AYTSF

SOMATOSENSORY
EVOKED POTENTIAL
SONIA BAÑUELOS, SOFÍA ESPINOZA
AND SARA GÓMEZ
 SOMATOSENSORY
EVOKED POTENTIAL
Somatosensory evoked potentials
(SEPs) are time-locked

potentials evoked by electric

stimulation of the sensory

or mixed peripheral nerves and

recorded along the large

fiber somatosensory pathway

SEP Responses
Are generated along large fiber sensory pathways, primarily fibers
carrying proprioceptive sense, but also touch and vibration, their
potentialsoriginating in receptors in muscles, tendons, and joints.
Essential feedback in movement control and closely associated with
the motor system.
A traveling potential created by electrical stimulation
passes along the pathway and SEP responses are recorded
from locations where the signal changes direction or
reaches a subsequent generator
Changes in direction in traveling signal are reflected by predictable, relatively steady, and
reproducible peaks. These individual peaks are named passed on latency after the stimulus and
polarity.
Upward deflections reflect negativity (labeled N) of the potential at the active electrode and
downward deflections reflect positivity (P). Polarity is determined by the recording montage
used: a cephalic bipolar montage in which both electrodes are active and placed on the head, or a
referential montage in wich an inactive reference electrode is placed at a noncephalic site.
Peak nomenclature has not been standardized and numbers used to identify the same evoked
potentials may differ slightly from laboratory to laboratory.
SEPs are considered short-latency potentials, occurring in the first 30 ms after stimulation of
upper-limb mixed nerves and within 50ms after stimulation of
lower-limb mixed nerves. By comparison, long-latency
SEP waveforms occur after 100ms following stimulation, and midlatency SEP potentials occur
between short- and long-latency values.
 REGISTRATION CONDITIONS
PLACEMENT OF ELECTRODES A combination of bipolar and referential log
assemblies is used for SEP logging.

BIPOLAR both recording electrodes are electrically REFERENTIAL the inactive electrode should be placed far
active. Near-field cortical potentials are enough away from the generator to be
best recorded with a bipolar cephalic lead. electrically silent. On the mastoid, opposite
shoulder, arm, hand or knee, earlobes attached.

Use surface and needle electrodes. The impedance of the electrodes should be less than 5000 O. passband of
approximately 30-3000 Hz.

PATIENT CONDITIONS
Mild sedation or non-pharmacologic relaxation techniques have been used to help minimize muscle
artifact.
Unmoving, relaxed.
 STIMULATION
Electrical stimulation of
mixed peripheral nerves.
Unilateral stimulation of
the peripheral nerves of
the upper and lower
extremities. STIMULATION
Applied bipolar
transcutaneous electrical Monophasic square-
stimulation. wave constant current or
constant voltage
electrical pulses of 0.2
ms (0.1–0.3 ms).
Stimulation frequencies
are 2-5 Hz for the upper
extremity and 1-2 Hz for
the lower extremity.
UPPER BODY Cathode: between LOWER BODY Cathode: located

MEMBER
the tendons of the
palmaris longus and
MEMBER midway between the
medial border of the
flexor carpi radialis Achilles tendon and
muscles, 2 cm T12S/L1: The 12th the posterior border
EP: Erb's point on each (distance) from the of the medial
wrist crease. thoracic vertebral malleus.
side, 2 cm above the
process.
midpoint of the
IC: iliac crest.
clavicle.
C5S: The fifth cervical
C5s: The fifth cervical Anode: 2-3 cm distal Anode: it is located 3
to the cathode.
spinous process (midline cm distal to the
spinous process. The ground electrode cathode.
is placed between
of the dorsal neck).
CPi: Centroparietal and the stimulation and
recording sites. CPi: ipsilateral
ipsilateral to the side
centroparietal.
of stimulation.
Cpc: contralateral
AC: Anterior cervical
centroparietal.
non-cephalic, just ELECTRODE MOUNTING ELECTRODE MOUNTING
CPz: Midway between Cz
above the thyroid.
Epi-EPc, C5s-Ref and Pz. EPF (PF1- PF2), LP
(EPc), CPi-Ref (EPc) y (T12S-IC), P31, N34
Cpc-Cpi. Fz: Frontopolar midline. (Fpz-C5S), P37
(CPzFpz, Pi-Fpz, CPi-
Cpc).
CHARACTERISTIC PEAKS AND THEIR
PHYSIOLOGICAL ASSOCIATION
N20 Is a negative peak that appears after 20 milliseconds, most of the
characteristic peaks (waves) follow this samen naming formula. If it
is negative we use N, when it's positive P is used and the following
number indicates the time it takes to appear.

P30, N35 AND P45 Follows N20 including P22, P27 and N30 are from
the somatosensory cortex.

N18 corresponds to Thalamocortical pathway

N/P11 are from cervical dorsal roots

N/P12 comes from dorsal column

N/P13 ARE FOUND IN DORSAL COLUMN FASCICULUS CUNEATUS

 CLINICAL
APPLICATIONS
SEPs are used to identify the issues with peripheral nerves indicating
certain disorders.

NEUROPATHY PLEXOPATHY AND MYELOPATHY

Examples are inflammatory THORACIC OUTLET Abnormal N13 and P14
demyelinating polyneuropathy
(prolongation of EP-N13
SYNDROME
conduction time), chronic SEPs abnormal ACQUIRED AND INHERITED
inflammatory demyelinating MOTOR NEURON
polyneuropathy (where sensory RADICULOPATHY DISORDERS
nerve potentials N9-median and
N20-tibial were absent or less SEPs may be delayed or
absent in patients with Spastic paraparesis HSP),
than a µV) , chronic immune primary lateral sclerosis
sensory polyradiculopathy (with signsof spondylotic cervical
prolonged median N-13, and N9) radiculopathy (PLS), and amyo-trophic
lateral sclerosis (ALS)are
found with abnormal SEPs
 MULTIPLE SCLEROSIS ATAXIC SYNDROMES
CLINICAL SEPs may be used in
multiple sclerosis (MS)
SEPs may localize the
lesion to the peripheral
as a nonspe-cific or spinal level in cases
APPLICATIONS diagnostic biomarker
SEP have better
diagnostic yield with
of sensory
myelopathy
ataxia,
andFriedreich ataxia.
and
silent lesions.

PROGNOSTICATION IN FUTURE APPLICATIONS

COMA
Patients with MS have
SEPs assist in the shown that the baseline
prognostication mmEP score (including
ofhypoxic-anoxic SEP)strongly correlates
encephalopathy (HE) with the Expanded
after cardiac arrestand Disability Status Scale,
acute severe brain injury disease course, and
prognosis
Thank you!