Facco E, Baratto F, Munari M, Donà B, Casartelli Liviero M, Behr A U, Giron G P
Department of Anesthesiology and Intensive Care, University of Padua, Italy.
Electroencephalogr Clin Neurophysiol. 1991 Nov-Dec;80(6):469-76. doi: 10.1016/0168-5597(91)90128-k.
Motor evoked potentials (MEPs) following magnetic stimulation were recorded in 22 patients comatose as a result of head injury (13 cases), stroke (7 cases) or anoxia (2 cases). Somatosensory evoked potentials (SEPs) from median nerve were recorded as well in 19 cases in the same session. Thirteen patients died or remained vegetative (59.1%), 3 were severely disabled (13.6%) and 6 showed a good recovery (27.3%). MEPs were significantly related to the outcome; they appeared to be a more accurate prognostic indicator than the Glasgow Coma Scale (GCS). However, 1 out of 6 patients with bilaterally absent MEPs (16.7%) showed a good recovery. SEPs were significantly related to the outcome as well, but the combined use of SEP and MEP improved the outcome prediction, decreasing the rate of false negatives. Two patients had normal sensorimotor function, 13 a combined sensorimotor dysfunction, while 4 had a pure motor dysfunction. Our results suggest that SEPs and MEPs may improve the assessment of sensorimotor dysfunction in comatose patients. A significant relationship between MEPs and outcome appears to exist, but the assessment of MEP reliability requires further study.
对22例因头部受伤（13例）、中风（7例）或缺氧（2例）而昏迷的患者进行了磁刺激后的运动诱发电位（MEP）记录。在同一次检查中，还对19例患者记录了正中神经的体感诱发电位（SEP）。13例患者死亡或呈植物状态（59.1%），3例严重残疾（13.6%），6例恢复良好（27.3%）。MEP与预后显著相关；它们似乎是比格拉斯哥昏迷量表（GCS）更准确的预后指标。然而，6例双侧MEP缺失的患者中有1例（16.7%）恢复良好。SEP也与预后显著相关，但SEP和MEP联合使用可改善预后预测，降低假阴性率。2例患者感觉运动功能正常，13例合并感觉运动功能障碍，4例为单纯运动功能障碍。我们的结果表明，SEP和MEP可能改善对昏迷患者感觉运动功能障碍的评估。MEP与预后之间似乎存在显著关系，但MEP可靠性的评估需要进一步研究。
