Event-related potentials in patients with total locked-in state due to fulminant Guillain-Barre syndrome

Aldo Ragazzoni, Antonello Grippo, Fabrizio Tozzi, Gaetano Zaccara

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

A series of electrophysiological investigations were performed over a 6-month period in two patients affected by fulminant Guillain-Barre polyradiculoneuropathy, who developed an ascending paralysis leading, within 72 h, to flaccid quadriplegia, internal and external ophthalmoplegia, absence of all brainstem reflexes and no respiratory effort: the clinical state resembled brain death. Brain CTs were normal and spinal fluid examination revealed albuminocytological dissociation. All motor nerves tested were unexcitable, whereas sensory responses were markedly abnormal but present. Sequential EEG recordings revealed normal, partially reactive alpha rhythm in both patients. In one patient, normal auditory event-related potentials (ERPs: peak N1, P2, N2, P3, evoked in an 'oddball' paradigm) and CNV-like potentials could be recorded not earlier than the 20th day into the illness. In earlier recordings, N1 and P2 peaks as well as mismatch negativity (MMN) were present over the frontal and central scalp electrodes. This patient has now partially recovered motor functions and no cognitive defects are present, but he has little recollection of the events occurring in the first 2 weeks spent in the ICU, when he was completely paralyzed. The other patient generated normal N1 and P2 ERP peaks, but no N2, P3 and MMN were detected in a series of recordings. He died without having ever regained appropriate behavioral responses. The ERP abnormalities observed raise the matter of the origin of cognitive dysfunction in patients with severe and prolonged de-efferentation/de-afferentation. ERPs allow monitoring the level of alertness and attention and appear more specific than EEG in identifying a state of awareness in patients in which communication is severely impaired as a consequence of neurological disorders. Copyright (C) 2000 Elsevier Science B.V.

Original languageEnglish
Pages (from-to)99-109
Number of pages11
JournalInternational Journal of Psychophysiology
Volume37
Issue number1
DOIs
Publication statusPublished - Jul 1 2000

Fingerprint

Guillain-Barre Syndrome
Evoked Potentials
Ophthalmoplegia
Electroencephalography
Polyradiculoneuropathy
Dissociative Disorders
Alpha Rhythm
Sick Leave
Quadriplegia
Brain Death
Nervous System Diseases
Scalp
Paralysis
Cognition
Brain Stem
Reflex
Electrodes
Communication
Brain

Keywords

  • Consciousness
  • Contingent negative variation
  • Event-related potentials
  • Fulminant Guillain-Barre syndrome
  • Locked-in syndrome
  • Mismatch negativity
  • P300

ASJC Scopus subject areas

  • Behavioral Neuroscience

Cite this

Event-related potentials in patients with total locked-in state due to fulminant Guillain-Barre syndrome. / Ragazzoni, Aldo; Grippo, Antonello; Tozzi, Fabrizio; Zaccara, Gaetano.

In: International Journal of Psychophysiology, Vol. 37, No. 1, 01.07.2000, p. 99-109.

Research output: Contribution to journalArticle

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