Cognitive processing in non-communicative patients: what can event-related potentials tell us?

Zulay R. Lugo, Lucia R. Quitadamo, Luigi Bianchi, Fréderic Pellas, Sandra Veser, Damien Lesenfants, Ruben G.L. Real, Cornelia Herbert, Christoph Guger, Boris Kotchoubey, Donatella Mattia, Andrea Kübler, Steven Laureys*, Quentin Noirhomme

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.

Original languageEnglish
Article number569
JournalFrontiers in Human Neuroscience
Publication statusPublished - 14 Nov 2016

Bibliographical note

© 2016 Lugo, Quitadamo, Bianchi, Pellas, Veser, Lesenfants, Real, Herbert, Guger, Kotchoubey, Mattia, Kübler, Laureys and Noirhomme. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution and reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.


  • event-related potentials
  • locked-in syndrome
  • minimally conscious state
  • P300
  • unresponsive wakefulness syndrome
  • vegetative state


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