J Neurol Neurosurg Psychiatry 63:759-764 doi:10.1136/jnnp.63.6.759
  • Paper

Event related potentials recorded in patients with locked-in syndrome

  1. Marco Onofrja,
  2. Astrid Thomasa,
  3. Cristina Pacia,
  4. Michele Scesib,
  5. Renato Tombarib
  1. aDepartment of Neurology, University of Chieti, Italy, bIntensive Care Unit, University of Chieti, Italy
  1. Professor Marco Onofrj, Clinica Neurologica, Ospedale clinicizzato “SS Annunziata”, Dipartimento di Oncologia e Neuroscienze, Via dei Vestini, 66100 Chieti, Italy. Telephone 0039 871 358527; fax 0039 871 562019; E-Mail: Onofrj{at} or Onofrj{at}
  • Received 9 April 1997
  • Revised 19 June 1997
  • Accepted 30 June 1997


OBJECTIVE To determine the possibility of recording “cognitive” event related potentials (ERPs) in locked-in patients and therefore to determine whether ERPs can have a role in differential diagnosis of coma.

METHODS ERPs to classic auditory or visual “odd ball paradigms” were recorded three to four days, seven to eight days, and 30 to 60 days after admission to the intensive care unit, in four patients affected by basilar artery thrombembolism resulting in locked-in syndrome. Two patients (one 32 year old man, one 31 year old woman) could move the eyes laterally and vertically spontaneously and on command. One patient (a 39 year old man) had a “one and half syndrome”, one patient (a 40 year old woman) could only elevate the left eyelid and eye. Results were compared with data from 30 age matched controls. In the last recording session a letter recognition paradigm was applied, in which ERPs were produced by the identification of letters forming a word. Results were compared with five age matched controls. Brainstem lesions extending to the pontomesencephalic junction were found on MRI and CT.

RESULTS ERPs to the oddball paradigms were recorded in three patients in the first recording session, in all patients in the second recording session. Latency, amplitude, and topographic distribution of ERP components were inside normal limits. With the letter recognition paradigm the patients could emit a P3 component to correspond with target letters, with the same margin of error as controls.

CONCLUSION It is possible to record ERPs in patients with locked-in syndrome shortly after the acute ischaemic lesion, and therefore to assess objectively cognitive activities. Furthermore the letter recognition paradigm could be implemented to facilitate linguistic communication with patients with locked-in syndrome.


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