Recording Of Visual Evoked Potentials Research Articles

The developmental effects of extremely low frequency electric fields on visual and somatosensory evoked potentials in adult rats

The purpose of our study was to investigate the developmental effects of extremely low frequency electric fields (ELF-EFs) on visual evoked potentials (VEPs) and somatosensory-evoked potentials (SEPs) and to examine the relationship between lipid peroxidation and changes of these potentials. In this context, thiobarbituric acid reactive substances (TBARS) levels were determined as an indicator of lipid peroxidation. Wistar albino female rats were divided into four groups; Control (C), gestational (prenatal) exposure (Pr), gestational+ postnatal exposure (PP) and postnatal exposure (Po) groups. Pregnant rats of Pr and PP groups were exposed to 50 Hz electric field (EF) (12 kV/m; 1 h/day), while those of C and Po groups were placed in an inactive system during pregnancy. Following parturition, rats of PP and Po groups were exposed to ELF-EFs whereas rats of C and Pr groups were kept under the same experimental conditions without being exposed to any EF during 68 days. On postnatal day 90, rats were prepared for VEP and SEP recordings. The latencies of VEP components in all experimental groups were significantly prolonged versus C group. For SEPs, all components of PP group, P2, N2 components of Pr group and P1, P2, N2 components of Po group were delayed versus C group. As brain TBARS levels were significantly increased in Pr and Po groups, retina TBARS levels were significantly elevated in all experimental groups versus C group. In conclusion, alterations seen in evoked potentials, at least partly, could be explained by lipid peroxidation in the retina and brain.

Lack of habituation of evoked visual potentials in analytic information processing style: evidence in healthy subjects.

Habituation is considered one of the most basic mechanisms of learning. Habituation deficit to several sensory stimulations has been defined as a trait of migraine brain and also observed in other disorders. On the other hand, analytic information processing style is characterized by the habit of continually evaluating stimuli and it has been associated with migraine. We investigated a possible correlation between lack of habituation of evoked visual potentials and analytic cognitive style in healthy subjects. According to Sternberg-Wagner self-assessment inventory, 15 healthy volunteers (HV) with high analytic score and 15 HV with high global score were recruited. Both groups underwent visual evoked potentials recordings after psychological evaluation. We observed significant lack of habituation in analytical individuals compared to global group. In conclusion, a reduced habituation of visual evoked potentials has been observed in analytic subjects. Our results suggest that further research should be undertaken regarding the relationship between analytic cognitive style and lack of habituation in both physiological and pathophysiological conditions.

Correlation of pattern reversal visual evoked potential parameters with the pattern standard deviation in primary open angle glaucoma.

To evaluate whether glaucomatous visual field defect particularly the pattern standard deviation (PSD) of Humphrey visual field could be associated with visual evoked potential (VEP) parameters of patients having primary open angle glaucoma (POAG). Visual field by Humphrey perimetry and simultaneous recordings of pattern reversal visual evoked potential (PRVEP) were assessed in 100 patients with POAG. The stimulus configuration for VEP recordings consisted of the transient pattern reversal method in which a black and white checker board pattern was generated (full field) and displayed on VEP monitor (colour 14″) by an electronic pattern regenerator inbuilt in an evoked potential recorder (RMS EMG EP MARK II). The results of our study indicate that there is a highly significant (P<0.001) negative correlation of P100 amplitude and a statistically significant (P<0.05) positive correlation of N70 latency, P100 latency and N155 latency with the PSD of Humphrey visual field in the subjects of POAG in various age groups as evaluated by Student's t-test. Prolongation of VEP latencies were mirrored by a corresponding increase of PSD values. Conversely, as PSD increases the magnitude of VEP excursions were found to be diminished.

Does athletic training in volleyball modulate the components of visual evoked potentials? A preliminary investigation

This longitudinal study investigated visual evoked potentials (VEPs) in 11 young female volleyball players who participated in extensive training for 2 years. The control group consisted of 7 age-matched female students who were not involved in any regular sports activity. Recordings of VEPs were performed twice: baseline recording (i.e., before training began) and after 2 years of systematic, volleyball-specific athletic training. The effect of athletic training on visual signal conductivity was assessed by recording the latency of N75, P100 and N135 components of the VEPs waveform. Extensive experience with volleyball training reduced signal conductivity time through visual pathway. Specifically, the latency of P100 was reduced on average by 2.2 ms during binocular viewing. Moreover, athletes had reduced N75 latency (difference of 3.3 ms) for visual stimuli that generated greater response from peripheral retina. These results indicate that sport training can affect very early sensory processing in athletes.

9. Visual stimulation for long-term monitoring of brain functions via evoked potentials evaluation

Introduction At present, predominantly stationary visual stimulators are used for diagnostic examination of visual evoked potentials (VEPs). They cover significantly the central visual field of the tested subject and such examination does not allow any other parallel activity during the stimulation. Therefore, it cannot be used e.g. for a long-term monitoring and evaluation of functional changes of CNS functions – for continual assessment of visual perception. Methods We have introduced a visual stimulator (Czech Republic patent No. 303192 pending), the principle of which is that the source of light stimuli is in periphery of the visual field – a row of light emitting diodes (LEDs) is placed on the head of a stimulated subject on a standard peak (a part of a baseball cap). A control unit switches individual LEDs (flash or motion stimuli are generated) and synchronizes VEPs evaluation. The set of LEDs is located about 20° from the center of the stimulus field. There are several variants of stimulation available because of significant inter-individual differences in reactivity of subjects to particular stimuli. The motion stimuli have similar parameters as stimulations used for clinical diagnostic purposes (see Kuba, M., Kubova, Z., Kremlacek, J., et al. Motion-onset VEPs: Characteristics, methods, and diagnostic use. Vision Res., 2007, vol. 47, p. 189–202 – http://dx.doi.org/10.1016/j.visres.2006.09.020 ). Recording of VEPs (with the use of built-in amplifiers) and on-line evaluation of their parameter changes can be done via “blue-tooth” transmission to a standard computer or in a built-in microprocessor (in preparation). Results Since using of this kind of VEPs examination does not interfere with common human activities, it is possible to use it not only for standard diagnostic purposes in neuro-ophthalmological diseases but also for monitoring of CNS function changes or level of vigilance/fatigue, e.g. in drivers or some other professions. Supported by EU project CZ.1.05/3.1.00/13.0284 and by Charles University project PRVOUK P37/07.

Corneal Abrasion and Visual Evoked Potentials Monitoring: Causes and Prevention

Aims: The objective of this review is to explore the methods of eye protection from corneal abrasions during general anesthesia as they relate to procedures utilizing visual evoked potentials (VEP) monitoring. Because these protective measures may lower the accuracy of the VEP equipment, we wish to establish through existing literature current effective eye protection (with a focus on TegadermTM) and why they could potentially interfere with VEP recording.

Usefulness of Intraoperative Monitoring of Visual Evoked Potentials in Transsphenoidal Surgery

Postoperative visual outcome is a major concern in transsphenoidal surgery (TSS). Intraoperative visual evoked potential (VEP) monitoring has been reported to have little usefulness in predicting postoperative visual outcome. To re-evaluate its usefulness, we adapted a high-power light-stimulating device with electroretinography (ERG) to ascertain retinal light stimulation. Intraoperative VEP monitoring was conducted in TSSs in 33 consecutive patients with sellar and parasellar tumors under total venous anesthesia. The detectability rates of N75, P100, and N135 were 94.0%, 85.0%, and 79.0%, respectively. The mean latencies and amplitudes of N75, P100, and N135 were 76.8 ± 6.4 msec and 4.6 ± 1.8 μV, 98.0 ± 8.6 msec and 5.0 ± 3.4 μV, and 122.1 ± 16.3 msec and 5.7 ± 2.8 μV, respectively. The amplitude was defined as the voltage difference from N75 to P100 or P100 to N135. The criterion for amplitude changes was defined as a > 50% increase or 50% decrease in amplitude compared to the control level. The surgeon was immediately alerted when the VEP changed beyond these thresholds, and the surgical manipulations were stopped until the VEP recovered. Among the 28 cases with evaluable VEP recordings, the VEP amplitudes were stable in 23 cases and transiently decreased in 4 cases. In these 4 cases, no postoperative vision deterioration was observed. One patient, whose VEP amplitude decreased without subsequent recovery, developed vision deterioration. Intraoperative VEP monitoring with ERG to ascertain retinal light stimulation by the new stimulus device was reliable and feasible in preserving visual function in patients undergoing TSS.

83. Intraoperative visual evoked potentials: A study in pituitary microadenoma surgery

Conflicting reports on the usefulness of intraoperative monitoring of visual function by means of visual evoked potentials (VEPs) are reported. In order to verify the real usefulness of this method in supporting pituitary surgery, we studied 10 patients with pituitary microadenoma without any visual problems to collect normative data. 10 patients (mean age 50 yrs), undergoing trans-sphenoidal surgery for pituitary microadenomas, were studied with intraoperative VEP monitoring. All patients had a normal pre- and postoperative visual function. ERG responses were recorded in 5 patients, mean latency = 54,11 ms (±3.98 DS). Intraoperative VEPs were recorded in 18 of 20 sides (90%). The variability of N2 latency did not exceed 10% of the baseline value (before surgical manoeuvres, mean = 140.95 ms ± 18.88 SD) and the P2–N2 amplitude variability was less than 50% in all but one patient. Our study confirms that generally VEPs remain stable during microsurgical procedures. Intraoperative VEP recording might be a potentially useful tool in the monitoring of the functional integrity of the posterior visual pathway.

Nonthermal ablation with microbubble-enhanced focused ultrasound close to the optic tract without affecting nerve function

Tumors at the skull base are challenging for both resection and radiosurgery given the presence of critical adjacent structures, such as cranial nerves, blood vessels, and brainstem. Magnetic resonance imaging-guided thermal ablation via laser or other methods has been evaluated as a minimally invasive alternative to these techniques in the brain. Focused ultrasound (FUS) offers a noninvasive method of thermal ablation; however, skull heating limits currently available technology to ablation at regions distant from the skull bone. Here, the authors evaluated a method that circumvents this problem by combining the FUS exposures with injected microbubble-based ultrasound contrast agent. These microbubbles concentrate the ultrasound-induced effects on the vasculature, enabling an ablation method that does not cause significant heating of the brain or skull. In 29 rats, a 525-kHz FUS transducer was used to ablate tissue structures at the skull base that were centered on or adjacent to the optic tract or chiasm. Low-intensity, low-duty-cycle ultrasound exposures (sonications) were applied for 5 minutes after intravenous injection of an ultrasound contrast agent (Definity, Lantheus Medical Imaging Inc.). Using histological analysis and visual evoked potential (VEP) measurements, the authors determined whether structural or functional damage was induced in the optic tract or chiasm. Overall, while the sonications produced a well-defined lesion in the gray matter targets, the adjacent tract and chiasm had comparatively little or no damage. No significant changes (p > 0.05) were found in the magnitude or latency of the VEP recordings, either immediately after sonication or at later times up to 4 weeks after sonication, and no delayed effects were evident in the histological features of the optic nerve and retina. This technique, which selectively targets the intravascular microbubbles, appears to be a promising method of noninvasively producing sharply demarcated lesions in deep brain structures while preserving function in adjacent nerves. Because of low vascularity--and thus a low microbubble concentration--some large white matter tracts appear to have some natural resistance to this type of ablation compared with gray matter. While future work is needed to develop methods of monitoring the procedure and establishing its safety at deep brain targets, the technique does appear to be a potential solution that allows FUS ablation of deep brain targets while sparing adjacent nerve structures.

P3-5: Temporal Interactions between Binocular Inputs in Visual Evoked-Potentials

The interaction between neural activity driven by inputs through the two eyes were examined using visual evoked-potentials (VEP) in normal human subjects. VEP recordings were obtained at the occipital electrodes using binocularly asynchronous pattern-reversal checkerboard stimuli: The patter-reversal times for the two eyes differed by 0, ±50, ±150, or ±350 ms, with the positive stimulus-onset asynchrony (SOA) meaning that the right-eye reversal occurred first. For comparison, monocular VEPs were also obtained using trial conditions where the checkerboard pattern-reversals were shown to only one eye, while a blank field to the other. The VEPs of the various trial conditions were analyzed using both temporal and frequency analysis methods. Three observations were made: First, the N75 amplitude was significantly reduced in the ±50 ms SOA conditions. Second, on ±150 ms and ± ms SOA conditions, a negative potential was observed over the period when the stimuli were binocularly incongruent. Third, the alpha-ban...

Hemispheric differences in VEPs to lateralised stimuli are a marker of recovery from neglect

Visual-evoked potentials (VEPs) were recorded in seventeen patients with unilateral lesions of the right hemisphere (RH) and visuospatial neglect. Hemispheric differences were detected for VEP components in the time window from 130 to 280 msec; this result replicates data from a previous study using a larger group of patients (Di Russo et al., 2008). Three patients were tested twice; their hemispheric differences, i.e., the differences in latency and amplitude of VEPs to ipsilesional and contralesional stimuli, were evaluated at the beginning and end of visuospatial rehabilitation training for neglect. The hemispheric differences were limited to components anterior N1 (N1a), posterior N1 (N1p) and P2 (not C1 and P1) and showed a significant decrease after training; amelioration at the behavioural level was also observed. Fourteen patients were tested only once, at different steps of their training. For the overall group, we determined the correlation between VEP hemispheric differences and the number of sessions attended by the patients at the time of VEP recording. The correlation was negative, the higher the number of sessions, the lower the hemispheric asymmetry, and high, ranging from .45 to .64, for both the latency and amplitude of the N1p and P2 components, and for the amplitude of the N1a component. The correlation between VEP hemispheric differences and time from onset (TFO) of the pathological event was not significant. Overall, the hemispheric differences between specific components of the VEP responses to lateralised stimuli appear to be a good marker of recovery from neglect.

Visual-Evoked Potentials for Intraoperative Neurophysiology Monitoring

Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method Sasaki T, Imamura T, Suzuki K, Kasey H, Mankato R, et al. J Neurosurgery 112:273–284, 2010 Object: To obtain a clinically useful method of intraoperative monitoring of visual evoked potentials (VEPs), the authors developed a new light-stimulating device and introduced electroretinography (ERG) to ascertain retinal light stimulation after induction of venous anesthesia. Methods: The new stimulating device consists of 16 red light–emitting diodes embedded in a soft silicone disc to avoid deviation of the light axis after frontal scalp-flap reflection. After induction of venous anesthesia with propofol, the authors performed ERG and VEP recording in 100 patients (200 eyes) who were at intraoperative risk for visual impairment. Results: Stable ERG and VEP recordings were obtained in 187 eyes. In 12 eyes, stable ERG data were recorded but VEPs could not be obtained, probably because all 12 eyes manifested severe preoperative visual dysfunction. The disappearance of ERG data and VEPs in the 13th eye after frontal scalp-flap reflection suggested technical failure attributable to deviation of the light axis. The criterion for amplitude changes was defined as a 50% increase or decrease in amplitude compared with the control level. In 1 of 187 eyes the authors observed an increase in intraoperative amplitude and postoperative visual function improvement. Of 169 eyes without amplitude changes, 17 manifested improved visual function postoperatively, 150 showed no change, and 2 worsened (1 patient with a temporal tumor developed a slight visual field defect in both eyes). Of 3 eyes with intraoperative VEP deterioration and subsequent recovery upon changing the operative maneuver, 1 improved and 2 exhibited no change. The VEP amplitude decreased without subsequent recovery to 50% of the control level in 14 eyes, and all of these developed various degrees of postoperative deterioration of visual function. Conclusions: With the strategy introduced here it is possible to record intraoperative VEPs in almost all patients except in those with severe visual dysfunction. In some patients, postoperative visual deterioration can be avoided or minimized by intraoperative VEP recording. All patients without an intraoperative decrease in the VEP amplitude were without severe postoperative deterioration in visual function, suggesting that intraoperative VEP monitoring may contribute to prevent postoperative visual dysfunction.

Objective perimetry using a four-channel multifocal VEP system: correlation with conventional perimetry and thickness of the retinal nerve fibre layer

PurposeThere is evidence that multifocal visual evoked potentials (VEPs) can be used as an objective tool to detect visual field loss. The aim of this study was to correlate multifocal...

Improving reproducibility of VEP recording in rats: electrodes, stimulus source and peak analysis

The aims of this study were to evaluate and improve the reproducibility of visual evoked potential (VEP) measurement in rats and to develop a mini-Ganzfeld stimulator for rat VEP recording. VEPs of Sprague-Dawley rats were recorded on one randomly selected eye on three separate days within a week, and the recordings were repeated three times on the first day to evaluate the intrasession repeatability and intersession reproducibility. The VEPs were recorded with subdermal needle and implanted skull screw electrodes, respectively, to evaluate the effect of electrode configuration on VEP reproducibility. We also designed a mini-Ganzfeld stimulator for rats, which provided better eye isolation than the conventional visual stimuli such as flash strobes and large Ganzfeld systems. The VEP responses from mini-Ganzfeld were compared with PS33-PLUS photic strobe and single light-emitting diode (LED). The latencies of P1, N1, P2, N2, and P3 and the amplitude of each component were measured and analysed. Intrasession and intersession within-subject standard deviations (Sw), coefficient of variation, repeatability (R95) and intraclass correlation coefficient (ICC) were calculated. The VEPs recorded using the implanted skull electrodes showed significantly larger amplitude and higher reproducibility compared to the needle electrodes (P<0.05). The mini-Ganzfeld stimulator showed superior repeatability and reproducibility in VEP recording. The intra/intersession ICCs of latency were 0.85/0.70 for mini-Ganzfeld, 0.72/0.62 for PS33-PLUS and only 0.59/0.42 for single LED. The latencies of the early peaks (N1 and P2) demonstrated better reproducibility than the later waves. The mean intrasession and intersession ICCs were 0.96 and 0.86 for the early peaks. Using a combination of skull screw electrodes, mini-Ganzfeld stimulator and early peak analysis, we achieved a high reproducibility in the rat VEP measurement. The latencies of the early peaks of rat VEPs were more consistent, which may be due to their generation in the primary visual cortex via the retino-geniculate fibres.

Habituation of evoked responses is greater in patients with familial hemiplegic migraine than in controls: a contrast with the common forms of migraine

Familial hemiplegic migraine (FHM) is a rare, dominantly inherited subtype of migraine with transient hemiplegia during the aura phase. Mutations in at least three different genes can produce the FHM phenotype. The mutated FHM genes code for ion transport proteins that animal and cellular studies have associated with disturbed ion homeostasis, altered cellular excitability, neurotransmitter release, and decreased threshold for cortical spreading depression. The common forms of migraine are characterized interictally by a habituation deficit of cortical and subcortical evoked responses that has been attributed to neuronal dysexcitability. FHM and the common forms of migraine are thought to belong to a spectrum of migraine phenotypes with similar pathophysiology, and we therefore examined whether an abnormal habituation pattern would also be found in FHM patients. In a group of genotyped FHM patients (five FHM-1, four FHM-2), we measured habituation of visual evoked potentials (VEP), auditory evoked potentials including intensity dependence (IDAP), the nociception-specific blink reflex (nsBR) and compared the results to a group of healthy volunteers (HV). FHM patients had a more pronounced habituation during VEP (P=0.025) and nsBR recordings (P=0.023) than HV. There was no difference for IDAP, but the slope tended to be steeper in FHM. Contrary to the common forms of migraine, FHM patients are not characterized by a deficient, but rather by an increased habituation in cortical/brain stem evoked activities. These results suggest differences between FHM and the common forms of migraine, as far as central neuronal processing is concerned.

Reproducibility of Intraoperative Visual Evoked Potentials: A Review of 141 Cases Undergoing Prone Spinal Procedures

ABSTRACT.Visual evoked potentials (VEPs) and surface electroretinograms (ERGs) were recorded using flash stimulation during prolonged spine procedures performed in the prone position on 141 subjects without known visual deficits in the presence of various anesthetic protocols that included inhalation and intravenous agents. Waveforms were subjectively evaluated with respect to morphology, latency, amplitude, and reproducibility, with specific attention to the effects of minimal alveolar concentration (MAC) of the inhalant in the anesthetic regimen. Although inter-subject variability was noted in the morphology of the VEPs, waveforms were highly reproducible within individual subjects and were relatively invariant over time. Reproducibility correlated inversely with the MAC level of inhalation agent. Potentials recorded using infraorbital-to-midline electrodes were also robust, reproducible, and stable, and similarly varied inversely with the MAC of inhalation agent. These waveforms were similar in morphology to previously reported clinical and intraoperative electroretinograms (a short duration electronegative component, followed by a longer duration, higher amplitude, positive wave). Our data demonstrate that intraoperative VEPs and ERGs can be successfully performed with current anesthetic regimens, especially when a relatively low level of gaseous anesthetic is combined with opioid infusions. Reliable intraoperative recordings of VEPs and ERGs may facilitate early detection of compromise to visual pathways.

Innovative evaluation of visual field defects in epileptic patients after standard anterior temporal lobectomy, using partial field visual evoked potentials

The purpose of this paper is to obtain an electrophysiological evaluation of visual field defects consecutive to the direct lesion of optic radiations in drug-resistant epileptic patients after a standard electrocorticographically adjusted lobectomy, and to correlate it with conventional perimetric results, and with the volume of resected tissue during surgical treatment. Twenty-four patients with temporal lobe epilepsy defined through long term EEG-video, ictal and interictal SPECT, as well as Magnetic Resonance Imaging were studied. Visual evoked potentials (VEPs) with partial and total visual field stimulation were carried out before and after 6, 12 and 24 months surgical treatment. A control group was also studied. No differences between patients and control subjects were observed during the evaluation of the full-field VEPs. However, there were statistical differences between groups in the half-field VEP recordings and in the VEP recordings of contralateral to resected side superior quadrant (CSQ) before lobectomy and 6 months later (Mann-Whitney's U-test, p<0.05). Significant associations were found between VEP abnormalities and perimetric results in CSQ. A close relationship between perimetry, VEPs and volume of the resected tissue in hippocampus, parahippocampus, medial and lower temporal giri was also found. Visual field defects consecutive to standard temporal lobe resection in epileptic patients could be objectively evaluated by partial stimulation VEPs corresponding to the size of resected tissue.

Standard and limitation of intraoperative monitoring of the visual evoked potential

Visual evoked potential (VEP) has been installed as one of the intraoperative visual function monitoring. It remains unclear, however, whether intraoperative VEP monitoring facilitates as a real time visual function monitoring with satisfactory effectiveness and sensitivity. To evaluate this, relationships between VEP waveform changes and postoperative visual function were analysed retrospectively. Intraoperative VEP monitoring was carried out for 106 sides (eyes) in 53 surgeries, including two intraorbital, 36 parasellar and 15 cortical lesions in Shinshu University Hospital under total intravenous anaesthesia. Red light flash stimulation was provided to each eye independently. VEP recording and postoperative visual function were analysed. In 103 out of 106 sides (97%), steady VEP monitoring was recorded. Stable VEP was acquired from eyes having corrected visual acuity greater than 0.4. VEP was not recorded in one side with corrected visual acuity of 0.3 and two sides in whom sevoflurane was used incidentally for anaesthesia. Transient VEP decrease was observed in three sides, but visual function was preserved. Permanent VEP decrease was seen in seven sides, which presented visual impairment postoperatively. In one side, visual acuity improved but minor visual field defect was encountered postoperatively, though VEP unchanged throughout the surgery. Intraoperative monitoring of VEP predicts postoperative visual function: reversible change in VEP means visual function to be preserved. Visual field defect without decrease in the visual acuity may not be predicted by VEP monitoring. Intraoperative VEP monitoring will be mandatory for surgeries harbouring a risk of visual impairment.

Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method

To obtain a clinically useful method of intraoperative monitoring of visual evoked potentials (VEPs), the authors developed a new light-stimulating device and introduced electroretinography (ERG) to ascertain retinal light stimulation after induction of venous anesthesia. The new stimulating device consists of 16 red light-emitting diodes embedded in a soft silicone disc to avoid deviation of the light axis after frontal scalp-flap reflection. After induction of venous anesthesia with propofol, the authors performed ERG and VEP recording in 100 patients (200 eyes) who were at intraoperative risk for visual impairment. Stable ERG and VEP recordings were obtained in 187 eyes. In 12 eyes, stable ERG data were recorded but VEPs could not be obtained, probably because all 12 eyes manifested severe preoperative visual dysfunction. The disappearance of ERG data and VEPs in the 13th eye after frontal scalp-flap reflection suggested technical failure attributable to deviation of the light axis. The criterion for amplitude changes was defined as a 50% increase or decrease in amplitude compared with the control level. In 1 of 187 eyes the authors observed an increase in intraoperative amplitude and postoperative visual function improvement. Of 169 eyes without amplitude changes, 17 manifested improved visual function postoperatively, 150 showed no change, and 2 worsened (1 patient with a temporal tumor developed a slight visual field defect in both eyes). Of 3 eyes with intraoperative VEP deterioration and subsequent recovery upon changing the operative maneuver, 1 improved and 2 exhibited no change. The VEP amplitude decreased without subsequent recovery to 50% of the control level in 14 eyes, and all of these developed various degrees of postoperative deterioration of visual function. With the strategy introduced here it is possible to record intraoperative VEPs in almost all patients except in those with severe visual dysfunction. In some patients, postoperative visual deterioration can be avoided or minimized by intraoperative VEP recording. All patients without an intraoperative decrease in the VEP amplitude were without severe postoperative deterioration in visual function, suggesting that intraoperative VEP monitoring may contribute to prevent postoperative visual dysfunction.

Bilateral loss of cortical somatosensory evoked potential at birth predicts cerebral palsy in term and near-term newborns

Bilateral loss of cortical somatosensory evoked potential (SEP) is considered the single best indicator of adverse outcome in acute encephalopathy of adult patients and older children. This study determines whether the presence or absence of the neonatal cortical SEP can predict cerebral palsy at two years in survivors of neonatal encephalopathy scored according to Sarnat criteria. We also compare SEPs with visual evoked potentials (VEPs), the EEG and neonatal neurological status. Fifty-nine neonates admitted to the neonatal intensive care unit had SEP, VEP and EEG recordings analysed according to the presence ( n = 37, 63%) or absence ( n = 22, 37%) of neonatal encephalopathy (score ≥ 1). Cortical SEP was always present in the perinatal period in those surviving without major neurological disability, while it was bilaterally absent in all but one patient with a subsequent diagnosis of cerebral palsy. Multivariate analysis using the logistic regression model showed that bilateral loss of cortical SEP and Sarnat Score correctly classified the neurological outcome in all patients. Bilateral absence of cortical SEP indicates early identification of neonates at risk of cerebral palsy indicating that EPs have a clinical role in the workup of neonatal encephalopathy.