Late Auditory and Event-Related Potentials Can Be Useful to Predict Good Functional Outcome After Coma

doi:10.1016/j.apmr.2004.08.011

Archives of Physical Medicine and Rehabilitation

Volume 86, Issue 5, May 2005, Pages 917-923

https://doi.org/10.1016/j.apmr.2004.08.011 Get rights and content

Abstract

Luauté J, Fischer C, Adeleine P, Morlet D, Tell L, Boisson D. Late auditory and event-related potentials can be useful to predict good functional outcome after coma.

Objective

To investigate whether late auditory and event-related potentials, and in particular N100 and mismatch negativity, together with clinical parameters, can help to predict good functional outcome in comatose patients.

Design

Prospective cohort study.

Setting

Hospital.

Participants

Consecutively sampled comatose patients (N=346) whose etiologies of coma were stroke (125 patients), brain injury (96 patients), anoxia (64 patients), complication of neurosurgery (54 patients), and encephalitis (7 patients).

Interventions

Not applicable.

Main outcome measures

Glasgow Outcome Scale score at 1 year postonset. Patients in a minimally conscious state and those who awoke and died during the follow-up period were classified separately.

Results

Univariate analysis showed that all variables studied, except brainstem auditory evoked potentials, correlated significantly with functional outcome. Mismatch negativity showed the highest positive predictive value for good outcome. A validated model was obtained with multivariate logistic analysis, including pupillary light reflex, N100, mismatch negativity, etiology, and age.

Conclusions

Late auditory and event-related potentials, and particularly N100 and mismatch negativity, provide strong prognostic factors for good functional outcome. Furthermore, these components may enhance the accuracy of prognosis when associated with other clinical parameters available at the early stage of coma.

Section snippets

Inclusion criteria

Between December 1997 and February 2002, all comatose patients admitted to intensive care unit (ICU) with a Glasgow Coma Scale (GCS) score of less than 8 were included in this study. The sample totaled 346 patients (213 men, 133 women) between the ages of 8 and 93 years (mean age, 50.73±17.9y), with a GCS score of less than 8 at the time of electrophysiologic recording (GCS score 3 and 4, 156 cases; GCS score 5 to 7, 190 cases). All patients had undergone at least 1 brain computed tomography

Results

Of the 346 consecutive patients included in this study, 1 year after onset of coma, 102 patients (29%) died (GOS, 1), 8 patients (2%) were considered to be in a permanent vegetative state (GOS, 2), 31 patients (9%) were in a minimally conscious state, 60 patients (17%) were severely disabled (GOS, 3), 76 patients (22%) had moderate disabilities (GOS, 4), 46 patients (13%) had a complete recovery (GOS, 5), and 26 patients (8%) awoke and died before 1 year.

Thus, the statistical analysis included

Discussion

Our study showed that the presence of mismatch negativity is a strong predictor of good outcome with a high specificity; furthermore, it showed that a reliable model for good outcome can be obtained with clinical and electrophysiologic data.

Because electrophysiology provides objective assessment of the functional state of the brain, many researchers have used evoked potentials for prognostication of coma outcome. However, strong prognostic markers are missing for good outcome. Primary cortical

Conclusions

Our study showed, using a large sample and a comprehensive statistical analysis, that late AEPs and ERPs are strong individual prognostic factors for good functional outcome. Furthermore, in association with other relevant clinical parameters, several profiles of good functional outcome can be provided with high accuracy, using multivariate logistic regression analysis and/or tree-based analysis. Hence, with few clinical and electrophysiologic variables, which are easy to collect at the early

Supplier

Acknowledgments

We thank Michelle Canova for her helpful participation in constructing tables of the statistical analysis. We thank Professor Hadyn Ellis for his helpful contribution in correcting English grammar.

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Citation Excerpt :
Despite these contradictory findings, more recent studies (Zanatta et al., 2012, 2015; Del Felice et al., 2017) found that the preservation of the N70 component in HIE was associated with a good long-term functional recovery (PPV 100%, 95% CI 87–100%). The literature on MMN in comatose patients provides robust evidence of its predictive prognostic value for recovery (Kane et al., 1993; Fischer et al., 2004; Luauté et al., 2005; Naccache et al., 2005; Wijnen et al., 2007), across different etiologies and different time onsets ranging from a few days after coma (Kane et al., 1993) to weeks (Fischer et al., 2004; Naccache et al., 2005). A number of earlier studies converged on the conclusion that MMN was associated with awakening, especially in TBI with 100% PPV for recovery, which was confirmed also in a subset of sedated patients (Kane et al., 1993, 1996).
The analysis of spontaneous EEG activity and evoked potentials is a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). The past few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury, opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of both consolidated and investigational electrophysiological techniques for the prognostic and diagnostic assessment of DoC. We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats. The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation.
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Original articleLate Auditory and Event-Related Potentials Can Be Useful to Predict Good Functional Outcome After Coma

Abstract

Objective

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Inclusion criteria

Results

Discussion

Conclusions

Supplier

Acknowledgments

Lancet

Lancet

Electroencephalogr Clin Neurophysiol

Clin Neurophysiol

Clin Neurophysiol

Clin Neurophysiol

Lancet

Arch Phys Med Rehabil

Acta Psychol

Clin Neurophysiol

Lancet

Lancet

Ann Fr Anesth Reanim

Lancet

Arch Phys Med Rehabil

Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study

J Neurosurg

Middle latency auditory evoked potentials in intensive care patients and normal controls

Int J Neurosci

Comparison of speech-evoked v tone-evoked P300 responseimplications for predicting outcomes in patients with traumatic brain injury

Am J Phys Med Rehabil

Use of somatosensory-evoked potentials and cognitive event-related potentials in predicting outcomes of patients with severe traumatic brain injury

Am J Phys Med Rehabil

Event-related potentials—neurophysiological tools for predicting emergence and early outcome from traumatic coma

Intensive Care Med

Coma outcome prediction using event-related potentialsP(3) and mismatch negativity

Audiol Neurootol

Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment

Crit Care Med

Mismatch negativityclinical and other applications

Audiol Neurootol

The mismatch negativitya powerful tool for cognitive neuroscience

Ear Hearing

Original article
Late Auditory and Event-Related Potentials Can Be Useful to Predict Good Functional Outcome After Coma