Evoked Potentials
Introduction
An Evoked Potential is an electrical potential recorded from the nervous system, which
is responding to a stimulus and is used for a neurophysiological examination. It can be
recorded from the somatosensory cortex or directly through the scalp. These electric
potentials in the nervous system are produced by systematic stimulation of a sensory
organ or a peripheral nerve, mainly by sight, sound or touch. These stimuli evoke
electrical signals that travel along the nerves and through the spinal cord to special
areas in the brain. There they lead to potential differences in the cerebral cortex,
which can be recorded by placing electrodes on the respected area. Evoked potentials
are time-locked to the beginning of stimulation and consist of series of waves
characteristic to the stimulus modality. Evoked potentials are mainly used in the
neurological field. They help to detect neurological diseases as nerve damages, spinal
cord dysfunctions or a demyelinating disease as multiple sclerosis.
Depending of the type of stimulus we can differentiate four main different types of
evoked potentials:
Visual evoked potentials (VEP):
Visual evoked potentials are used to examine the optical nerves and the visual
pathway. Visual stimulation can have various types, for example the flashing light on
a monitor. Using VEPs sight disorders can be detected as well than optic nerve
damage. A typical disorder detected by VEP is the optic neuritis, an inflammation of
the optic nerve, mainly caused by multiple sclerosis. The velocity of the transmission
of the impulse to the convertion of the impulse in the brain is measured.
Brainstem auditory evoked potentials (BAEP):
Auditory evoked potentials are evoked by acoustic stimuli like a speech sound
transmitted by earphones. Brainstem auditory evoked potentials are helpful in the
diagnose of a hearing ability and detection of brainstem tumors and multiple sclerosis.
Even silent lesions (disease without symptoms) can be detected by BAEPs, although
BAEPs are less sensitive and specific than SSEPs. The velocity of the transmission of
the impulse is measured in the acoustic system of the brainstem.
Somatosensory evoked potentials (SSEP):
SSEPs are providing an evaluation of the central somatosensory pathway and the
peripheral sensible nerves. The stimulation occurs transcutaneously, usually by an
electric stimulus. The velocity of the transmission of the impulse to the brain or the
spinal cord is measured. SSEPs are used for the detection of cervical myelopathy
(spinous cord dysfunction). Somatosensory evoked potentials are also used during
surgery to examine neurological dysfunction in order to avoid risking brain damage.
SSEPs additionally help in the prognosis of the comatose state of patients.
Motor evoked potentials (MEP):
For motor evoked potentials no sensory organ is stimulated, but the motor cortex itself
either directly or through transcranial magnetic stimulation (TMS). For the TMS
procedure a magnetic field generator is placed near the head and via electromagnetic
induction the brain receives electric currents. MEPs are mainly used intraoperatively
to monitor the intactness of the motor system. MEPs are also used to measure the
transmittance between the brain and a muscle at a disorder of cranial nerves or the
spinal cord.
Conclusion:
Evoked potential studies are considered to be safe procedures. They are objective and
very sensitive compared to other neurological examinations and can be also used for
comatose or anaesthetised patients. Especially in the diagnose of a developing
multiple sclerosis evoked potentials still play a major role. The main disadvantage of
evoked potentials is the lack of being disease specific. VEPs can be for example
abnormal in optic neuritis as well as in an ocular disease. The use of evoked potentials
has been reduced in the last years due to progressive advances in imaging technology,
especially magnetic resonance imaging (MRI) and is now often used only
complementary.
