosensory evoked potentials were invariably absent in these patients as were the visual evoked potentials. Brain-stem evoked potentials were abnormal, either lacking all waves or with only wave I or II present. Cerebral angiography performed in 33 of the patients within minutes to a few hours after the neurophysiological examination verified an established brain death, showing full intracerebral circulatory arrest in all.

Spontaneous EEG activity was initially present in 32 patients on the first examination, 20 of whom had bilaterally abolished cortical somatosensory potentials. Ten of the patients died a few hours afters initial examination, another 10 were followed for 2–3 days and subsequently developed electrocortical silence (ECS). Twelve of the patients with spontaneous EEG activity had preserved cortical somatosensory potentials, either uni- or bilaterally. The only two who survived were found in this group. In the patients followed with multiple recordings over a few days, the first parameter to indicate a grave prognosis was always disappearance of the cortical somatosensory potentials bilaterally, which generally occurred hours, and sometimes a day or two, before cessation of the spontaneous EEG activity.

EEG records from 7 patients did not meet the technical criteria of ECS; all, however, had abolished cortical somatosensory potentials bilaterally, and none in this group survived.

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Traumatic brain injuries are often associated with damage to sensory and cognitive processing pathways. Because evoked potentials (EPs) and event-related potentials (ERPs) are generated by neuronal activity, they are useful for assessing the integrity of neural processing capabilities in patients with traumatic brain injury (TBI). This review of somatosensory, auditory and visual ERPs in assessments of TBI patients is provided with the hope that it will be of interest to clinicians and researchers who conduct or interpret electrophysiological evaluations of this population. Because this article reviews ERP studies conducted in three different sensory modalities, involving patients with a wide range of TBI severity ratings and circumstances, it is difficult to provide a coherent summary of findings. However, some general trends emerge that give rise to the following observations and recommendations: 1) bilateral absence of somatosensory evoked potentials (SEPs) is often associated with poor clinical prognosis and outcome; 2) the presence of normal ERPs does not guarantee favorable outcome; 3) ERPs evoked by a variety of sensory stimuli should be used to evaluate TBI patients, especially those with severe injuries; 4) time since onset of injury should be taken into account when conducting ERP evaluations of TBI patients or interpreting results; 5) because sensory deficits (e.g., vision impairment or hearing loss) affect ERP results, tests of peripheral sensory integrity should be conducted in conjunction with ERP recordings; and 6) patients' state of consciousness, physical and cognitive abilities to respond and follow directions should be considered when conducting or interpreting ERP evaluations.
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EEG and evoked potentials in comatose patients with severe brain damage

Abstract

Lancet

Electroenceph. clin. Neurophysiol.

Electroenceph. clin. Neurophysiol.

Brain Res.

Lancet

Electroenceph. clin. Neurophysiol.

J. Neurol. Neurosurg. Psychiat.

Electroenceph. clin. Neurophysiol.

Multimodal evoked potentials in closed head trauma

Arch. Neurol. (Chic.)

A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death

J. Amer. med. Ass.

The EEG in determination of brain death

The effect of thiopenthone on somatosensory evoked responses and EEGs in comatose patients

J. Neurol. Neurosurg. Psychiat.

Subcomponents of the cervical evoked response in patients with intracerebral circulatory arrest

J. Neurol. Neurosurg. Psychiat.

Brainstem auditory and short latency somatosensory evoked responses in brain death

Neurology (NY)

Evaluation of brain function in severe human head trauma with multimodality evoked potentials

J. Neurosurg.

Central conduction time in primate brain ischemia. A study in baboons

Stroke

Recovery of monkey brain after prolonged ischemia. I. Electrophysiological and brain electrolytes

J. Cereb. Blood Flow Metab.