Prospective studies of multimodal evoked potentials in patients after cranio-cerebral injury]

In 42 patients aged 18-68 years somatosensory, visual and brainstem auditory evoked potentials were studied in the first month after trauma and after 6-8 months after craniocerebral trauma for evaluation of their diagnostic importance in less severe craniocerebral trauma. On the basis of the results of neurological examination, CT of the head, and duration of unconsciousness in 22 cases brain concussion and in 20 cases brain contusion was diagnosed. In patients after brain concussion the frequency of early and late abnormalities after head trauma was as follows: for SSEP 36.4% and 27.3% respectively, for visual evoked potentials 21.1% and 5.3%, for auditory potentials 9.5% and 4.8%. In cases of brain contusion abnormalities were found in the 1st month and 6-8 months after trauma in SSEP in 60% and 20% respectively, in visual EP in 11.1% and 22.2%, and in auditory EP in 30% and 40%. In the group of concussion the greatest and most persistent changes developed in the later components od SSEP. Among certain patients with brain contusion deterioration of the results of visual and auditory evoked potentials were noted late after trauma.     

The diagnostic value of sensory evoked potentials in pediatric Wilson disease

We studied the sensory evoked potentials in pediatric Wilson disease to verify their subclinical neurologic involvement and to elucidate the role of cirrhosis in abnormal evoked potentials in non-neurologic Wilson disease. Thirty children (17 male, 13 female), diagnosed with Wilson disease before 18 years, were enrolled. The mean age during studies was 15.8 +/- 6.3 years, and disease duration since diagnosis was 3.0 +/- 3.3 years. In 12 neurologic Wilson disease cases, there were prolonged interpeak latencies of brainstem auditory evoked potentials III-V, I-V, somatosensory evoked potentials N13-N20 (P < 0.01 vs controls and non-neurologic cases), and P100 latency (P < 0.01 vs controls). All 12 patients had at least one abnormal evoked potential, including 91.7% brainstem auditory, 58.3% somatosensory, and 25% visual evoked potentials. In 18 non-neurologic Wilson disease cases, there were still prolonged interpeak latencies for brainstem auditory evoked potentials I-V and somatosensory evoked potentials N13-N20 (P < 0.05 vs controls), with 27.8% of them having at least one abnormal evoked potential, including 16.6% brainstem auditory, 5.6% somatosensory, and 11.1% visual evoked potentials. In those with non-neurologic Wilson disease, there were no significant differences in all the evoked potential parameters between the cirrhotic and non-cirrhotic patients.     

Correlation between morphological abnormalities of Chiari malformation and evoked potentials]

We studied correlation between morphological abnormalities of Chiari malformation and evoked potentials (short-latency somatosensory evoked potential [SSEP] and auditory brainstem response [ABR]). On SSEP the inter-peak latency prolongation of P3-N1 was revealed in 6 out of 8 cases with Chiari malformations. The feature of positive wave between P3 and N1 was divided into 2 groups. The tendency of the positivity between P3 and N1 was more marked in cases of prolonged P3-N1 latency and correlated with the medullary kink. On ABR the prolongation of III-V inter-peak latency was revealed in one side in 3 patients Chiari malformations with malformed pons and tegmentum.     

支架置入术对椎基底动脉系统短暂性脑缺血发作患者诱发电位的影响

目的 观察支架置入术能否改善椎基底动脉系统短暂性脑缺血发作（TIA）患者的亚临床症状。方法 11例症状性椎基底动脉狭窄的椎基底动脉系统TIA患者,支架置入术前后分别检测体感诱发电位（SEP）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）,记录各诱发电位的潜伏期及波幅。结果 （1）术前诱发电位均异常,主要表现为SEP N20及P40潜伏期异常,BAEPⅠ、Ⅲ、Ⅴ波潜伏期延长,VEP P100潜伏期延长。（2）与术前相比,术后1周BAEP表现为Ⅰ～Ⅲ波潜伏期缩短（P =0.046）、Ⅲ波幅升高（P =0.05）;SEP表现为N20潜伏期缩短（P =0.012）,N13～N20间期缩短（P =0.013）,P14～N20间期缩短（P =0.005）;VEP表现为 P100潜伏期缩短（P =0.022）。结论 支架置入术后,椎基底动脉系统TIA患者的SEP、BAEP、VEP好转,提示患者的亚临床症状恢复。     

Visual and brain stem auditory evoked responses in Wilson''s disease

Sensory evoked potentials were studied in 15 patients with Wilson's disease. Thirteen patients were investigated with pattern reversal visual stimulation. A prolonged P 100 latency of the VEP was present in 7 patients. Brain stem auditory responses were evoked in 12 patients. Prolongation of III-V and I-V interpeak latency was found in 8 patients. The evoked potential studies demonstrated subclinical disturbances in optic and caudal brainstem auditory pathways. Further studies are in progress to evaluate the role of these techniques in monitoring the therapy of newly diagnosed cases.     

Influence of GAA expansion size and disease duration on central nervous system impairment in Friedreich's ataxia: contribution to the understanding of the pathophysiology of the disease.

OBJECTIVE: To verify if GAA expansion size could account for the severity of the central nervous system involvement in Friedreich's ataxia (FA). METHODS: Retrospective study of 52 FA patients (mean age 26.9+/-12.1 years; mean disease duration 10.6+/-7.6 years) homozygous for GAA expansion. Median nerve somatosensory evoked potentials (SSEPs) were available in 36 FA patients, upper limb motor evoked potentials (MEPs) to transcranial magnetic stimulation in 32, brainstem auditory evoked potentials (BAEPs) in 24, and visual evoked potentials (VEPs) in 34. N20, P100, MEP amplitude, SSEP and MEP central conduction time (CCT and CMCT), P100 latency and I-III and I-V interpeak latency, and a BAEP abnormality score were correlated with disease duration and GAA expansion size on the shorter (GAA1) and larger (GAA2) allele in each pair. RESULTS: The GAA1 size inversely correlated with the N20 amplitude (r = -0.49; P<0. 01). Disease duration directly correlated with CMCT (r = 0.57; P<0.01) and BAEP score (r = 0.61; P<0.01) and inversely with MEP (r = -0.40; P<0.05) and P100 amplitude (r = -0.39; P<0.05). CONCLUSIONS: Our data suggest that central somatosensory pathway involvement in FA is mainly determined by GAA1 expansion size. Vice versa, degeneration of pyramidal tracts, auditory and visual pathways seems to be a continuing process during the life of FA patients.     

Study of multimodal evoked potentials in patients with type 1 Gaucher's disease

To detect early subclinical nervous dysfunction in Gaucher's disease type 1, we carried out motor, brainstem auditory, visual, and somatosensory evoked potentials in 17 patients with Gaucher's disease type 1. Central motor evoked potential abnormalities were found in nine patients (69.2%), consisting of an increased motor threshold in all, with prolonged central motor conduction time in two patients. Brainstem auditory evoked potentials were abnormal in five patients (31.2%), and the most frequent abnormality was a bilateral increased I-III interpeak latency. Visual evoked potentials showed a delayed latency of the P100 wave in four patients (25%). Somatosensory evoked potential abnormalities were found in three patients (18.7%), consisting of an increased N13-N20 interval in two patients and a not reproducible N13 wave in one patient. Our findings suggest that the multimodal evoked potential approach provides information about nervous subclinical damage in Gaucher's disease type 1; transcranial magnetic stimulation proved to be the most sensitive tool. Early detection of subclinical neurologic dysfunction can be useful in view of more effective therapeutic strategies.     

Electrophysiological studies on hydranencephaly

Electrophysiological studies were performed on two children with hydranencephaly that was diagnosed by CT and/or magnetic resonance imaging (MRI). Case 1 was a 4-months-old boy who had no rostral tissue above the midbrain. Case 2 was a 5-years-old boy in whom CT showed the presence of the thalamus. Short latency somatosensory evoked potentials (SSEP) in both cases exhibited the absence of cortical activity (N1 and P4) with the preservation of waves of brainstem origin. However, in case 1, the wave component N0 was not observed, while N0 was seen in case 2. Thus, the N0 was component of SSEP on median nerve stimulation in children, which corresponds to N16 in adults, may originate in the thalamus.     

Long Latency Auditory Evoked Potentials in Nonlesional Partial Epilepsy

Event-related potentials have been occasionally investigated in epilepsy. We recorded slow vertex responses or long-latency auditory evoked potentials (LLAEPs) to auditory stimuli in patients with complex partial and secondarily generalized seizures. Fifty consecutive neurologically-normal patients with normal imaging studies and 50 controls were compared. Slow vertex response (SVR) recordings utilized monaural condensation clicks presented at 0.5 Hz and 100 dB sound pressure level (SPL) with 40 dB contralateral masking; filter bandpass was 1–50 Hz, analysis time was 500 mseconds, and 200 averages were recorded and replicated. Long-latency auditory evoked potentials were recorded from Fz and Cz to linked-ear and ipsilateral-ear reference. Long-latency auditory evoked potential latencies of N100 potentials were significantly prolonged in patients as compared to controls, while P180 and N200 were longer in latency among patients but did not achieve statistical significance. N100 and P180 were significantly prolonged in latency on the side of the electroencephalogram (EEG)-documented epileptogenic focus in the seizure patients.These findings support previous suggestions of frontal or temporal cortical origin for SVRs, and suggest that LLAEP components may be prolonged in latency on the side of an irritative focus. Long-latency auditory evoked potential latency prolongation or asymmetry may therefore assist in the noninvasive neurophysiologic assessment of epilepsy patients.     

Binaural interaction of the auditory brain-stem potentials and middle latency auditory evoked potentials in infants and adults

Binaural interactions in brain-stem auditory evoked potentials and in middle latency auditory evoked potentials were studied in 18 normal hearing adults and 10 normal term infants. Binaural interactions at the times of ABR waves V and VI were comparable in term infants and adults. Binaural interaction during the time domain of the middle latency auditory evoked potentials was the greatest at N20 in term infants and at N40 in adults. Measurement of binaural interaction during maturation may be a useful tool in assessing neurologically affected infants.     

气功所致精神障碍患者脑诱发电位系列实验研究

目的 研究气功所致精神障碍患者与正常人在诱发了诱发电位的检测中的不同特点。方法 应用美国仪器和四种方法，对１２例气功偏差所致精神障碍患者和５２例正常人的诱导电位作了检测。结果 与正常人比较，患者组ＡＥＰ的Ｐ１、Ｐ２、Ｎ２、Ｐ３；ＶＥＰ的Ｎ１、Ｎ２、Ｐ３和ＳＥＰ的Ｐ２潜伏期均明显延迟ＡＥＰ、ＶＥＰ和ＳＥＰ的若干波幅同时明显改变。另在ＣＮＶ中机见Ｐ１ＮＶ和Ａ－Ｃ潜伏期延迟，波畅Ｂ增大，Ａ－Ｓ２＾－和Ｓ     

Electrophysiological study on hydranencephaly.

An electrophysiological study was performed on 2 children with hydranencephaly diagnosed by CT and/or MRI. Case 1 was a 4-month-old boy who had no rostral tissues above the midbrain. Case 2 was a 5-year-old boy in whom CT showed retention of the thalamus. Short latency somatosensory evoked potentials (SSEP) in both cases exhibited the absence of cortical activity (N1 and P4) with the preservation of waves of brain stem origin. However, in case 1, wave component No was not observed, while No was seen in case 2. It was postulated, thus, that the No component of SSEP on median nerve stimulation in children, which corresponds to N16 in adults, may originate in the thalamus.     

Menstrual cycle synchronized changes in brain stem auditory evoked potentials and visual evoked potentials.

BACKGROUND: Several studies have reported changes in the spontaneous electroencephalogram of women across the menstrual cycle (MC), raising questions on whether sensory or cognitive evoked potentials would change with MC as well. Some of these studies have found changes synchronized with MC in visual event-related brain potentials (ERPs) and brain stem auditory evoked potentials (BAEPs), whereas others have reported none. METHODS: In the present study, we attempted to study the changes in P300 component of visual ERPs, and in BAEPs across the MC in healthy women. RESULTS: The latency of P300 was longer during the ovulatory phase. Decrease across the MC phases was found for the amplitude of BAEP waves I and III, and for the wave V latency and the III-V interpeak latency. CONCLUSIONS: The results indicate that there may be a small relationship between visual ERP or BAEP and MC phase.     

Parkinson disease and cognitive evoked potentials

Long latency auditory evoked potentials were recorded in 50 patients with Parkinson's disease, some case were also investigated by the Rapid Evaluation of Cognitive Functions test (RECF) and Trail Making A test (TMA). Latencies of P2, N2 and P300 waves were longer in the parkinsonian group than in a control group matched for age. Latencies of N2 and P300 waves were correlated significantly with scores for RECF and TMA presumed to be sensitive to organic brain lesions. On the other hand no significant correlation was found between RECF and P1 and P2 latencies. In addition, correlation was lacking between Verbal Automatism test scores, presumed to be resistant to organic brain lesions, and P300 wave latencies. Cognitive evoked potential (CEP) latency increases with age in normal subjects. In the parkinsonian group the coefficient of correlation between these two factors was lower but still significant. The parkinsonian patients with dementia as defined by DSM III criteria, or an RECF score of less than 46, showed longer N2 and P300 latencies but no significant difference in N1 and P2 latencies. In contrast, comparison of P300 and N2 wave latencies in depressed and non-depressed parkinsonian patients failed to show any significant difference. The bilateral akinetic forms had marked lengthening of P300 wave latencies and a lower TMA score. Neither the duration of the disease, type of treatment, duration of L-Dopa therapy significantly influenced the latency of cognitive event-related potentials.     

Cerebrotendinous xanthomatosis: 11-year treatment with chenodeoxycholic acid in five patients. An electrophysiological study

We report the electrophysiological follow-up of five cerebrotendinous xanthomatosis patients treated for 11 years with chenodeoxycholic acid (CDCA). Nerve conduction velocity (NCV) was reduced in three cases. P100 latency of visual evoked potentials was delayed in four cases, interpeaks I–III and I–V of brainstem auditory evoked potentials (BAEPs) was increased in two and interpeak N13–20 of upper limb somatosensory evoked potentials (SEPs) was slowed in one. After 4 months of therapy with CDCA, NCV was normal and did not show any significant change during the 11 years of observation. Central motor conduction time of motor evoked potentials (MEPs) and N24–P40 interpeak latency of lower limb SEPs were increased in five and four cases, respectively, in spite of 2/3-year treatment with CDCA. Improvement of evoked potentials, especially of MEPs and SEPs, was slower and continued over the whole 11-year period. The size of xanthomas slightly decreased in some patients during treatment and the clinical manifestations stabilized, avoiding progressive worsening, but there was no significant improvement in neurological deficit. Two sisters of patients who never took CDCA showed progressive worsening of clinical manifestations, upper limb SEPs and BAEPs.     

Auditory and visual P300 cognitive evoked responses in patients with COPD: relationship to degree of pulmonary impairment.

Twenty-two subjects with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on cognitive P300 auditory and visual evoked potentials. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. Auditory P300 latency was significantly correlated with the FEV1/FVC ratio (Pearson Product Moment correlations r = -.56, N = 20, probability level = 0.1), indicating that increasingly severe airflow impairment is associated with longer auditory P300 latencies. There was no significant association of FEV1/FVC with visual P300 latency or with auditory or visual evoked potential amplitude measures. Progressive impairment of the auditory P300 evoked potential latency occurs with increasing severity of COPD. This impairment is present even in patients with mild COPD, suggesting some degree of accompanying cognitive decline early in the course of COPD with worsening as the disease progresses.     

Cortical and spinal evoked potentials in parkinsonism. Part I. Visual potentials evoked with a checkerboard pattern

In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).     

Electroencephalogram and evoked potential parameters examined in Chinese mild head injury patients for forensic medicine

Objective To evaluate the usefulness of quantitative electroencephalogram （QEEG）, flash visual evoked potential （F-VEP） and auditory brainstem responses （ABR） as indicators of general neurological status. Methods Comparison was conducted on healthy controls （N=30） and patients with brain concussion （N=60） within 24 h after traumatic brain injury. Follow-up study of patient group was completed with the same standard paradigm 3 months later. All participants were recorded in multi-modality related potential testing in both early and late concussion at the same clinical setting. Glasgow coma scale, CT scanning, and physical examinations of neuro-psychological function, optic and auditory nervous system were performed before electroencephalogram （EEG） and evoked potential （EEG-EP） testing. Any participants showed abnormal changes of clinical examinations were excluded from the study. Average power of frequency spectrum and power ratios were selected for QEEG testing, and latency and amplitude of F-VEP and ABR were recorded. Results Between patients and normal controls, the results indicated： （1） Highly significance （P 〈 0.01） in average power of α1 and power ratios of θ/α1, 0/α2, α1/α2 of EEG recording; （2） N70-P 100 amplitude of F-VEP in significant difference at early brain concussion; and （3） apparent prolongation of Ⅰ～Ⅲ inter-peak latency of ABR appeared in some individuals at early stage after concussion. The follow-up study showed that some patients with concussion were also afflicted with characteristic changes of EEG components for both increments of α1 average power and θ/α2 power ratio after 3 months recording. Conclusion EEG testing has been shown to be more effective and sensitive than evoked potential tests alone on detecting functional state of patients with mild traumatic brain injury （MTBI）. Increments of α1 average power and θ/α2 power ratio are the sensitive EEG parameters to determining early concussion and evaluating outcome of postconcussion symptoms （PCS）. Follow-up study associated with persistent PCS may be consistent with the postulate of substantial biological, rather than psychological origin. The study suggests that combination of EEG and EP parameters can contribute to the evaluation of brain function as a whole for clinical and forensic applications.     

Sensory and cognitive evoked potentials in a case of congenital hydrocephalus

We studied auditory and visual evoked potentials in D.W., a patient with congenital stenosis of the cerebral aqueduct. Head CT scans revealed marked hydrocephalus with expanded ventricles filling more than 80% of the cranium and compressing brain tissue to less than 1 cm in thickness. Despite the striking neuroanatomical abnormalities, however, the patient functioned well in daily life and was attending a local community college at the time of testing. Evoked potentials provided evidence of preserved sensory processing at cortical levels. Pattern reversal visual evoked potentials had normal latencies and amplitudes. Brain-stem auditory evoked potentials (BAEPs) showed normal wave V latencies. Na and Pa components of middle-latency AEP had normal amplitudes and latencies at the vertex, although amplitudes at lateral electrodes were larger than at the midline. In contrast to the normal sensory responses, long-latency auditory evoked potentials to standard and target tones showed abnormal P3 components. Standard tones (probability 85%), evoked N1 components with normal amplitudes (-3.7 microV) and latencies (103 msec), but also elicited large P3 components (17 microV, latency 305 msec) that were never observed following frequent stimuli in control subjects. Target stimuli (probability 15%) elicited P3s in D.W. and controls, but P3 amplitudes were enhanced in D.W. (to more than 40 microV) and the P3 showed an unusual, frontal distribution. The results are consistent with a subcortical source of the P300. Moreover, they suggest that the substitution of controlled for automatic processes may help high-functioning hydrocephalics compensate for abnormalities in cerebral structure.     

Origin of short latency somatosensory evoked potential in cats: especially potentials derived from thalamus and cortex

Short latency somatosensory evoked potential (SSEP) was recorded in cats to identify the potentials originating from the cortex and the thalamus, and the following results were obtained. When SSEP was elicited on the bregma by stimulation of the contralateral superficial radial nerve, P2, P4, P4.5, P5.5, P7, P8, N8.5, P11, P9.5, N11.5, N12.5 and N14 were recognized. Of these components N11.5, N12.5 and N14 consisted of large negative potential (LNP). When KCl was applied to the sensorimotor cortex to induce spreading depression, the positive component of the primary evoked potential was markedly decreased and the negative component disappeared. In SSEP, components preceding N8.5 were unchanged. N8.5-P11 and P11-N12.5, however, markedly diminished or disappeared. The latency of the first component of the field potential recorded in the VPL nucleus of the thalamus was about 5 ms. When a small amount of Nembutal was injected into VPL nucleus, components between P2 and P4.5 remained unchanged, but P5.5 disappeared. P7, P8 and N8.5 were preserved. The amplitude of N8.5-P11 was markedly decreased and LNP disappeared. From these results, among various components of SSEP, P5.5 should originate from the thalamus, and P7, P8 and N8.5 from the extralemniscal system. N8.5-P11 should mainly represent post-synaptic potential (PSP) in the deep somatic layer, and P11-N12.5 represent PSP in the apical dentrites of the sensorimotor cortex. N14 probably represents PSP via the diffuse projection system. Thus, LNP should consist of complex potentials of specific and non-specific sensory systems.