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Published on: December 18, 2015
Let live or let die after traumatic coma: Scrutinizing somatosensory evoked potentials
Jacques Luauté1, François Cotton1, Jean-Jacques Lemaire1
1Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France.
Abstract:
It is now firmly established that bilateral abolition of somatosensory evoked potentials (SEPs) after a nontraumatic coma has 100% specificity for nonawakening. In traumatic coma, a bilateral absence of the N20 components of SEPs does not implicate nonawareness. Comatose brain-injured patients should be systematically explored with auditory evoked potentials to check the functional integrity of another sensory pathway and the mesencephalic tegmento-tectal region on cerebral MRI should be carefully examined. Repeated evaluations during follow-up are also mandatory.
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