Predictive value of sensory and cognitive evoked potentials for awakening from coma

被引:148
作者
Fischer, C
Luauté, J
Adeleine, P
Morlet, D
机构
[1] Hospices Civils Lyon, Dept Clin Neurophysiol, Lyon, France
[2] Hospices Civils Lyon, Dept Neurol Rehabil, Lyon, France
[3] Hospices Civils Lyon, Dept Biostat, Lyon, France
[4] Univ Lyon 1, EA1880, F-69365 Lyon, France
[5] INSERM, U280, F-69008 Lyon, France
关键词
D O I
10.1212/01.WNL.0000134670.10384.E2
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives: To determine the prognostic role of late auditory (N100) and cognitive evoked potentials (MMN) for awakening in a cohort of comatose patients categorized by etiology. Methods: The authors prospectively studied a series of 346 comatose patients. Coma was caused by stroke (n=125), trauma (n=96), anoxia (n=64), complications of neurosurgery (n=54), and encephalitis (n=7). Patients were followed for 12 months and classified as awake or unawake. Univariate and multivariate analyses were performed using regression logistic and Cox models. Results: Pupillary light reflex, N100, middle-latency auditory evoked potentials, age, and etiology were the most discriminating factors for awakening. Statistical analysis showed that pupillary reflex was the strongest prognostic variable for awakening ( estimated probability 79.7%). The estimated probability of awakening rose to 87% when N100 was present and to 89.9% when middle-latency evoked potentials (MLAEPs) were present. It was 13.7% when pupillary reflex was absent in anoxic patients. When MMN was present, 88.6% of patients awakened. No patient in whom MMN was present became permanently vegetative. Conclusion: Pupillary reflex is the strongest prognostic variable, followed by N100 and MLAEPs allowing a reliable model for awakening. The presence of MMN is a predictor of awakening and precludes comatose patients from moving to a permanent vegetative state. Evaluation of primary sensory cortex and higher-order processes by middle-latency-, late, and cognitive evoked potentials should be performed in the prognosis for awakening in comatose patients.
引用
收藏
页码:669 / 673
页数:5
相关论文
共 21 条
[1]   Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression [J].
Andrews, PJD ;
Sleeman, DH ;
Statham, PFX ;
McQuatt, A ;
Corruble, V ;
Jones, PA ;
Howells, TP ;
Macmillan, CSA .
JOURNAL OF NEUROSURGERY, 2002, 97 (02) :326-336
[2]  
ASHWAL S, 1994, NEW ENGL J MED, V330, P1499
[3]  
ASHWAL S, 1994, NEW ENGL J MED, V330, P1572
[4]   Review of the use of somatosensory evoked potentials in the prediction of outcome after severe brain injury [J].
Carter, BG ;
Butt, W .
CRITICAL CARE MEDICINE, 2001, 29 (01) :178-186
[5]   Early recovery after closed traumatic head injury: Somatosensory evoked potentials and clinical findings [J].
Claassen, J ;
Hansen, HC .
CRITICAL CARE MEDICINE, 2001, 29 (03) :494-502
[6]   Mismatch negativity and N100 in comatose patients [J].
Fischer, C ;
Morlet, D ;
Giard, MH .
AUDIOLOGY AND NEURO-OTOLOGY, 2000, 5 (3-4) :192-197
[7]   Mismatch negativity and late auditory evoked potentials in comatose patients [J].
Fischer, C ;
Morlet, D ;
Bouchet, P ;
Luaute, J ;
Jourdan, C ;
Salord, F .
CLINICAL NEUROPHYSIOLOGY, 1999, 110 (09) :1601-1610
[8]   The minimally conscious state - Definition and diagnostic criteria [J].
Giacino, JT ;
Ashwal, S ;
Childs, N ;
Cranford, R ;
Jennett, B ;
Katz, DI ;
Kelly, JP ;
Rosenberg, JH ;
Whyte, J ;
Zafonte, RD ;
Zasler, ND .
NEUROLOGY, 2002, 58 (03) :349-353
[9]   ERPs obtained with the auditory oddball paradigm in coma and altered states of consciousness:: clinical relationships, prognostic value, and origin of components [J].
Guérit, JM ;
Verougstraete, D ;
de Tourtchaninoff, M ;
Debatisse, D ;
Witdoeckt, C .
CLINICAL NEUROPHYSIOLOGY, 1999, 110 (07) :1260-1269
[10]  
JENNETT B, 1975, LANCET, V1, P480