40 Hz--middle latency auditory evoked response in comatose patients

Quantitative Electroencephalography Analysis for Improved Assessment of Consciousness Levels in Deep Coma Patients Using a Proposed Stimulus Stage

"Coma" is defined as an inability to obey commands, to speak, or to open the eyes. So, a coma is a state of unarousable unconsciousness. In a clinical setting, the ability to respond to a command is often used to infer consciousness. Evaluation of the patient's level of consciousness (LeOC) is important for neurological evaluation. The Glasgow Coma Scale (GCS) is the most widely used and popular scoring system for neurological evaluation and is used to assess a patient's level of consciousness. The aim of this study is the evaluation of GCSs with an objective approach based on numerical results. So, EEG signals were recorded from 39 patients in a coma state with a new procedure proposed by us in a deep coma state (GCS: between 3 and 8). The EEG signals were divided into four sub-bands as alpha, beta, delta, and theta, and their power spectral density was calculated. As a result of power spectral analysis, 10 different features were extracted from EEG signals in the time and frequency domains. The features were statistically analyzed to differentiate the different LeOC and to relate with the GCS. Additionally, some machine learning algorithms have been used to measure the performance of the features for distinguishing patients with different GCSs in a deep coma. This study demonstrated that GCS 3 and GCS 8 patients were classified from other levels of consciousness in terms of decreased theta activity. To the best of our knowledge, this is the first study to classify patients in a deep coma (GCS between 3 and 8) with 96.44% classification performance.

An automatic detection method for 40-Hz auditory steady state response and its application in prognosis of comatose patients

OBJECTIVE

We proposed a 40-Hz auditory steady-state response (ASSR) automatic detection method, and studied the prognosis of comatose patients by combining the 40-Hz ASSR detection results of multiple paradigms of auditory stimulation.

METHODS

The 40-Hz ASSR elicitation experiments were carried out on 32 comatose patients, with the detection results used as prognosis predictors. To achieve automatic detection, the detection was modeled as a binary hypothesis test for a sinusoidal waveform with unknown amplitude and phase, based on the generalized likelihood ratio test (GLRT). The patients were followed up for 6 months, and each patient's outcome was classified as either favorable outcome (severe disability, moderate disability or good recovery) or unfavorable outcome (vegetative state/unresponsive wakefulness syndrome or death) according to the Glasgow outcome scale (GOS). The performance of the prognosis predictors was assessed using the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

The largest AUC in univariate analysis involving a single stimulation paradigm was 0.849, while the AUC obtained by combining multiple predictors was increased to 0.966.

CONCLUSIONS

For comatose patients, the absence of 40-Hz ASSR in multiple stimulation paradigms may indicate an unfavorable prognosis. Furthermore, the combination of multiple auditory stimulation paradigms may increase the outcome prediction accuracy.

SIGNIFICANCE

The combination of multi-paradigm 40-Hz ASSR automatic detection results may provide a feasible automatic outcome prediction method for comatose patients.

Discrepancies in Hearing Thresholds between Pure-Tone Audiometry and Auditory Steady-State Response in Non-Malingerers

OBJECTIVES

To evaluate discrepancies between pure-tone audiometry (PTA) and auditory steady state response (ASSR) tests in non-malingerers and investigate brain lesions that may explain the discrepancies, especially in cases where the PTA threshold was worse than the estimated ASSR threshold.

DESIGN

PTA, speech audiometry, auditory brainstem response, ASSR, and neuroimaging tests were carried out on individuals selected from 995 cases of hearing impairment. Among these, medical records of 25 subjects (19 males, 6 females; mean age = 46.5 ± 16.0 years) with significant discrepancy between PTA and estimated ASSR thresholds were analyzed retrospectively. To define acceptable levels of discrepancy in PTA and ASSR hearing thresholds, 56 patients (27 males, 29 females; mean age = 53.0 ± 13.6 years) were selected for the control group. Magnetic resonance images, magnetic resonance angiograms, and positron emission tomograms were reviewed to identify any neurologic abnormalities.

RESULTS

Pathologic brain lesions were found in 20 cases (80%) in the study group, all of which showed a significant discrepancy in hearing threshold between PTA and ASSR. Temporal lobe lesions were found in 14 cases (70%), frontal lobe lesions in 12 (60%), and thalamic lesions without the frontal or temporal lobe in 2 cases (10%). On repeated PTA and ASSR tests a few months later, the discrepancy between ASSR and behavioral hearing thresholds was reduced or resolved in 6 cases (85.7%). Temporal lobe lesions were found in all 3 cases in which the estimated ASSR threshold worsened with unchanged PTA threshold, and frontal lobe lesions were found in all 3 cases in which the PTA threshold improved but the estimated ASSR threshold was unchanged. No neurological lesions were found in 5 cases (20%) of patients with a discrepancy between ASSR and behavioral hearing thresholds.

CONCLUSIONS

Clinicians should not rely exclusively on ASSR, especially in cases of central nervous system including temporal, frontal lobe, or thalamus lesions. If no lesions are found in a neuroimaging study of a patient with a discrepancy between PTA thresholds and estimated ASSR thresholds, further functional studies of the brain may be needed. If clinicians encounter patients with a discrepancy between PTA thresholds and estimated ASSR thresholds, an evaluation of brain lesions and repeat audiologic tests are recommended in lieu of relying solely on ASSR.

Outcome Prediction by 40-Hz Steady-State Response After Large Hemispheric Infarction

Background and Purpose: The 40-Hz steady state response (SSR) reflects early sensory processing and has the potential to differentiate disease severity. This study aims to evaluate the predictive value of 40-Hz SSRs on the prognosis of patients with large hemispheric infarction (LHI).

Methods: We conducted a retrospective study in patients with LHI admitted to the neurological intensive care unit (NICU) of Nanfang Hospital, Southern Medical University, Guangzhou, China, between June 2008 and December 2014. Forty-hertz SSRs were recorded within 72 h of onset and categorized into 3 grades. The correlation between 40-Hz SSR grading and clinical outcome was examined.

Results: Of the 97 eligible participants, 41 (42.3%) died within 30 days and 68 (70.1%) exhibited a poor outcome (modified Rankin Scale of 5 and 6) at 90 days after the onset of LHI. We found that 40-Hz SSRs correlated significantly with NIHSS scores at admission and patient outcome. Moreover, Grade III 40-Hz SSR (bilateral sine waves that either disappeared or were not clearly identifiable) had a specificity of 97% and a positive predictive value of 94% in predicting 90-days poor outcome; Grade III 40-Hz SSR also had a specificity of 91% and a positive predictive value of 74% in predicting 30-days mortality.

Conclusions: 40-Hz SSR could be used as a simple and specific method in predicting poor prognosis after LHI.

40Hz auditory steady-state responses in patients with disorders of consciousness: Correlation between phase-locking index and Coma Recovery Scale-Revised score

OBJECTIVE

We aimed to elucidate whether 40Hz auditory steady-state response (ASSR) could be sensitive to the state of patients with disorders of consciousness (DOC) as estimated with Coma Recovery Scale-Revised (CRS-R) diagnostic tool.

METHODS

Fifteen DOC patients and 24 healthy controls took part in the study. The 40Hz click trains were used to evoke ASSRs. Mean evoked amplitude (EA) and phase-locking index (PLI) within 38-42Hz window were calculated for 100ms bins, starting from -200 to 700ms relative to stimulus onset.

RESULTS

The PLI values from the patient group in the period of 200-500ms after the stimulus onset positively correlated with the CRS-R total score and with the scores of the Auditory and Visual subscales.

CONCLUSIONS

The phase-locking index of 40Hz auditory steady-state responses can be an indicator of the level of dysfunction of the central nervous system in DOC.

SIGNIFICANCE

Our results emphasize the role of central auditory system integrity in determining the level of functioning of DOC patients and suggest the possibility to use the ASSR protocol as an objective diagnostic method in DOC patients.

Assessment of low-frequency hearing with narrow-band chirp-evoked 40-Hz sinusoidal auditory steady-state response

Objective To determine the clinical utility of narrow-band chirp-evoked 40-Hz sinusoidal auditory steady state responses (s-ASSR) in the assessment of low-frequency hearing in noisy participants. Design Tone bursts and narrow-band chirps were used to respectively evoke auditory brainstem responses (tb-ABR) and 40-Hz s-ASSR thresholds with the Kalman-weighted filtering technique and were compared to behavioral thresholds at 500, 2000, and 4000 Hz. A repeated measure ANOVA and post-hoc t-tests, and simple regression analyses were performed for each of the three stimulus frequencies. Study sample Thirty young adults aged 18-25 with normal hearing participated in this study. Results When 4000 equivalent response averages were used, the range of mean s-ASSR thresholds from 500, 2000, and 4000 Hz were 17-22 dB lower (better) than when 2000 averages were used. The range of mean tb-ABR thresholds were lower by 11-15 dB for 2000 and 4000 Hz when twice as many equivalent response averages were used, while mean tb-ABR thresholds for 500 Hz were indistinguishable regardless of additional response averaging. Conclusion Narrow-band chirp-evoked 40-Hz s-ASSR requires a ∼15 dB smaller correction factor than tb-ABR for estimating low-frequency auditory threshold in noisy participants when adequate response averaging is used.

Human auditory steady-state responses

Steady-state evoked potentials can be recorded from the human scalp in response to auditory stimuli presented at rates between 1 and 200 Hz or by periodic modulations of the amplitude and/or frequency of a continuous tone. Responses can be objectively detected using frequency-based analyses. In waking subjects, the responses are particularly prominent at rates near 40 Hz. Responses evoked by more rapidly presented stimuli are less affected by changes in arousal and can be evoked by multiple simultaneous stimuli without significant loss of amplitude. Response amplitude increases as the depth of modulation or the intensity increases. The phase delay of the response increases as the intensity or the carrier frequency decreases. Auditory steady-state responses are generated throughout the auditory nervous system, with cortical regions contributing more than brainstem generators to responses at lower modulation frequencies. These responses are useful for objectively evaluating auditory thresholds, assessing suprathreshold hearing, and monitoring the state of arousal during anesthesia.

Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain

This report identifies evidence of partially functional cerebral regions in catastrophically injured brains. To study five patients in a persistent vegetative state (PVS) with different behavioural features, we employed [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET), MRI and magnetoencephalographic (MEG) responses to sensory stimulation. Each patient's brain expressed a unique metabolic pattern. In three of the five patients, co-registered PET/MRI correlate islands of relatively preserved brain metabolism with isolated fragments of behaviour. Two patients had suffered anoxic injuries and demonstrated marked decreases in overall cerebral metabolism to 30-40% of normal. Two other patients with non-anoxic, multifocal brain injuries demonstrated several isolated brain regions with relatively higher metabolic rates, that ranged up to 50-80% of normal. Nevertheless, their global metabolic rates remained <50% of normal. MEG recordings from three PVS patients provide clear evidence for the absence, abnormality or reduction of evoked responses. Despite major abnormalities, however, these data also provide evidence for localized residual activity at the cortical level. Each patient partially preserved restricted sensory representations, as evidenced by slow evoked magnetic fields and gamma band activity. In two patients, these activations correlate with isolated behavioural patterns and metabolic activity. Remaining active regions identified in the three PVS patients with behavioural fragments appear to consist of segregated corticothalamic networks that retain connectivity and partial functional integrity. A single patient who suffered severe injury to the tegmental mesencephalon and paramedian thalamus showed widely preserved cortical metabolism, and a global average metabolic rate of 65% of normal. The relatively high preservation of cortical metabolism in this patient defines the first functional correlate of clinical- pathological reports associating permanent unconsciousness with structural damage to these regions. The specific patterns of preserved metabolic activity identified in these patients do not appear to represent random survivals of a few neuronal islands; rather they reflect novel evidence of the modular nature of individual functional networks that underlie conscious brain function. The variations in cerebral metabolism in chronic PVS patients indicate that some cerebral regions can retain partial function in catastrophically injured brains.

Acute effect of nicotine on non-smokers: II. MLRs and 40-Hz responses

This paper is the second in a series of three investigating the role of cholinergic mechanisms in the auditory system by assessing the acute effects of nicotine, an acetylcholinomimetic drug, on aggregate responses within the auditory pathway. In a single-blind procedure, auditory responses were obtained from 20 normal-hearing, non-smokers (10 male) under two conditions (nicotine, placebo). The effects of nicotine on central, mesogenous responses of the auditory system (middle latency and 40-Hz responses) are described in this second paper. Results indicated that transdermal administration of nicotine to non-smokers does significantly affect the central, neural transmission of acoustic information. Na-Pa amplitude and Nb latency of the middle latency response and latency measures of the 40-Hz response were acutely altered by the presence of nicotine.

Auditory steady-state response and bispectral index for assessing level of consciousness during propofol sedation and hypnosis

We assessed the effect of propofol on the auditory steady-state response (ASSR), bispectral (BIS) index, and level of consciousness in two experiments. In Experiment 1, propofol was infused in 11 subjects to obtain effect-site concentrations of 1, 2, 3, and 4 microg/mL. The ASSR and BIS index were recorded during baseline and at each concentration. The ASSR was evoked by monaural stimuli. Propofol caused a concentration-dependent decrease of the ASSR and BIS index values (r(2) = 0.76 and 0.93, respectively; P<0.0001). The prediction probability for loss of consciousness was 0.89, 0.96, and 0.94 for ASSR, BIS, and arterial blood concentration of propofol, respectively. In Experiment 2, we compared the effects of binaural versus monaural stimulus delivery on the ASSR in six subjects during awake baseline and propofol-induced unconsciousness. During baseline, the ASSR amplitude with binaural stimulation (0.47+/-0.13 microV, mean +/- SD) was significantly (P<0.002) larger than with monaural stimulation (0.35+/-0.11 microV). During unconsciousness, the amplitude was 0.09+/-0.09 microV with monaural and 0.06+/-0.04 microV with binaural stimulation (NS). The prediction probability for loss of consciousness was 0.97 (0.04 SE) for monaural and 1.00 (0.00 SE) for binaural delivery. We conclude that the ASSR and BIS index are attenuated in a concentration-dependent manner by propofol and provide a useful measure of its sedative and hypnotic effect. BIS was easier to use and slightly more sensitive. The ASSR should be recorded with binaural stimulation. The ASSR and BIS index are both useful for assessing the level of consciousness during sedation and hypnosis with propofol. However, the BIS index was simpler to use and provided a more sensitive measure of sedation.

IMPLICATIONS

We have compared two methods for predicting whether the amount of propofol given to a human subject is sufficient to cause unconsciousness, defined as failure to respond to a simple verbal command. The two methods studied are the auditory steady-state response, which measures the electrical response of the brain to sound, and the bispectral index, which is a number derived from the electroencephalogram. The results showed that both methods are very good predictors of the level of consciousness; however, bispectral was easier to use.

Auditory steady-state responses to click trains from the rat temporal cortex

In order to investigate the mechanisms underlying the generation of steady-state responses (SSRs), auditory evoked potentials elicited by click trains presented at several stimulation rates (30, 40, 50, 60 Hz) were recorded in 7 awake rats by means of epidural electrodes placed over the temporal cortex. Mean amplitude-rate function calculated on the recorded responses appeared almost flat and showed the maximum value at 50 Hz, while mean phases showed a linear increase when increasing the stimulation rate. In each rat, predictions of the recorded responses at 30, 40, 50 and 60 Hz were synthesized by superimposing middle-latency auditory evoked potentials (MAEPs) at suitable time intervals at each rate. Mean amplitudes calculated on the predicted curves decreased linearly when increasing the stimulation rate and appeared higher in comparison to those obtained from the recorded SSRs. Predicted phases showed a linear increase when increasing the stimulation rate and were leading with respect to corresponding phase values calculated for recorded SSRs. Our findings indicate that the MAEP superimposition mechanism does not adequately predict the generation of temporal recorded SSRs in rats. This was explained by admitting that phenomena related to the recovery cycle and, to a lesser extent, to rate-dependent facilitating effects come into play.

Middle latency auditory evoked potentials in intensive care patients and normal controls

Evoked potentials have been introduced into intensive care unit to objectively measure parameters of coma. In particular, auditory brainstem evoked potentials have been useful for localizing brainstem dysfunction in comatose patients. The middle latency auditory evoked potentials (MLAEPs) believed to be a response of subcortical auditory radiations and the primary auditory cortex. MLAEPs were measured in 40 adults (mean age 24.9 +/- 2.9 years; range: 19-34 years) with normal hearing and in 102 intensive care patients (mean age: 48.4 +/- 18.9 years; range: 14-86 years) under the influence of biological variables. Latencies (control group, mean +/- SD: V = 5.74 +/- .29 ms, N0 = 9.11 +/- 1.74 ms, P0 = 12.94 +/- 1.87 ms, Na = 17.23 +/- 1.77 ms, and Pa = 29.22 +/- 3.43 ms), amplitudes (control group, mean +/- SE: N0-P0 = 2.00 +/- .34 microV, P0-Na = 3.88 +/- .67 microV, Na-Pa = 2.83 +/- .29 microV) and the amplitude ratio (control group, mean +/- SE: P0-Na/Na-Pa = 1.53 +/- .39) were calculated. In the control group in both females and males, right-sided stimulation produced shorter average MLAEP latencies and higher amplitudes than left-sided stimulation (Pa-right 28.26 +/- 3.53 ms; Pa-left 30.17 +/- 3.33 ms). MLAEPs showed significant differences according to sex but did not depend significantly on age. A temperature dependence was found for the latency of wave V (short latency AEP), which was prolonged at lower temperatures and for the amplitude Na-Pa, which was increased at decreased temperatures between 38.9 and 35.4 degrees C. There was a significant association between the amplitude Na-Pa and PO2 (P = .017). Alterations of PCO2 in the range of 26 to 54 mmHg did not influence the MLAEPs. Also, renal dysfunction or hepatic dysfunction and alterations of mean arterial pressure (range: 50-102 mmHg) did not affect MLAEP latencies and amplitudes significantly. Increases in latencies and decreases in amplitude were seen in sedated patients. These results in intensive care patients suggest that the combination of early AEP (acute phase) and MLAEP (post acute phase) may be useful to monitor comatose patients.

EEG-controlled "overdosage" of anesthetics in a patient with a history of intra-anesthetic awareness

In spite of the ever-growing pharmacologic arsenal available for induction and maintenance of anesthesia, to our knowledge no treatment regimen exists that will provide full protection against intraoperative awareness. To date, no single monitoring technique is able to detect awareness or predict recall. Although the frequency of these complications is rare, the occurrence of any such event can be very distressful for the patient. Based on our clinical experience with a patient with a history of recall and a marked resistance to benzodiazepines, we present electroencephalogram-based anesthetic management as a technique to address this difficult problem.

Auditory and visual event-related perturbations in the 40 Hz auditory steady-state response

The effects of salient auditory and visual 'foreground' stimuli on responses to 'background' probe stimuli were investigated. The foreground stimuli were given at long and aperiodic intervals and required a discriminative judgment. Simultaneously, evoked potentials were obtained in response to background probe auditory stimuli presented in a continuous train at about 40/sec. The 40 Hz steady-state rhythm (SSR) evoked under such conditions was extracted using digital averaging and filtering techniques and examined continuously for evidence of change in latency or amplitude during the period surrounding the foreground stimulus. Within the first 200-300 msec after the onset of an acoustic foreground stimulus the latencies of individual peaks in the rhythm were momentarily reduced by a mean of 5.5 msec. A shift in the 40 Hz rhythm was also seen following visual foreground stimuli, although the shift was about one-third that following acoustic stimuli. A latency shift of comparable magnitude was not produced by deliberate manipulation of intensity or signal-to-noise ratio of the stimuli used to evoke the rhythm. The latency shift response is discussed in terms of a transient period of sensory facilitation during orienting or alerting associated with the foreground stimuli.

Steady-state responses from the cat auditory cortex

Responses to 350 ms trains of clicks with 10-100 Hz repetition rate were recorded from the auditory cortices of six cats. Click trains of 30-50 and 90-100 Hz elicited a clear steady-state response (SSR) in awake state. SSRs were small or absent below 30 Hz and in 60-70 Hz stimulus range. In slow wave sleep the optimal rate to elicit SSR shifted towards lower frequencies. 90 Hz SSR was largest in paradoxical sleep. SSRs were strongly suppressed by barbiturate anesthesia. The amplitude of the SSR from the medial geniculate body (MGB) in two cats gradually decreased from 20 to 100 Hz and was more resilient to barbiturate anesthesia than the cortical SSRs. Only low amplitude or no SSRs could be recorded from vertex, visual and association cortices and from the hippocampus in control recordings. The results suggest different generation mechanisms for SSRs recorded from cat auditory cortex and MGB. Human auditory SSRs resemble cat auditory cortical SSRs more than those recorded from cat MGB. The results imply that auditory SSRs in humans are generated in the cortex.

The decomposition of the middle latency auditory evoked potential (MLAEP) Pa component into superficial and deep source contributions

The results of recent investigations have suggested that the Middle Latency Auditory Evoked Potential (MLAEP) Pa component derives its physiological origins from both cortical and subcortical sources. The purpose of the present investigation was to determine if support for this hypothesis could be obtained from the off-line manipulation of the topographically recorded Pa component. The multichannel MLAEP from 15 normal hearing, neurologically intact subjects was collected following monaural left and right ear click stimulation. Data was originally collected using the linked ear reference and was subsequently re-referenced using the common average reference (CAR). These mapped data were converted off-line to source current density using the source derivation (SD) technique described by Hjorth (1975, 1980). This technique is sensitive to current activity that is generated in the superficial cerebral cortex. These SD maps of the MLAEP were subsequently subtracted from the CAR maps of the MLAEP. The derived CAR-SD maps are believed to represent that activity that is generated deep to the cerebral cortex (Hjorth and Rodin 1988). Interpretation of the mapped data have demonstrated support for the hypothesis that Pa is generated by a minimum of two systems including: 1) bilateral sources located in the posterior temporal lobes, and 2) a deeper midline generator system.

Event-related perturbations in an electrophysiological measure of auditory function: a measure of sensitivity during orienting?

The effects of salient foreground stimuli in evoked potentials to weak background probe stimuli were examined in situations requiring passive observation or discriminative judgments of foreground tone stimuli. The background probe stimuli consisted of a continual train of weak acoustic stimuli presented at a rate of about 40 stimuli per second. Under such conditions, a 40-Hz steady-state rhythm (SSR) is established, which has been proposed to consist of the algebraic summation of individual middle-latency components evoked by stimuli in the train. The 40-Hz SSR was averaged over trials and extracted from the composite event-related potential signal using narrow-band digital filtering, for continuous examination of latency and amplitude during the course of the period immediately preceding and following the foreground stimulus. The foreground stimulus was followed by a brief period (peaking at about 200 ms) during which the latency of response to the background probe stimuli was reduced. The extent of this latency reduction was in proportion to the magnitude of the simultaneous slow-wave ERP responses and, to a lesser extent, heart rate responses. It is proposed that the results may reflect a transient period of sensitization during orienting, at a presumably early level in the auditory system, and that the method thus offers a means for determining the extent and temporal course of such effects.

The brain-stem and 40 Hz middle latency auditory evoked potentials in brain death

Bilateral recordings of brain stem auditory evoked responses were compared with the 40 Hz middle latency auditory evoked responses in 38 patients either brain dead or in coma grade IV. In 4 cases the 40 Hz auditory evoked potential was partly preserved, while the brain stem auditory evoked potential was not reproducible beyond wave II. Recording of the 40 Hz auditory evoked potential is found to be more sensitive in some rare instances.

Functional imaging of brain responses to repetitive sensory stimulation: sources estimated from EEG and SPECT

This study examined the effect of modality of stimulation on two measures of cerebral function: (a) the scalp distribution of sensory evoked potentials and (b) the cerebral distribution of radiolabelled HMPAO. Steady-state stimulation in the auditory, somatosensory or visual modality was presented to six subjects. Scalp potentials were measured from a distribution of electrodes, and the radiopharmaceutical was injected through an indwelling intravenous catheter midway through the stimulation/recording session. Equivalent dipole sources estimated from the spatial distribution of the scalp potentials were found to be consistent with regions of high HMPAO uptake as imaged by Single Photon Emission Computed Tomography (SPECT).

Topographic distribution of the 40 Hz auditory evoked-related potential in normal and aged subjects

Galambos, Makeig and Talmachoff (1981) described what they called the 40 Hz event-related potential (ERP). This steady-state response is an EEG following response to repetitive auditory stimulation which becomes sinusoidal in form and maximal in amplitude at rates between 35 and 45 Hz. The present study was designed to examine the scalp topography of the 40 Hz ERP in order to complement previous magnetoencephalographic studies which implicate auditory cortex in the generation of the response. In addition, this study was designed to collect normative data on an aged sample in order to assess the effects of aging on the response. 40 Hz ERP's were recorded from a group of seven audiometrically and neurologically normal elderly subjects (mean age = 69.6 years) and a younger group of five normal adults (mean age = 38.0 years), using 1000 Hz tones presented binaurally at 40 per second. A 21 channel recording system was used to obtain a comprehensive picture of the scalp distribution of the response. Recorded ERP's were Fourier transformed to enhance the signal-to-noise ratio. No significant differences were found in phase or amplitude of the 40 Hz ERP between the two age groups, indicating that the normal aging process does not have an effect on this response. Topographic maps of the 40 Hz ERP showed reversals of electrode potential in temporal regions, supporting an interpretation of bilateral sources in temporal cortex. The data presented in this study complement previous studies of the 40 Hz event-related magnetic field and support the position that temporal cortex is involved in the generation of the response.