Prognostic value of somatosensory-evoked potentials in neurology: A critical review in hypoxic encephalopathy

Prediction of prognosis in comatose patients surviving a cardiac arrest is still one of the intractable problems in critical care neurology because of lack of fool-proof ways to assess the outcome. Of all these measures, somatosensory-evoked potential (SSEP) has been perhaps the most evaluated and heavily relied-upon tool over the past several decades for assessing coma. Recent studies have given rise to concerns regarding the "absoluteness" of SSEP signals for the prognostic evaluation of coma. In this critical review, we searched the literature to focus on studies conducted so far on the prognostic evaluation of postanoxic coma using SSEPs. All those studies published on the use of SSEP as a prognostication tool in postanoxic coma were reviewed. A narrative review was created that included the strengths as well as limitations of the use of SSEP in postanoxic coma. The use of SSEP in coma has been universal for the purpose of prognostication. However, it has its own advantages as well as limitations. The limitations include challenges in performing and getting SSEP signals during coma as well as the challenges involved in reading and interpreting the signals. The recent usage of therapeutic hypothermia has become another factor that often interferes with the SSEP recording. Finally, based on these study results, some recommendations are generated for the effective use of SSEPs in comatose patients for further prognostication. We advocate that SSEP should be an integral component for the assessment of postanoxic comatose patients due to its several advantages over other assessment tools. However, SSEP recordings should follow certain standards. One should be aware that its interpretation may be biased by several factors. The bias created by the concept of "self-fulfilling hypothesis" should always be borne in mind before discontinuation of life support systems in terminal patients.