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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Dec 1997; 63(6): 759–764.
PMCID: PMC2169855

Event related potentials recorded in patients with locked-in syndrome

Abstract

OBJECTIVE—To determine the possibility of recording "cognitive" event related potentials (ERPs) in locked-in patients and therefore to determine whether ERPs can have a role in differential diagnosis of coma.
METHODS—ERPs to classic auditory or visual "odd ball paradigms" were recorded three to four days, seven to eight days, and 30 to 60days after admission to the intensive care unit, in four patients affected by basilar artery thrombembolism resulting in locked-in syndrome. Two patients (one 32 year old man, one 31 year old woman) could move the eyes laterally and vertically spontaneously and on command. One patient (a 39 year old man) had a "one and half syndrome", one patient (a 40 year old woman) could only elevate the left eyelid and eye. Results were compared with data from 30 age matched controls. In the last recording session a letter recognition paradigm was applied, in which ERPs were produced by the identification of letters forming a word. Results were compared with five age matched controls. Brainstem lesions extending to the pontomesencephalic junction were found on MRI and CT.
RESULTS—ERPs to the oddball paradigms were recorded in three patients in the first recording session, in all patients in the second recording session. Latency, amplitude, and topographic distribution of ERP components were inside normal limits. With the letter recognition paradigm the patients could emit a P3 component to correspond with target letters, with the same margin of error as controls.
CONCLUSION—It is possible to record ERPs in patients with locked-in syndrome shortly after the acute ischaemic lesion, and therefore to assess objectively cognitive activities. Furthermore the letter recognition paradigm could be implemented to facilitate linguistic communication with patients with locked-in syndrome.

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Selected References

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  • Ritter W, Vaughan HG., Jr Averaged evoked responses in vigilance and discrimination: a reassessment. Science. 1969 Apr 18;164(3877):326–328. [PubMed]
  • Polich J. P300 from a passive auditory paradigm. Electroencephalogr Clin Neurophysiol. 1989 Jul-Aug;74(4):312–320. [PubMed]
  • Renault B, Signoret JL, Debruille B, Breton F, Bolgert F. Brain potentials reveal covert facial recognition in prosopagnosia. Neuropsychologia. 1989;27(7):905–912. [PubMed]
  • Stuss DT, Sarazin FF, Leech EE, Picton TW. Event-related potentials during naming and mental rotation. Electroencephalogr Clin Neurophysiol. 1983 Aug;56(2):133–146. [PubMed]
  • Deecke L, Bashore T, Brunia CH, Grünewald-Zuberbier E, Grünewald G, Kristeva R. Movement-associated potentials and motor control. Report of the EPIC VI Motor Panel. Ann N Y Acad Sci. 1984;425:398–428. [PubMed]
  • Simson R, Vaughan HG, Ritter W. The scalp topography of potentials associated with missing visual or auditory stimuli. Electroencephalogr Clin Neurophysiol. 1976 Jan;40(1):33–42. [PubMed]
  • Hillyard SA, Hink RF, Schwent VL, Picton TW. Electrical signs of selective attention in the human brain. Science. 1973 Oct 12;182(4108):177–180. [PubMed]
  • Desmedt JE. P300 in serial tasks: an essential post-decision closure mechanism. Prog Brain Res. 1980;54:682–686. [PubMed]
  • Picton TW. The P300 wave of the human event-related potential. J Clin Neurophysiol. 1992 Oct;9(4):456–479. [PubMed]
  • Rugg MD, Pickles CD, Potter DD, Roberts RC. Normal P300 following extensive damage to the left medial temporal lobe. J Neurol Neurosurg Psychiatry. 1991 Mar;54(3):217–222. [PMC free article] [PubMed]
  • Onofrj M, Fulgente T, Nobilio D, Malatesta G, Bazzano S, Colamartino P, Gambi D. P3 recordings in patients with bilateral temporal lobe lesions. Neurology. 1992 Sep;42(9):1762–1767. [PubMed]
  • Polich J, Squire LR. P300 from amnesic patients with bilateral hippocampal lesions. Electroencephalogr Clin Neurophysiol. 1993 Jun;86(6):408–417. [PubMed]
  • O'Donnell BF, Cohen RA, Hokama H, Cuffin BN, Lippa C, Shenton ME, Drachman DA. Electrical source analysis of auditory ERPs in medial temporal lobe amnestic syndrome. Electroencephalogr Clin Neurophysiol. 1993 Dec;87(6):394–402. [PubMed]
  • Tarkka IM, Stokić DS, Basile LF, Papanicolaou AC. Electric source localization of the auditory P300 agrees with magnetic source localization. Electroencephalogr Clin Neurophysiol. 1995 Nov;96(6):538–545. [PubMed]
  • Halgren E, Baudena P, Clarke JM, Heit G, Liégeois C, Chauvel P, Musolino A. Intracerebral potentials to rare target and distractor auditory and visual stimuli. I. Superior temporal plane and parietal lobe. Electroencephalogr Clin Neurophysiol. 1995 Mar;94(3):191–220. [PubMed]
  • Baudena P, Halgren E, Heit G, Clarke JM. Intracerebral potentials to rare target and distractor auditory and visual stimuli. III. Frontal cortex. Electroencephalogr Clin Neurophysiol. 1995 Apr;94(4):251–264. [PubMed]
  • Onofrj M, Fulgente T, Thomas A, Locatelli T, Comi G. P300 asymmetries in focal brain lesions are reference dependent. Electroencephalogr Clin Neurophysiol. 1995 Jun;94(6):432–439. [PubMed]
  • Yingling CD, Hosobuchi Y. A subcortical correlate of P300 in man. Electroencephalogr Clin Neurophysiol. 1984 Feb;59(1):72–76. [PubMed]
  • Rogers RL, Baumann SB, Papanicolaou AC, Bourbon TW, Alagarsamy S, Eisenberg HM. Localization of the P3 sources using magnetoencephalography and magnetic resonance imaging. Electroencephalogr Clin Neurophysiol. 1991 Oct;79(4):308–321. [PubMed]
  • Onofrj M, Curatola L, Malatesta G, Colamartino P, Bazzano S, Fulgente T, Ferracci F. Delayed P3 event-related potentials (ERPs) in thalamic hemorrhage. Electroencephalogr Clin Neurophysiol. 1992 Jul;83(1):52–61. [PubMed]
  • Yingling CD, Hosobuchi Y, Harrington M. P300 as a predictor of recovery from coma. Lancet. 1990 Oct 6;336(8719):873–873. [PubMed]
  • Kane NM, Curry SH, Butler SR, Cummins BH. Electrophysiological indicator of awakening from coma. Lancet. 1993 Mar 13;341(8846):688–688. [PubMed]
  • Farwell LA, Donchin E. Talking off the top of your head: toward a mental prosthesis utilizing event-related brain potentials. Electroencephalogr Clin Neurophysiol. 1988 Dec;70(6):510–523. [PubMed]
  • Onofrj M, Fulgente T, Thomas A. Event related potentials recorded in Dorsal Simultanagnosia. Brain Res Cogn Brain Res. 1995 Dec;3(1):25–32. [PubMed]
  • Duffy FH, Bartels PH, Burchfiel JL. Significance probability mapping: an aid in the topographic analysis of brain electrical activity. Electroencephalogr Clin Neurophysiol. 1981 May;51(5):455–462. [PubMed]
  • Verhagen WI, Huygen PL, Schulte BP. Clinical and electrophysiological study in a patient surviving from locked-in syndrome. Clin Neurol Neurosurg. 1986;88(1):57–61. [PubMed]
  • Towle VL, Maselli R, Bernstein LP, Spire JP. Electrophysiologic studies on locked-in patients: heterogeneity of findings. Electroencephalogr Clin Neurophysiol. 1989 Nov;73(5):419–426. [PubMed]
  • Gütling E, Isenmann S, Wichmann W. Electrophysiology in the locked-in-syndrome. Neurology. 1996 Apr;46(4):1092–1101. [PubMed]
  • Maurri S, Lambruschini P, Barontini F. Total mesencephalic "locked-in" syndrome. A case report and review of the literature. Riv Neurol. 1989 Nov-Dec;59(6):211–216. [PubMed]
  • Steriade M, Gloor P, Llinás RR, Lopes de Silva FH, Mesulam MM. Report of IFCN Committee on Basic Mechanisms. Basic mechanisms of cerebral rhythmic activities. Electroencephalogr Clin Neurophysiol. 1990 Dec;76(6):481–508. [PubMed]

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