British Society for Clinical Neurophysiology

...to promote and encourage for the public benefit the science and practice of clinical neurophysiology and related sciences

Lecture Details

The role of clinical neurophysiology in disorders of consciousness
Peter Kaplan

Dr. Peter Kaplan is Professor of Neurology and serves as the Director of Epilepsy and EEG at Johns Hopkins Bayview Medical Center. He focuses on epilepsy, clinical neurophysiology and nonconvulsive status epilepticus. He has written extensively about these subjects as well as about eclampsia and neurologic disease in women.

Dr. Peter Kaplan received his medical training from St. Bartholomews Medical School, University of London. He then obtained membership to the Royal College of Physicians in England. He completed his residency in neurology at Duke University Medical Center. He completed fellowships in epilepsy and clinical neurophysiology at the same institution.

Over the last decade, significant improvements have been made in understanding and categorizing coma and disorders of consciousness. Although imaging techniques have been paramount in exploring disorders of consciousness, electrophysiologic techniques continue to be important for studying brain function in behaviorally unresponsive patients. In acute coma, electroencephalogram and evoked potentials have important roles in excluding nonconvulsive seizures, determining prognosis, monitoring for signs of improvement or worsening, and examining for markers of conscious response to external stimuli. Absence of cortical SSEPs is the most specific marker of poor prognosis after cardiac arrest. Recognition of stimulus-induced epileptiform discharges and clinical seizures has further blurred the lines along the ictal–interictal spectrum in coma. For chronic disorders of consciousness, more experimental techniques, such as cognitive event-related potentials and long-latency evoked potentials, have demonstrated an expanded role in determining prognosis and examining for indicators of consciousness. Like functional magnetic resonance imaging, these specialized techniques have demonstrated signs of preserved cognition in patients who otherwise appear unconscious. Future directions for clinical electrophysiologic testing in disorders of consciousness are likely to include automated and quantitative signal processing techniques and better standardization of cognitive event-related potentials.