Sensorimotor central conduction time in comatose patients.
Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comatose as a result of head injury (13 cases), stroke (7 cases) or anoxia (2 cases). Somatosensory evoked potentials (SEPs) from median nerve were recorded as well in 19 cases in the same session. Thirteen patients died or remained vegetative (59.1%), 3 were severely disabled (13.6%) and 6 showed a good recovery (27.3%). MEPs were significantly related to the outcome; they appeared to be a more accurate prognostic indicator than the Glasgow Coma Scale (GCS). However, 1 out of 6 patients with bilaterally absent MEPs (16.7%) showed a good recovery. SEPs were significantly related to the outcome as well, but the combined use of SEP and MEP improved the outcome prediction, decreasing the rate of false negatives. Two patients had normal sensorimotor function, 13 a combined sensorimotor dysfunction, while 4 had a pure motor dysfunction. Our results suggest that SEPs and MEPs may improve the assessment of sensorimotor dysfunction in comatose patients. A significant relationship between MEPs and outcome appears to exist, but the assessment of MEP reliability requires further study.
Facco
E
E
Department of Anesthesiology and Intensive Care, University of Padua, Italy.
Baratto
F
F
Munari
M
M
Donà
B
B
Casartelli Liviero
M
M
Behr
A U
AU
Giron
G P
GP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003128:Coma / Q000503:physiopathology*; D004558:Electric Stimulation; D005071:Evoked Potentials / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D008280:Magnetics; D008875:Middle Aged; D009132:Muscles / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology*; D011379:Prognosis; D012044:Regression Analysis; D013997:Time Factors