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Evoked potential
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"Vep" redirects here. For other uses, see VEP.

It has been suggested that this article be merged with Event-related potential.
(Discuss) Proposed since October 2013.
An evoked potential or evoked response is an electrical potential recorded
from the nervous system of a human or other animal following presentation of a
stimulus, as distinct from spontaneous potentials as detected by
electroencephalography (EEG), electromyography (EMG), or other
electrophysiological recording method.

Evoked potential
Intervention
MeSH

D005071

Evoked potential amplitudes tend to be low, ranging from less than a microvolt to several microvolts, compared to tens of
microvolts for EEG, millivolts for EMG, and often close to a volt for ECG. To resolve these low-amplitude potentials against the
background of ongoing EEG, ECG, EMG, and other biological signals and ambient noise, signal averaging is usually
required. The signal is time-locked to the stimulus and most of the noise occurs randomly, allowing the noise to be averaged
out with averaging of repeated responses.[1]
Signals can be recorded from cerebral cortex, brain stem, spinal cord and peripheral nerves. Usually the term "evoked
potential" is reserved for responses involving either recording from, or stimulation of, central nervous system structures. Thus
evoked compound motor action potentials (CMAP) or sensory nerve action potentials (SNAP) as used in nerve conduction
studies (NCS) are generally not thought of as evoked potentials, though they do meet the above definition.
Contents [hide]
1 Sensory evoked potentials
1.1 Steady-state evoked potential
1.1.1 The "simultaneous stimulation" technique
1.1.2 The sweep technique
1.1.3 Evoked potential feedback
1.2 Visual evoked potential
1.2.1 VEP Stimuli
1.2.2 VEP Electrode Placement
1.2.3 VEP Waves
1.2.4 Types of VEP
1.3 Auditory evoked potential
1.4 Somatosensory evoked potential
1.5 Laser evoked potential
2 Intraoperative monitoring
3 Motor evoked potentials
4 See also
5 References
6 External links

Sensory evoked potentials

[edit]

Sensory evoked potentials (SEP), are recorded from the central nervous system following stimulation of sense organs (for
example, visual evoked potentials elicited by a flashing light or changing pattern on a monitor;[2] auditory evoked potentials by
a click or tone stimulus presented through earphones) or by tactile or somatosensory evoked potential (SSEP) elicited by
tactile or electrical stimulation of a sensory or mixed nerve in the periphery. They have been widely used in clinical diagnostic
medicine since the 1970s, and also in intraoperative neurophysiology monitoring (IONM), also known as surgical
neurophysiology.
There are three kinds of evoked potentials in widespread clinical use: auditory evoked potentials, usually recorded from the
scalp but originating at brainstem level; visual evoked potentials, and somatosensory evoked potentials, which are elicited by
electrical stimulation of peripheral nerve. See below.
Long and Allen [3] reported the abnormal brainstem auditory evoked potentials (BAEP) in an alcoholic woman who recovered
from Ondine's curse. These investigators hypothesized that their patient's brainstem was poisoned, but not destroyed, by her
chronic alcoholism.

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Steady-state evoked potential [edit]

An evoked potential is the electrical response of the brain to a sensory stimulus. Regan constructed an analogue Fourier
series analyzer to record harmonics of the evoked potential to flickering (sinusoidally modulated) light but, rather than
integrating the sine and cosine products, fed them to a two-pen recorder via lowpass filters.[4] This allowed him to
demonstrate that the brain attained a steady-state regime in which the amplitude and phase of the harmonics (frequency
components) of the response were approximately constant over time. By analogy with the steady-state response of a
resonant circuit that follows the initial transient response he defined an idealized steady-state evoked potential (SSEP) as a
form of response to repetitive sensory stimulation in which the constituent frequency components of the response remain
constant with time in both amplitude and phase.[4][5] Although this definition implies a series of identical temporal waveforms, it
is more helpful to define the SSEP in terms of the frequency components that are an alternative description of the timedomain waveform, because different frequency components can have quite different properties[5][6] For example, the
properties of the high-frequency flicker SSEP (whose peak amplitude is near 4050 Hz) correspond to the properties of the
subsequently discovered magnocellular neurons in the retina of the macaque monkey, while the properties of the mediumfrequency flicker SSEP ( whose amplitude peak is near 1520 Hz) correspond to the properties of parvocellular neurons.[7]
Since a SSEP can be completely described in terms of the amplitude and phase of each frequency component it can be
quantified more unequivocally than an averaged transient evoked potential.
It is sometimes said that SSEPs are elicited only by stimuli of high repetition frequency, but this is not generally correct. In
principle, a sinusoidally modulated stimulus can elicit a SSEP even when its repetition frequency is low. Because of the highfrequency rolloff of the SSEP, high frequency stimulation can produce a near-sinusoidal SSEP waveform, but this is not
germane to the definition of a SSEP. By using zoom-FFT to record SSEPs at the theoretical limit of spectral resolution F
(where F in Hz is the reciprocal of the recording duration in seconds) Regan and Regan discovered that the amplitude and
phase variability of the SSEP can be sufficiently small that the bandwidth of the SSEPs constituent frequency components
can be at the theoretical limit of spectral resolution up to at least a 500-second recording duration (0.002 Hz in this case).[8]
Repetitive sensory stimulation elicits a steady-state magnetic brain response that can be analysed in the same way as the
SSEP.[6]
The "simultaneous stimulation" technique [edit]
This technique allows several (e.g., four) SSEPs to be recorded simultaneously from any given location on the scalp.[9]
Different sites of stimulation or different stimuli can be tagged with slightly different frequencies that are virtually identical to
the brain, but easily separated by Fourier series analyzers.[9] For example, when two unpatterned lights are modulated at
slightly different frequencies (F1 and F2) and superimposed, multiple nonlinear cross-modulation components of frequency
(mF1 nF2) are created in the SSEP, where m and n are integers.[6] These components allow nonlinear processing in the
brain to be investigated. By frequency-tagging two superimposed gratings, spatial frequency and orientation tuning properties
of the brain mechanisms that process spatial form can be isolated and studied.[10][11] Stimuli of different sensory modalities
can also be tagged. For example, a visual stimulus was flickered at Fv Hz and a simultaneously presented auditory tone was
amplitude modulated at Fa Hz. The existence of a (2Fv + 2Fa) component in the evoked magnetic brain response
demonstrated an audio-visual convergence area in the human brain, and the distribution of this response over the head
allowed this brain area to be localized.[12] More recently, frequency tagging has been extended from studies of sensory
processing to studies of selective attention[13] and of consciousness.[14]
The sweep technique [edit]
The sweep technique is a hybrid frequency domain/time domain technique.[15] A plot of, for example, response amplitude
versus the check size of a stimulus checkerboard pattern plot can be obtained in 10 seconds, far faster than when timedomain averaging is used to record an evoked potential for each of several check sizes.[15] In the original demonstration of
the technique the sine and cosine products were fed through lowpass filters (as when recording a SSEP ) while viewing a
pattern of fine checks whose black and white squares exchanged place six times per second. Then the size of the squares
was progressively increased so as to give a plot of evoked potential amplitude versus check size (hence sweep).
Subsequent authors have implemented the sweep technique by using computer software to increment the spatial frequency
of a grating in a series of small steps and to compute a time-domain average for each discrete spatial frequency.[16] A single
sweep may be adequate or it may be necessary to average the graphs obtained in several sweeps with the averager
triggered by the sweep cycle.[17] Averaging 16 sweeps can improve the signal-to-noise ratio of the graph by a factor of
four.[17] The sweep technique has proved useful in measuring rapidly adapting visual processes[18] and also for recording
from babies, where recording duration is necessarily short. Norcia and Tyler have used the technique to document the
development of visual acuity[16][19] and contrast sensitivity[20] through the first years of life. They have emphasized that, in
diagnosing abnormal visual development, the more precise the developmental norms, the more sharply can the abnormal be
distinguished from the normal, and to that end have documented normal visual development in a large group of
infants.[16][19][20] For many years the sweep technique has been used in paediatric ophthalmology (electrodiagnosis) clinics
Worldwide.
Evoked potential feedback [edit]
This technique allows the SSEP to directly control the stimulus that elicits the SSEP without the conscious intervention of the
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experimental subject.[4][17] For example, the running average of the SSEP can be arranged to increase the luminance of a
checkerboard stimulus if the amplitude of the SSEP falls below some predetermined value, and to decrease luminance if it
rises above this value. The amplitude of the SSEP then hovers about this predetermined value. Now the wavelength (colour)
of the stimulus is progressively changed. The resulting plot of stimulus luminance versus wavelength is a plot of the spectral
sensitivity of the visual system.[5][17]

Visual evoked potential [edit]

In 1934, Adrian and Matthew noticed potential changes of the occipital EEG can be observed under stimulation of light.
Ciganek developed the first nomenclature for occipital EEG components in 1961. During that same year, Hirsch and
colleagues recorded a visual evoked potential (VEP) on the occipital lobe (externally and internally), and they discovered
amplitudes recorded along the calcarine fissure were the largest. In 1965, Spehlmann used a checkerboard stimulation to
describe human VEPs. An attempt to localize structures in the primary visual pathway was completed by Szikla and
colleagues. Halliday and colleagues completed the first clinical investigations using VEP by recording delayed VEPs in a
patient with retrobulbar neuritis in 1972. A wide variety of extensive research to improve procedures and theories has been
conducted from the 1970s to today.
VEP Stimuli [edit]
The diffuse light flash stimulus is rarely used due to the high variability within and across subjects. However, it is beneficial to
use this type of stimulus when testing infants or individuals with poor visual acuity. The checkerboard and grating patterns
use light and dark squares and stripes, respectively. These squares and stripes are equal in size and are presented to one at
a time via a television or computer screen.
VEP Electrode Placement [edit]
Electrode placement is extremely important to elicit a good VEP response free of artifact. One electrode is placed 2.5 cm
above the inion and a reference electrode is placed at Fz. For a more detailed response, two additional electrodes can be
placed 2.5 cm to the right and left of Oz.
VEP Waves [edit]
The VEP nomenclature is determined by using capital letters stating whether the peak is positive (P) or negative (N) followed
by a number which indicates the average peak latency for that particular wave. For example, P50 is a wave with a positive
peak at approximately 50 ms following stimulus onset.
The average amplitude for VEP waves usually falls between 5 and 10 microvolts.
Types of VEP [edit]
Some specific VEPs are:
Monocular pattern reversal (most common)
Sweep visual evoked potential
Binocular visual evoked potential
Chromatic visual evoked potential
Hemi-field visual evoked potential
Flash visual evoked potential
LED Goggle visual evoked potential
Motion visual evoked potential
Multifocal visual evoked potential
Multi-channel visual evoked potential
Multi-frequency visual evoked potential
Stereo-elicited visual evoked potential
Steady state visually evoked potential

Auditory evoked potential [edit]

Auditory evoked potential can be used to trace the signal generated by a sound through the ascending auditory pathway.
The evoked potential is generated in the cochlea, goes through the cochlear nerve, through the cochlear nucleus, superior
olivary complex, lateral lemniscus, to the inferior colliculus in the midbrain, on to the medial geniculate body, and finally to the
cortex.[21]
Auditory evoked potentials (AEPs) are a subclass of event-related potentials (ERP)s. ERPs are brain responses that are
time-locked to some event, such as a sensory stimulus, a mental event (such as recognition of a target stimulus), or the
omission of a stimulus. For AEPs, the event is a sound. AEPs (and ERPs) are very small electrical voltage potentials
originating from the brain recorded from the scalp in response to an auditory stimulus, such as different tones, speech
sounds, etc.

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Somatosensory evoked potential [edit]

Somatosensory Evoked Potentials (SSEPs) are used in neuromonitoring to assess the function of a patient's spinal cord
during surgery. They are recorded by stimulating peripheral nerves, most commonly the tibial nerve, median nerve or ulnar
nerve, typically with an electrical stimulus. The response is then recorded from the patient's scalp.
Because of the low amplitude of the signal once it reaches the patient's scalp and the relatively high amount of electrical
noise caused by background EEG, scalp muscle EMG or electrical devices in the room, the signal must be averaged. The use
of averaging improves the signal-to-noise ratio. Typically, in the operating room, over 100 and up to 1,000 averages must be
used to adequately resolve the evoked potential.
The two most looked at aspects of an SSEP are the amplitude and latency of the peaks. The most predominant peaks have
been studied and named in labs. Each peak is given a letter and a number in its name. For example, N20 refers to a negative
peak (N) at 20ms. This peak is recorded from the cortex when the median nerve is stimulated. It most likely corresponds to
the signal reaching the somatosensory cortex. When used in intraoperative monitoring, the latency and amplitude of the peak
relative to the patient's post-intubation baseline is a crucial piece of information. Dramatic increases in latency or decreases
in amplitude are indicators of neurological dysfunction.
During surgery, the large amounts of anesthetic gases used can affect the amplitude and latencies of SSEPs. Any of the
halogenated agents or nitrous oxide will increase latencies and decrease amplitudes of responses, sometimes to the point
where a response can no longer be detected. For this reason, an anesthetic utilizing less halogenated agent and more
intravenous hypnotic and narcotic is typically used.

Laser evoked potential [edit]

Conventional SSEPs monitor the functioning of the part of the somatosensory system involved in sensations such as touch
and vibration. The part of the somatosensory system that transmits pain and temperature signals is monitored using laser
evoked potentials (LEP). LEPs are evoked by applying finely focused, rapidly rising heat to bare skin using a laser. In the
central nervous system they can detect damage to the spinothalamic tract, lateral brain stem, and fibers carrying pain and
temperature signals from the thalamus to the cortex. In the peripheral nervous system pain and heat signals are carried along
thin (C and A delta) fibers to the spinal cord, and LEPs can be used to determine whether a neuropathy is located in these
small fibers as opposed to larger (touch, vibration) fibers.[22]

Intraoperative monitoring

[edit]

Somatosensory evoked potentials provide monitoring for the dorsal columns of the spinal cord. Sensory evoked potentials
may also be used during surgeries which place brain structures at risk. They are effectively used to determine cortical
ischemia during carotid endarterectomy surgeries and for mapping the sensory areas of the brain during brain surgery.
Electrical stimulation of the scalp can produce an electrical current within the brain that activates the motor pathways of the
pyramidal tracts. This technique is known as transcranial electrical motor potential (TcMEP) monitoring. This technique
effectively evaluates the motor pathways in the central nervous system during surgeries which place these structures at risk.
These motor pathways, including the lateral corticospinal tract, are located in the lateral and ventral funiculi of the spinal cord.
Since the ventral and dorsal spinal cord have separate blood supply with very limited collateral flow, an anterior cord
syndrome (paralysis or paresis with some preserved sensory function) is a possible surgical sequela, so it is important to
have monitoring specific to the motor tracts as well as dorsal column monitoring.
Transcranial magnetic stimulation versus electrical stimulation is generally regarded as unsuitable for intraoperative
monitoring because it is more sensitive to anesthesia. Electrical stimulation is too painful for clinical use in awake patients.
The two modalities are thus complementary, electrical stimulation being the choice for intraoperative monitoring, and
magnetic for clinical applications.

Motor evoked potentials

[edit]

Motor evoked potentials (MEP) are recorded from muscles following direct stimulation of exposed motor cortex, or transcranial
stimulation of motor cortex, either magnetic or electrical. Transcranial magnetic MEP (TCmMEP) potentially offer clinical
diagnostic applications. Transcranial electrical MEP (TCeMEP) has been in widespread use for several years for
intraoperative monitoring of pyramidal tract functional integrity.
During the 1990s there were attempts to monitor "motor evoked potentials", including "neurogenic motor evoked potentials"
recorded from peripheral nerves, following direct electrical stimulation of the spinal cord. It has become clear that these
"motor" potentials were almost entirely elicited by antidromic stimulation of sensory tractseven when the recording was from
muscles (antidromic sensory tract stimulation triggers myogenic responses through synapses at the root entry level). TCMEP,
whether electrical or magnetic, is the most practical way to ensure pure motor responses, since stimulation of sensory cortex
cannot result in descending impulses beyond the first synapse (synapses cannot be backfired).
TMS-induced MEPs have been used in many experiments in cognitive neuroscience. Because MEP amplitude is correlated
with motor excitability, they offer a quantitative way to test the role of various types of intervention on the motor system

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(pharmacological, behavioral, lesion, etc.). TMS-induced MEPs may thus serve as an index of covert motor preparation or
facilitation, e.g., induced by the mirror neuron system when seeing someone's else actions.[23] In addition, MEPs are used as
a reference to adjust the intensity of stimulation that need to delivered by TMS when targeting cortical regions whose
response might not be as easily measurable, e.g., in the context of TMS-based therapy.

See also

[edit]

Bereitschaftspotential
Contingent negative variation
Difference due to Memory
Early left anterior negativity
Error-related negativity
Event-related potential
Evoked field
Electroencephalography
Electroretinography

References

Event-related brain potential components:

N100, N200, N2pc, N170, N400, Visual N1
C1 and P1, P200, P300, P3a, P3b, P600 (neuroscience)
International Society for Clinical Electrophysiology of Vision
Late Positive Component
Lateralized readiness potential
Mismatch negativity
Neural oscillation
Somatosensory evoked potential

[edit]

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23. ^ Catmur C., Walsh V., Heyes C. (2007). "Sensorimotor learning configures the human mirror system" . Curr. Biol. 17 (17):
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External links
Evoked Potentials

[edit]
at the US National Library of Medicine Medical Subject Headings (MeSH)

Categories: Evoked potentials Electroencephalography Medical tests

This page was last modified on 31 December 2014, at 21:48.

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