Brain Topography

, Volume 27, Issue 4, pp 467–479

MMN and Novelty P3 in Coma and Other Altered States of Consciousness: A Review

Review

DOI: 10.1007/s10548-013-0335-5

Cite this article as:
Morlet, D. & Fischer, C. Brain Topogr (2014) 27: 467. doi:10.1007/s10548-013-0335-5

Abstract

In recent decades, there has been a growing interest in the assessment of patients in altered states of consciousness. There is a need for accurate and early prediction of awakening and recovery from coma. Neurophysiological assessment of coma was once restricted to brainstem auditory and primary cortex somatosensory evoked potentials elicited in the 30 ms range, which have both shown good predictive value for poor coma outcome only. In this paper, we review how passive auditory oddball paradigms including deviant and novel sounds have proved their efficiency in assessing brain function at a higher level, without requiring the patient’s active involvement, thus providing an enhanced tool for the prediction of coma outcome. The presence of an MMN in response to deviant stimuli highlights preserved automatic sensory memory processes. Recorded during coma, MMN has shown high specificity as a predictor of recovery of consciousness. The presence of a novelty P3 in response to the subject’s own first name presented as a novel (rare) stimulus has shown a good correlation with coma awakening. There is now a growing interest in the search for markers of consciousness, if there are any, in unresponsive patients (chronic vegetative or minimally conscious states). We discuss the different ERP patterns observed in these patients. The presence of novelty P3, including parietal components and possibly followed by a late parietal positivity, raises the possibility that some awareness processes are at work in these unresponsive patients.

Keywords

Auditory ERPsMMNNovelty P3ComaVSMCS

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog)INSERM U1028, CNRS UMR5292LyonFrance
  2. 2.Université Lyon 1LyonFrance
  3. 3.Functional Neurology and Epileptology Department, Neurological HospitalHospices Civils de LyonLyonFrance