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Whiplash and Concussion: Similar Acute Changes in Middle-Latency SEPs

  • Dominik Zumsteg (a1), Richard Wennberg (a1), Eva Gütling (a2) and Klaus Hess (a2)



Middle-latency somatosensory evoked potentials (SEPs) following median nerve stimulation can provide a sensitive measure of cortical function. We sought to determine whether the mechanical forces of whiplash injury or concussion alter normal processing of middle-latency SEPs.


In a cross-sectional pilot study 20 subjects with whiplash were investigated (50% between 0.5-2 months and 50% between 6-41 months post injury) and compared to 83 healthy subjects using a standard middle-latency SEP procedure. In a subsequent prospective study subjects with either acute whiplash (n=13) or Grade 3 concussion (n=16) were investigated within 48 hours and again three months post injury.


In the pilot study the middle-latency SEP component N60 was significantly increased in the ten subjects investigated within two months after whiplash. In contrast, the ten subjects examined more than six months after injury showed normal latencies. In the prospective study N60 latencies were increased after whiplash and concussion when tested within 48 hours of injury. At three months, latencies were improved though still significantly different from controls post whiplash and concussion.


Both whiplash injury and concussion alter processing of the middle-latency SEP component N60 in the acute post traumatic period. The acute changes appear to normalize between three-six months post injury. The SEP similarities suggest that the overlapping clinical symptomatology post whiplash and concussion may reflect a similar underlying mechanism of rotational mild traumatic brain injury.

RÉSUMÉ: Objectif:

Les potentiels évoqués somesthésiques (PÉSs) de latence moyenne obtenus par stimulation du nerf médian constituent une mesure sensible de la fonction corticale. Le but de cette étude était de déterminer si les forces mécaniques impliquées dans le coup de fouet cervical et dans la commotion cérébrale altèrent le traitement normal des PÉSs de latence moyenne.


Il s’agit d’une étude pilote transversale au cours de laquelle nous avons évalué 20 sujets qui avaient subi un coup de fouet cervical. La moitié des sujets ont été évalués entre 0,5 à 2 mois après l’incident et l’autre moitié de 6 à 41 mois après. Nous les avons comparés à 83 sujets témoins en santé au moyen de la technique standard d’évaluation des PÉSs de latence moyenne. Au cours d’une étude prospective subséquente, nous avons évalué des sujets présentant soit un coup de fouet cervical aigu (n = 13) ou une commotion cérébrale de grade 3 (n = 16) dans les 48 heures de l’incident et 3 mois après.


Dans l’étude pilote, la composante de latence moyenne N60 était significativement augmentée chez les dix sujets évalués dans les deux premiers mois après l’incident. Par contre, les dix sujets examinés plus de six mois après l’incident avaient des latences normales. Dans l’étude prospective, les latences N60 étaient augmentées après le coup de fouet cervical et la commotion cérébrale lors de l’évaluation faite dans les 48 heures de l’incident. Après trois mois, les latences étaient améliorées chez les sujets ayant subi un coup de fouet cervical ou une commotion cérébrale, même si elles demeuraient significativement différentes de celles des témoins.


Le coup de fouet cervical et la commotion cérébrale modifient le traitement de la composante N60 des PÉSs de latence moyenne au cours de la période post-traumatique aiguë. Les changements aigus semblent se normaliser entre trois et six mois après la blessure. La similitude des PÉSs suggère que le chevauchement de la symptomatologie clinique après le coup de fouet cervical et après la commotion cérébrale puisse refléter un mécanisme sous-jacent similaire soit une légère lésion cérébrale traumatique rotatoire.

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Corresponding author

Krembil Neuroscience Centre, University of Toronto, Toronto Western Hospital, 5W-425, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada


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