SEP testing in deeply comatose and brain dead patients: the role of nasopharyngeal,scalp and earlobe derivations in recording the P14 potential |
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| Institution: | 1. Central Integration of Pain (NeuroPain) Lab -Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron F-69677, France;2. Hospices Civils de Lyon, Neurological Hospital, Centre d’évaluation et traitement de la Douleur (CETD);3. Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan;2. Department of Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada;1. Department of Anesthesiology and Intensive Care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco;2. Emergency Department, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco;1. Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy;2. Department of Pediatrics, University of L''Aquila, L''Aquila, Italy;3. Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, ''G. Gaslini'' Institute, Genova, Italy;4. Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy;5. Oasi Research Institute (IRCCS), Unit of Neurology and Clinical Neurophysiopathology, Troina, Italy |
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| Abstract: | Median nerve somatosensory evoked potentials (SEPs) were tested in 50 patients (20 brain dead, 18 comatose and in 12 progessing from coma to brain death, i.e., 32 cases with brain death and 30 cases with coma were recorded).Derivations were taken from nasopharynx, earlobes, scalp, and neck using cephalic and non-cephalic references. Cortical and subcortical SEP components were evaluated, focussing on the P14 potential. There is evidence that rostral and caudal parts of the P14 generator (lemniscus medialis) are differently affected in brain death, resulting in an abolition of the rostral part, while occassionally leaving intact for some time the caudal part. Non-cephalic referenced scalp records pick up the whole P14 dipole, whereas nasopharyngeal and earlobe derivations pick up different parts of P14, depending on the reference used. Scalp-to-nasopharynx records derive the most rostral part of P14; this “rostral P14” was bilaterally lost in all brain dead patients, but preserved in all deeply comatose patients with diffuse brain-sttem injuries. Scalp-to-earlobe records in contrast, picked up a P14 dipole segment reaching more caudally, resulting in a P14 potential also in brain dead patients. It is concluded that midfrontal scalp-to-nasopharynx derivations give the moset valuable contribution to the electrophysiological assessment of brain death versus deep coma. |
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