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January 1985, Vol 42, No. 1 >
Article | January 1985

Abuse and Misuse of Evoked Potentials as a Diagnostic Test

Jun Kimura, MD
[+] Author Affiliations

Accepted for publication June 25, 1984.

Reprint requests to Division of Clinical Electrophysiology, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Kimura).


Arch Neurol. 1985;42(1):78-80. doi:10.1001/archneur.1985.04060010084022
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References
Comments

The topic selected for the newly established section on controversies is indeed a very timely one, since the abuse and misuse of evoked potential (EP) testing has become so prevalent during recent years. My overall objection to the indiscriminate clinical application of EP as a diagnostic test must be clearly dissociated from any research effort using it as a tool of electrophysiologic investigation. In fact, such clinical and experimental studies are of vital importance if we are to define its diagnostic value and limitations precisely.1-7 The fundamental function of the nervous system lies in the transmission of impulses that can be directly assessed by EP. Thus, the technique has been and will no doubt continue to be exploited as a powerful means to evaluate the physiology and pathophysiology of the peripheral nervous system and the CNS. This is not the issue under consideration.

Rather, the point in question relates

REFERENCES

1 +
Desmedt JE (ed):  Clinical Uses of Cerebral, Brain Stem and Spinal Somatosensory Evoked Potentials , in Progress in Clinical Neurophysiology . New York, S Karger AG, 1980;.
2 +
Barber C (ed): Evoked Potentials . Lancaster, Pa, MTP Press Ltd, 1980;.
3 +
Bodis-Wollner I:  Evoked Potentials . Ann NY Acad Sci 1982;;388:1-738.
4 +
Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;.
5 +
Halliday AM (ed): Evoked Potentials in Clinical Testing . New York, Churchill Livingstone, 1982;.
6 +
Chiappa KH, Yiannikas C: Evoked Potentials in Clinical Medicine . New York, Raven Press, 1983;.
7 +
Moor EJ (ed): Bases of Auditory Brain-Stem Evoked Responses . New York, Grune & Stratton Inc, 1983;.
8 +
Aminoff M: The clinical role of somatosensory evoked potential studies: A critical appraisal. Minimonograph #21, American Association of Electromyography and Electrodiagnosis, in press.
9 +
Eisen A, Cracco RQ:  Overuse of evoked potentials: Caution . Neurology 1983;;33:618-621.
10 +
Hume AL, Cant BR:  Central somatosensory conduction after head injury . Ann Neurol 1981;;10:411-419.
11 +
Goldie WD, Chiappa KH, Young RR, et al:  Brainstem auditory and short-latency somatosensory evoked responses in brain death . Neurology 1981;;31:248-256.
12 +
Dorfman LJ, Donaldson SS, Gupta PR, et al:  Electrophysiologic evidence of subclinical injury to the posterior columns of the human spinal cord after therapeutic radiation . Cancer 1982;;50:2815-2819.
13 +
Siivola J, Sulg I, Heiskari M:  Somatosensory evoked potentials in diagnostics of cervical spondylosis and herniated disc . Electroencephalogr Clin Neurophysiol 1981;;52:276-282.
14 +
Halliday AM, Carroll WM, Jones SJ:  Visual and somatosensory evoked potential studies in Charcot-Marie-Tooth disease . Electroencephalogr Clin Neurophysiol 1981;;52:584.
15 +
Cracco JB, Bosch VV, Cracco RQ:  Cerebral and spinal somatosensory evoked potentials in children with CNS degenerative diseases . Electroencephalogr Clin Neurophysiol 1980;;49:437-445.
16 +
Fine EJ, Hallett M:  Neurophysiological study of subacute combined degeneration . J Neurol Sci 1980;;45:331-336.
17 +
Eisen A, Elleher G:  Sensory nerve stimulation and evoked cerebral potentials . Neurology 1980;;30:1097-1105.
18 +
Jones SJ, Wynn Parry CB, Landi A:  Diagnosis of brachial plexus traction lesions by sensory nerve action potentials and somatosensory evoked potentials . Injury 1981;;12:376-382.
19 +
Thomas PK, Jefferys JGR, Smith IS, et al:  Spinal somatosensory evoked potentials in hereditary spastic paraplegia . J Neurol Neurosurg Psychiatry 1981;;44:243-246.
20 +
Stohr M, Petruch F, Scheglmann K:  Somatosensory evoked potentials following trigeminal nerve stimulation in trigeminal neuralgia . Ann Neurol 1981;;9:63-66.
21 +
Haldeman S, Bradley WE, Bhatia NN, et al:  Pudéndal evoked responses . Arch Neurol 1982;;39:280-283.
22 +
Robinson K, Rudge P:  The stability of the auditory evoked potentials in normal man and patients with multiple sclerosis . J Neurol Sci 1978;;36:147-156.
23 +
Matthews WB, Small DG:  Serial recording of visual and somatosensory evoked potentials in multiple sclerosis . J Neurol Sci 1979;;40:11-21.
24 +
Chiappa K:  Pattern shift visual, brainstem auditory, and short-latency somatosensory evoked potentials in multiple sclerosis . Neurolgy 1980;;30:110-123.
25 +
Cohen SN, Syndulko K, Hansch E, et al:  Variability on serial testing of visual evoked potentials in patients with multiple sclerosis , in Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;, pp 559-565.
26 +
Yamada T, Shivapour E, Wilkinson JT, et al:  Short and long latency somatosensory evoked potentials in multiple sclerosis . Arch Neurol 1982;;39:88-94.
27 +
Kjaer M:  The value of sequential evoked potential recordings in multiple sclerosis patients , in Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;, pp 567-568.
28 +
Yamada T, Machida M, Kimura J:  Far-field somatosensory evoked potentials after stimulation of the tibial nerve in man . Neurology 1982;;32:1151-1158.
29 +
Yamada T, Muroga T, Kimura J:  Tourniquet-induced ischemia and somatosensory evoked potentials . Neurology 1981;;31:1524-1529.
30 +
Eisen A, Purves S, Hoirch M:  Central nervous system amplification: Its potential in the diagnosis of early multiple sclerosis . Neurology 1982;;32:359-364.
31 +
Satya-Murti S, Wolpaw JR, Cacace AT, et al:  Late auditory evoked potentials can occur without brain stem potentials . Electroencephalogr Clin Neurophysiol 1983;;56:304-308.
32 +
Oh SJ, Kuba T, Soyer A, et al:  Lateralization of brainstem lesions by brainstem auditory evoked potentials . Neurology 1981;;31:14-18.
33 +
Molinari GF:  Neurologists are like cops . Neurology 1983;;33:1102-1103.
34 +
Donchin E, Callaway E, Cooper R, et al:  Publication criteria for studies of evoked potential in man (report of a committee) , in Desmedt JE (ed): Attention, Voluntary Contraction and Event-Related Cerebral Potentials, Progress in Clinical Neurophysiology . New York, S Karger AG, 1977;, vol 1, pp 1-11.
35 +
Desmedt JE, Noel P:  Average cerebral evoked potentials in the evaluation of lesions of the sensory nerves and the central somatosensory pathways , in Desmedt JE (ed): New Developments in Electromyography and Clinical Neurophysiology . New York, S Karger AG, 1973;, vol 2, pp 352-371.
36 +
Cracco RQ, Cracco JB, Anziska BJ:  Somatosensory evoked potentials in man: Cerebral, subcortical, spinal, and peripheral nerve potentials . Am J Electroencephalogr Tech 1979;;19:59-81.
37 +
Desmedt JE, Cheron G:  Pervertebral (Oesophageal) recording of subcortical somatosensory evoked potentials in man: The spinal P13 component and the dual nature of the spinal generators . Electroencephalogr Clin Neurophysiol 1981;;52:257-275.
38 +
Burke D, Skuse NF, Lethlean AK:  Cutaneous and muscle afferent components of the cerebral potential evoked by electrical stimulation of human peripheral nerves . Electroencephalogr Clin Neurophysiol 1981;;51:579-588.
39 +
Kimura J, Yamada T, Shivapour E, et al:  Neural pathways of somatosensory evoked potentials: Clinical implications , in Buser PA, Cobb WA, Okuma T (eds): Kyoto Symposia (EEG Suppl No. 36) . Amsterdam, Elsevier Biomedical Press, 1982;, pp 328-335.
40 +
Allison T, Hume AL:  A comparative analysis of short-latency somatosensory evoked potentials in man, monkey, cat, and rat . Exp Neurol 1981;;72:592-611.
41 +
Lueders H, Lesser R, Hahn J, et al:  Subcortical somatosensory evoked potentials to median nerve stimulation . Brain 1983;;106:341-372.
42 +
Maccabee PJ, Pinkhasov EL, Cracco RQ:  Short latency somatosensory evoked potentials to median nerve stimulation: effect of low frequency filter . Electroencephalogr Clin Neurophysiol 1983;;55:34-44.
43 +
Yamada T, Kimura J, Wilkinson JT, et al:  Short- and long-latency median somatosensory evoked potentials: Findings in patients with localized neurological lesions . Arch Neurol 1983;;40:215-220.
44 +
Sohmer H, Feinmesser M, Szabo G:  Sources of electrocochleographic responses as studied in patients with brain damage . Electroencephalogr Clin Neurophysiol 1974;;37:663-669.
45 +
Starr A, Hamilton AE:  Correlation between confirmed sites of neurological lesions and abnormalities of far-field auditory brainstem responses . Electroencephalogr Clin Neurophysiol 1976;;41:594-608.
46 +
Stockard JJ, Rossiter VS:  Clinical and pathologic correlates of brain stem auditory response abnormalities . Neurology 1977;;27:316-325.
47 +
Sohmer H, Gafni M, Chisin R:  Auditory nerve and brain stem responses: Comparison in awake and unconscious subjects . Arch Neurol 1978;;35:228-230.
48 +
Kimura J, Mitsudome A, Beck DO, et al:  Field distribution of antidromically activated digital nerve potentials: Model for far-field recording . Neurology 1983;;33:164-169.
49 +
Halliday AM, Barrett G, Blumhardt LD, et al:  The macular and paramacular subcomponents of the pattern evoked response , in Lehman D, Calloway E (eds): Human Evoked Potentials . New York, Plenum Press Inc, 1979;, pp 135-151.
50 +
Celesia GG, Archer CR, Kuroiwa Y, et al:  Visual function of the extrageniculo-calcarine system in man . Arch Neurol 1980;;37:704-706.

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1 +
Desmedt JE (ed):  Clinical Uses of Cerebral, Brain Stem and Spinal Somatosensory Evoked Potentials , in Progress in Clinical Neurophysiology . New York, S Karger AG, 1980;.
2 +
Barber C (ed): Evoked Potentials . Lancaster, Pa, MTP Press Ltd, 1980;.
3 +
Bodis-Wollner I:  Evoked Potentials . Ann NY Acad Sci 1982;;388:1-738.
4 +
Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;.
5 +
Halliday AM (ed): Evoked Potentials in Clinical Testing . New York, Churchill Livingstone, 1982;.
6 +
Chiappa KH, Yiannikas C: Evoked Potentials in Clinical Medicine . New York, Raven Press, 1983;.
7 +
Moor EJ (ed): Bases of Auditory Brain-Stem Evoked Responses . New York, Grune & Stratton Inc, 1983;.
8 +
Aminoff M: The clinical role of somatosensory evoked potential studies: A critical appraisal. Minimonograph #21, American Association of Electromyography and Electrodiagnosis, in press.
9 +
Eisen A, Cracco RQ:  Overuse of evoked potentials: Caution . Neurology 1983;;33:618-621.
10 +
Hume AL, Cant BR:  Central somatosensory conduction after head injury . Ann Neurol 1981;;10:411-419.
11 +
Goldie WD, Chiappa KH, Young RR, et al:  Brainstem auditory and short-latency somatosensory evoked responses in brain death . Neurology 1981;;31:248-256.
12 +
Dorfman LJ, Donaldson SS, Gupta PR, et al:  Electrophysiologic evidence of subclinical injury to the posterior columns of the human spinal cord after therapeutic radiation . Cancer 1982;;50:2815-2819.
13 +
Siivola J, Sulg I, Heiskari M:  Somatosensory evoked potentials in diagnostics of cervical spondylosis and herniated disc . Electroencephalogr Clin Neurophysiol 1981;;52:276-282.
14 +
Halliday AM, Carroll WM, Jones SJ:  Visual and somatosensory evoked potential studies in Charcot-Marie-Tooth disease . Electroencephalogr Clin Neurophysiol 1981;;52:584.
15 +
Cracco JB, Bosch VV, Cracco RQ:  Cerebral and spinal somatosensory evoked potentials in children with CNS degenerative diseases . Electroencephalogr Clin Neurophysiol 1980;;49:437-445.
16 +
Fine EJ, Hallett M:  Neurophysiological study of subacute combined degeneration . J Neurol Sci 1980;;45:331-336.
17 +
Eisen A, Elleher G:  Sensory nerve stimulation and evoked cerebral potentials . Neurology 1980;;30:1097-1105.
18 +
Jones SJ, Wynn Parry CB, Landi A:  Diagnosis of brachial plexus traction lesions by sensory nerve action potentials and somatosensory evoked potentials . Injury 1981;;12:376-382.
19 +
Thomas PK, Jefferys JGR, Smith IS, et al:  Spinal somatosensory evoked potentials in hereditary spastic paraplegia . J Neurol Neurosurg Psychiatry 1981;;44:243-246.
20 +
Stohr M, Petruch F, Scheglmann K:  Somatosensory evoked potentials following trigeminal nerve stimulation in trigeminal neuralgia . Ann Neurol 1981;;9:63-66.
21 +
Haldeman S, Bradley WE, Bhatia NN, et al:  Pudéndal evoked responses . Arch Neurol 1982;;39:280-283.
22 +
Robinson K, Rudge P:  The stability of the auditory evoked potentials in normal man and patients with multiple sclerosis . J Neurol Sci 1978;;36:147-156.
23 +
Matthews WB, Small DG:  Serial recording of visual and somatosensory evoked potentials in multiple sclerosis . J Neurol Sci 1979;;40:11-21.
24 +
Chiappa K:  Pattern shift visual, brainstem auditory, and short-latency somatosensory evoked potentials in multiple sclerosis . Neurolgy 1980;;30:110-123.
25 +
Cohen SN, Syndulko K, Hansch E, et al:  Variability on serial testing of visual evoked potentials in patients with multiple sclerosis , in Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;, pp 559-565.
26 +
Yamada T, Shivapour E, Wilkinson JT, et al:  Short and long latency somatosensory evoked potentials in multiple sclerosis . Arch Neurol 1982;;39:88-94.
27 +
Kjaer M:  The value of sequential evoked potential recordings in multiple sclerosis patients , in Courjon J, Mauguiere F, Revol M (eds): Clinical Applications of Evoked Potentials in Neurology . New York, Raven Press, 1982;, pp 567-568.
28 +
Yamada T, Machida M, Kimura J:  Far-field somatosensory evoked potentials after stimulation of the tibial nerve in man . Neurology 1982;;32:1151-1158.
29 +
Yamada T, Muroga T, Kimura J:  Tourniquet-induced ischemia and somatosensory evoked potentials . Neurology 1981;;31:1524-1529.
30 +
Eisen A, Purves S, Hoirch M:  Central nervous system amplification: Its potential in the diagnosis of early multiple sclerosis . Neurology 1982;;32:359-364.
31 +
Satya-Murti S, Wolpaw JR, Cacace AT, et al:  Late auditory evoked potentials can occur without brain stem potentials . Electroencephalogr Clin Neurophysiol 1983;;56:304-308.
32 +
Oh SJ, Kuba T, Soyer A, et al:  Lateralization of brainstem lesions by brainstem auditory evoked potentials . Neurology 1981;;31:14-18.
33 +
Molinari GF:  Neurologists are like cops . Neurology 1983;;33:1102-1103.
34 +
Donchin E, Callaway E, Cooper R, et al:  Publication criteria for studies of evoked potential in man (report of a committee) , in Desmedt JE (ed): Attention, Voluntary Contraction and Event-Related Cerebral Potentials, Progress in Clinical Neurophysiology . New York, S Karger AG, 1977;, vol 1, pp 1-11.
35 +
Desmedt JE, Noel P:  Average cerebral evoked potentials in the evaluation of lesions of the sensory nerves and the central somatosensory pathways , in Desmedt JE (ed): New Developments in Electromyography and Clinical Neurophysiology . New York, S Karger AG, 1973;, vol 2, pp 352-371.
36 +
Cracco RQ, Cracco JB, Anziska BJ:  Somatosensory evoked potentials in man: Cerebral, subcortical, spinal, and peripheral nerve potentials . Am J Electroencephalogr Tech 1979;;19:59-81.
37 +
Desmedt JE, Cheron G:  Pervertebral (Oesophageal) recording of subcortical somatosensory evoked potentials in man: The spinal P13 component and the dual nature of the spinal generators . Electroencephalogr Clin Neurophysiol 1981;;52:257-275.
38 +
Burke D, Skuse NF, Lethlean AK:  Cutaneous and muscle afferent components of the cerebral potential evoked by electrical stimulation of human peripheral nerves . Electroencephalogr Clin Neurophysiol 1981;;51:579-588.
39 +
Kimura J, Yamada T, Shivapour E, et al:  Neural pathways of somatosensory evoked potentials: Clinical implications , in Buser PA, Cobb WA, Okuma T (eds): Kyoto Symposia (EEG Suppl No. 36) . Amsterdam, Elsevier Biomedical Press, 1982;, pp 328-335.
40 +
Allison T, Hume AL:  A comparative analysis of short-latency somatosensory evoked potentials in man, monkey, cat, and rat . Exp Neurol 1981;;72:592-611.
41 +
Lueders H, Lesser R, Hahn J, et al:  Subcortical somatosensory evoked potentials to median nerve stimulation . Brain 1983;;106:341-372.
42 +
Maccabee PJ, Pinkhasov EL, Cracco RQ:  Short latency somatosensory evoked potentials to median nerve stimulation: effect of low frequency filter . Electroencephalogr Clin Neurophysiol 1983;;55:34-44.
43 +
Yamada T, Kimura J, Wilkinson JT, et al:  Short- and long-latency median somatosensory evoked potentials: Findings in patients with localized neurological lesions . Arch Neurol 1983;;40:215-220.
44 +
Sohmer H, Feinmesser M, Szabo G:  Sources of electrocochleographic responses as studied in patients with brain damage . Electroencephalogr Clin Neurophysiol 1974;;37:663-669.
45 +
Starr A, Hamilton AE:  Correlation between confirmed sites of neurological lesions and abnormalities of far-field auditory brainstem responses . Electroencephalogr Clin Neurophysiol 1976;;41:594-608.
46 +
Stockard JJ, Rossiter VS:  Clinical and pathologic correlates of brain stem auditory response abnormalities . Neurology 1977;;27:316-325.
47 +
Sohmer H, Gafni M, Chisin R:  Auditory nerve and brain stem responses: Comparison in awake and unconscious subjects . Arch Neurol 1978;;35:228-230.
48 +
Kimura J, Mitsudome A, Beck DO, et al:  Field distribution of antidromically activated digital nerve potentials: Model for far-field recording . Neurology 1983;;33:164-169.
49 +
Halliday AM, Barrett G, Blumhardt LD, et al:  The macular and paramacular subcomponents of the pattern evoked response , in Lehman D, Calloway E (eds): Human Evoked Potentials . New York, Plenum Press Inc, 1979;, pp 135-151.
50 +
Celesia GG, Archer CR, Kuroiwa Y, et al:  Visual function of the extrageniculo-calcarine system in man . Arch Neurol 1980;;37:704-706.

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