Brainstem auditory and visual evoked potentials in infants with myelomeningocele

Brainstem auditory evoked potentials (BAEPs) and visual evoked potentials (VEPs) were recorded in 47 infants with myelomeningocele to determine if the evoked potentials reflected the early neurological status, and if they had prognostic value as to the children's neurological outcome. The infants were tested between 1 day and 3 months of age (mean 24 days), while still in hospital after the myelomeningocele repair. Outcome was assessed at a mean of 2 years of age. Normal BAEPs were found in 41% and normal VEPs in 62% of the patients. BAEPs were abnormal in all infants studied who had symptomatic Arnold-Chiari (AC) malformation (n = 9); VEPs were abnormal in only 55% of symptomatic infants. Of the infants who did not have symptomatic AC malformation, 53% had normal BAEPs, 69% had normal VEPs. Of the patients with normal BAEPs, 81% had normal cerebral function on follow-up. Of the patients with abnormal BAEPs, 87% had central neurological abnormalities on follow-up. Of the patients with normal VEPs, 63% were normal on follow-up; of the patients with abnormal VEPs, 71% were abnormal on follow-up. Thus, the VEPs studied early in the neonatal course do not appear to be sufficiently sensitive to be valuable prognostically in these infants. However, the BAEPs were consistently abnormal in symptomatic AC malformation and showed a positive predictive value of 88% and an accuracy in predicting central neurological sequelae of 84%.