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Evoke [Password]l
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processing.... Drugs & Diseases > Neurology Clinical Utility of Evoked Potentials Updated: Oct 25, 2019 Author: Andrew B Evans, MD; Chief Editor: Selim R Benbadis, MD more...
Share Email Print Feedback Close Facebook Twitter LinkedIn WhatsApp webmd.ads2.defineAd(id: 'ads-pos-421-sfp',pos: 421); Sections Clinical Utility of Evoked Potentials Sections Clinical Utility of Evoked Potentials Overview Visual Evoked Potential Brainstem Auditory Evoked Potentials Somatosensory Evoked Potentials Current Clinical Role of Evoked Potentials Questions & Answers Show All References Overview Overview Evoked potentials (EPs), or evoked responses, measure the electrophysiologic responses of the nervous system to a variety of stimuli. In theory, almost any sensory modality can be tested; however, in clinical practice, only a few are used on a routine basis. The EPs most frequently encountered are the following:
Late evoked responses are generally used for studying higher cortical functions (eg, P300 in Alzheimer disease). Their clinical usefulness is limited by the experimental paradigm, and they are not used routinely or widely in general clinical neurology. Nevertheless, late evoked responses show promise and may make more inroads into clinical settings in the near future. Some centers have developed testing paradigms for olfactory and gustatory evoked responses as well.
The visual evoked potential (VEP) tests the function of the visual pathway from the retina to the occipital cortex. It measures the conduction of the visual pathways from the optic nerve, optic chiasm, and optic radiations to the occipital cortex. It is important to keep in mind that although the axons from the nasal half of the retina decussate at the optic chiasm, the temporal axons do not. Therefore, retrochiasmatic lesions may not be detected by full-field checkerboard stimulation.
The usual VEPs are evoked by checkerboard stimulation. Because the cells of the visual cortex are maximally sensitive to movement at the edges, a pattern-shift method is used, with a frequency of 1-2 Hz. The size of the checks affects the amplitude of the waveform and the latency of the P100.
The brainstem auditory evoked potential (BAEP), or brainstem auditory evoked response (BAER), measures the functioning of the auditory nerve and auditory pathways in the brainstem (see the image below).
BAEPs are useful in estimating or aiding in the assessment of hearing loss. The most commonly used method for this is evoked response audiometry. The frequency of stimulation is 50-70 Hz, and at least 3 different intensities should be used. Wave V latency shifts are used to estimate the amount of hearing loss.
Purves et al reported that pattern-shift visual evoked potentials (VEPs) were abnormal in 45% of patients without brainstem signs, somatosensory evoked potentials (SEPs) were abnormal in 35%, and BAEPs were abnormal in 14%. [28] When the 3 modalities were considered together, 97% of patients with definite MS, 86% of patients with probable MS, and 63% of patients with possible MS had abnormal findings on at least 1 of these tests. [28] Similar findings were reported by Ferrer et al. [29]
Taylor et al studied BAEP and VEP in 47 infants with meningomyelocele in an effort to determine whether evoked potentials EPs reflect early neurologic status and whether BAEPs and VEPs have prognostic value for neurologic outcome. [34] The infants, aged 1 day to 3 months, were tested while still in hospital after the meningomyelocele repair.
The first evoked potential (EP) measurement is credited to Richard Caton of Liverpool, England, in 1913, but he could not record his results because he had no camera. About 34 years later, the first human scalp recording was accomplished. Major improvements included introduction of the first signal averager (by Dawson in 1954) and of the first modern averager, in 1958.
In this study, electrical stimuli were applied to the tibial nerve in the popliteal fossa to study how the information is transferred from group I muscle afferents to motor neurons and to the somatosensory cortex. [39] For control purposes, identical stimuli were applied to the skin. The SEP evoked by skin stimulation alone had a peak latency that was 5 msec longer than the SEP to transcutaneous nerve stimulation. The threshold intensity to evoke an H reflex was at least twice as high as the threshold for an SEP.
Comparisons of SEP, visual evoked potential (VEP), and brainstem auditory evoked potential (BAEP) have found that VEP testing and SEP testing are about equally sensitive for revealing clinically unsuspected lesions and that BAEP is one half to one third less sensitive. The 3 tests should be viewed as complementary.
Recording motor evoked potential (MEP) and SEP during thoracoabdominal aortic surgery to assess ischemia of the spinal cord has been valued by a number of authors as a means of lowering the risk of postoperative neurologic injury. [59] Polo et al found SEP and MEP to be useful in scoliosis surgery for assessing hypotension-related anoxic cord injury. [60] Weigang et al found SEP monitoring to be useful in thoracoabdominal aortic endovascular stent grafting for prevention of spinal cord anoxia. [61]
Valeriani studied cortical myoclonus and concluded that the initial giant SEP corresponded to physiologic potentials evoked in healthy subjects, whereas the late giant SEP could be explained by the hyperpolarization that follows the postsynaptic excitation of the early components.
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