Cortical somatosensory evoked potentials in spinal cord injury patients

The amplitude and latency of somatosensory evoked potentials (SEPs) in healthy subjects depend on intensity of stimulation. The effect of this parameter on SEPs in patients with neurologic disorders has not been systematically studied, although it could have a profound impact if SEPs are to be used for prognostication. We have compared the latency and amplitude of SEPs in healthy subjects and patients with spinal cord injury (SCI). Stimulation intensity was standardized at two different biologically calibrated levels. Cortical SEPs in patients with SCI showed greater decrease in latency and increase in amplitude with increased intensity of stimulation in comparison to healthy subjects. These phenomena were observed in the majority of patients with incomplete SCI who subsequently showed improvement in cortical SEPs. We observed situations in which the SEP was absent with the usual intensity of stimulation and present only with the stronger stimulation intensity. Furthermore, SEP latencies often changed dramatically with different intensities of stimulation, potentially making any calculation of central conduction velocity meaningless without precise standardization of stimulation. These findings demonstrate a necessity for a biological calibration of stimulation intensity to improve the repeatability of SEPs. We suggest the use of two different standardized intensities of stimulation for SEP studies in SCI patients, one of which should be stronger than the intensity presently recommended.