Evoked potentials for the prediction of vegetative state in the acute stage of coma

Abstract

For comatose patients in intensive care units, it is important to anticipate their functional outcome as soon and as reliably as possible. Among clinical variables the Glasgow Coma Score (GCS) and the patient's pupil reactivity are the strongest predictive variables. Evoked potentials help to assess objectively brain function. Over the past 20 years, numerous studies have assessed their prognostic utility in terms of awakening from coma. Fewer studies, however, have focused upon the utility of evoked potentials in predicting progression to the vegetative state. In this area evoked potentials appear to have a highly predictive value. In anoxic coma the abolition of somatosensory evoked potentials (SEPs) is related to a poor outcome, defined as death or survival in a vegetative state, with a 100% specificity. Following traumatic brain injury, the predictive value for unfavourable outcome is 98.5% when there are no focal injuries likely to abolish SEP cortical components. In contrast, the presence of event-related evoked potentials, and particularly mismatched negativity (MMN), is a strong predictor of awakening and precludes comatose patients from moving to a permanent vegetative state (PVS).