Evoked Potentials.2,3,14-17
15.11.3 Evoked Potentials.2,3,14-17
Several types of evoked potentials (stimulated electrical signals) may be recorded: brainstem auditory evoked potentials (BAEPs), somatosensory evoked potentials (SSEPs, including various types such as the following, which are not mutually exclusive: short-latency, upper extremity, lower extremity, median nerve, posterior tibial nerve), and visual evoked potentials (VEPs, including pattern [PVEP] and flash [FVEP]). As in EEG, evoked potential testing uses recording electrodes and produces tracings.
Electrode terminology resembles that of EEGs (see above), with additional or modified electrodes such as the following,3 which may be used without expansion:
BAEP electrodes: |
|
Ac |
contralateral earlobe |
Ai |
ipsilateral earlobe |
EAM |
external auditory meatus |
EAMc |
contralateral EAM |
EAMi |
ipsilateral EAM |
M1 M2 |
mastoid process |
Mc |
contralateral M |
Mi |
ipsilateral M |
SSEP electrodes: |
|
AC |
anterior cervical |
C1′, C2′, C3′, C4′ |
near EEG C1, C2, C3, C4 |
C2S, C5S |
C2, C5 spinous processes |
Cc |
contralateral C3′ or C4′ |
Ci |
ipsilateral C3′ or C4′ |
CP |
midway between C3 or C4 and P3 or P4 |
CPc |
contralateral CP |
CPi |
ipsilateral CP |
Cz′ |
near 10–20 Cz |
EP |
Erb point |
EP1, EP2 |
left and right EP |
EPi |
ipsilateral EP |
Fpz′ |
near EEG Fpz |
IC |
iliac crest |
L2S, L3S |
L2, L3 spinous processes |
LN |
lateral neck |
LNi |
ipsilateral LN |
PFd, PFp |
popliteal fossa (distal, proximal) |
REF |
reference |
T6S, T10S, T12S |
T6, T10, T12 spinous processes |
VEP electrodes: |
|
I |
inion |
LO |
left occipital |
LT |
left posterior temporal |
MF |
midfrontal |
MO |
midoccipital |
MP |
midparietal |
RO |
right occipital |
RT |
right posterior temporal |
V |
vertex |
Waveforms recorded in evoked potential testing are identified with P for positive or N for negative plus a number indicating milliseconds between stimulus and response in normal adults:
VEP: |
N75, N100, N155, P75, P100, P135 |
SSEP: |
N9, N11, N13, N15, N18, N20, N34, N35, P9, P11, P13, P15, P27, P37 |
SSEPs were…recorded from the brachial plexus (Erb potential), cervical spine at C2 (N13), and the contralateral parietal area (N19) with a frontal (Fz) reference.
SSEPs showed normal Erb point and cervical potentials and significant delay of scalp components (N20 latency >>3 SDs, N13-N20 central conduction time >3 SDs, bilaterally).
Persistent delay of the P100 wave of the pattern-reversal VEP after an episode of optic neuritis is considered to be compatible with residual demyelination within the optic nerve.
An additional SSEP wave is the LP (lumbar potential).
Other waves, eg, in BAEP, are designated with roman numerals:
I through VII |
vertex-positive waves |
I′ through VI′ |
vertex-negative waves |
BAEPs of the proband showed normal wave I, increased latency of waves II and III (>3 SDs), and absent IV and V components despite normal hearing acuity.
I-III interpeak interval
V/I amplitude ratio