Origin and distribution of P13 and P14 far-field potentials after median nerve stimulation. Scalp,nasopharyngeal and neck recording in healthy subjects and in patients with cervical and cervico-medullary lesions

We studied median nerve SEPs in 10 healthy subjects, by means of simultaneous recording over the scalp, around the neck and near the ventral surface of the medulla using a nasopharyngeal (NP) electrode. This recording technique enabled us to clearly differentiate P13 and P14 potentials. The former was always found in NP records, while the latter was more evident in scalp traces. The same technique was used to study 9 patients with various lesions of the cervical cord or cervico-medullary junction. Patients with high cervical lesions demonstrated abnormalities of both P13 and P14 potentials, while patients with lesions of the cervico-medullary junction demonstrated a clear dissociation between normal P13 in scalp and NP traces, and abnormal scalp P14. Patients with lower cervical lesions, selectively involving the central grey matter, showed normal P13 and P14 potentials, in spite of abnormal N13 cervical responses. Our findings strongly suggest that both scalp and NP P13 have the same generators in higher segments of the cervical cord, and that NP more than scalp records are effective in analyzing the P13 response. We suggest that the selective recording of the P13 potential could be useful in the assessment of focal lesions of the higher cervical cord or of the cervico-medullary junction.