ERPs obtained with the auditory oddball paradigm in coma and altered states of consciousness: clinical relationships, prognostic value, and origin ofcomponents

Objective: To study the event related potentials (ERPs) in coma and altered states of consciousness, their relationship with the clinical status and c oma outcome. Methods: ERPs were recorded with a passive auditory oddball paradigm in 103 patients. Their probability of occurrence and the peak latencies and ampli tudes were studied as a function of the Glasgow Coma Score (GCS). Their rel ationship with outcome was studied in a subset of 83 patients examined with in the first 4 days, and expressed in terms of sensitivity, specificity, an d negative or positive prognostic values. Results: When present, the ERPs to rare stimuli consisted of a fronto-centr al negativity (N-endog mean latency: 330 ms) and a fronto-central positivit y (P-endog, mean latency: 431 ms) following the exogenous N100-P200 complex . Both their probability of occurrence and their latencies and amplitudes w ere related with the GCS in anoxic and traumatic comas. The N-endog and P-e ndog had high sensitivity with a negative predictive value of 70% and 100%, respectively; but a low specificity, with a positive predictive value of 4 4% and 41%, respectively. Conclusions: ERPs can be recorded in some comatose patients and are likely to reflect implicit orienting processes rather than preserved consciousness . Their presence implies a good prognosis but no conclusion can be drawn fr om their absence. (C) 1999 Elsevier Science ireland Ltd. All rights reserve d.