The cervical somatosensory evoked potential in man: far-field, conducted and segmental components

Somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from neck and scalp electrodes in 23 normal adults using cephalic and non-cephalic (knee) references simultaneously. With a cephalic reference, the neck SEP consisted of several 'negative' potentials that had the same latency at all recording locations. Simultaneous recordings from neck-scalp, neck-knee and scalp-knee derivations demonstrated that scalp far-field potentials significantly contributed to neck-to-scalp recordings and obscured the cervical SEPs. With a non-cephalic reference, the neck SEP consisted of a prominent positive wave (P9) followed by a large negative component (N13). A small positive potential, P10, seen in the lower neck, gradually increased in latency and amplitude from lower to upper neck and appeared as a P11 potential at upper cervical levels. In lower neck recordings, a negative wave, N11, was also present and in some subjects exhibited a latency shift from lower to upper neck. P9, P11 and N11 had a short refractory period suggesting a presynaptic origin whereas N13 had a longer refractory period indicating a postsynaptic generator. The consensus that P9 originates in the peripheral nervous system is consistent with its rapid recovery cycle. The bipolar characteristics of N11 and P11 as well as their latency shift and their short recovery cycle suggest that they reflect activity in the cervical dorsal columns. N13, that displayed no latency shift and had a longer recovery cycle, may originate in spinal cord dorsal horn interneurons.