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Prognostic Value of Evoked Responses and Event-Related Brain Potentials in

Published online by Cambridge University Press:  02 December 2014

Jing Tian Wang
Cognitive Electrophysiology Laboratory, New York State Psychiatric Institute, New York, USA and the Cognitive/Clinical Neuroscience Unit, Department of Psychology, Life Science Center, Dalhousie University, Halifax, NS, Canada
G. Bryan Young
Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada
John F. Connolly
Cognitive/Clinical Neuroscience Unit, Department of Psychology, Life Science Center, Dalhousie University, Halifax, NS and the Departments of Psychiatry, Medicine (Neurology) & Pediatrics, Dalhousie University, Halifax, NS, Canada
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The behaviourally unresponsive patient, unable to exhibit the presence of cognition, constitutes a conundrum for health care specialists. Prognostic uncertainty impedes accurate management decisions and the application of ethical principles. An early, reliable prognosis is highly desirable. In this review investigations studying comatose patients with coma of different etiologies were selected. It is concluded that objective prognostication is enhanced by the use of electrophysiological tests. Persistent abnormalities of brainstem auditory evoked potentials and short-latency somatosensory evoked potentials reliably indicate the likelihood of irreversible neurological deficit or death. Meanwhile, the presence of “cognitive” event-related brain potentials (e.g., P300 and mismatch negativity) reflects the functional integrity of higher level information processing and, therefore, the likelihood of capacity for cognition. An approach that combines clinical and electrophysiological values provides optimal prediction of outcome and level of disability.

Copyright © The Canadian Journal of Neurological 2004


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