Median-evoked somatosensory potentials in severe XXXX : does initial loss of cortical potentials exclude recovery?

@entity1 @entity1545 @entity131 @entity2806 @entity772
OBJECTIVE: In @entity1 with severe @entity1545 (SBI) median-evoked somatosensory potentials (M-SSEP) serve as a prognostic tool. Bilateral loss of cortical responses (BLCR) is usually thought to be a reliable marker of poor prognosis. Prognostic accuracy to predict a poor outcome depends on the cause of @entity772 and is best in @entity2806 ( @entity2806 ) reaching almost 100% which is in contrast to @entity1 with other etiologies of @entity772 , especially @entity131 ( @entity131 ). Only little evidence exists on the possibility of electrophysiological recovery of BLCR in repeated or serial SSEP-examinations and detailed functional outcome in these cases. METHODS: 28 @entity1 (78.6% male, 21.4% female, mean age 43.1  18.6 years) from our in- @entity1 early (post-acute) neurorehabilitation center with BLCR in their first M-SSEP were re-examined after a mean interval of 66  55.8 days. SBI was caused by different etiologies. We retrospectively analyzed (a) the recovery rate from BLCR in consecutive M-SSEP and (b) the detailed functional outcome of those @entity1 with recovered cortical responses. RESULTS: 14/28 (50%) @entity1 with primarily BLCR showed re-occurrence of cortical potentials, either uni- or bilaterally. Of the 14 @entity1 , one died due to a non-neurological cause. Of the remaining 13 @entity1 6 - most of them suffering from @entity131 ( @entity131 ) - could be transferred to further continuing neurorehabilitation and achieved good functional long-term outcome. BLCR in @entity2806 still had a poor prognosis with none of our @entity1 achieving an outcome better than vegetative state. CONCLUSIONS: Electrophysiological recovery from primarily BLCR seems possible and is accompanied by good functional outcome in a relevant number of @entity1 . Thus caution is warranted in predicting a poor prognosis based predominantly on SSEP, especially in @entity1 with @entity131 . Focusing SSEP-examination on the early days after severe @entity1545 and performing only one examination in the case of BLCR may lead to systematic underestimation of the possibility of recovery.
