Pseudorandom binary sequence stimulation applied to the visual evoked response. Normative data and a comparative study with pattern and flash stimulation.

The investigation of patients who are unable to fixate the pattern visual stimulus generally requires the use of diffuse flash stimulation to elicit the visual evoked response. However, by comparison with pattern, flash stimulation has proved relatively insensitive in identifying lesions of the visual pathway. We investigated a more complex method of flash stimulation. A pseudorandom binary sequence has been used to generate the diffuse visual evoked response stimulus. The pseudorandom binary sequence, rather than producing a single flash, switches in a pseudorandom fashion between two levels of illumination. The result is a diffuse visual stimulus approximating band-limited white noise. The series is periodic, enabling signal averaging to be performed. By applying the methods of random signal analysis, the impulse or transient response of the visual pathway can be determined. Our normal pseudo-random binary sequence visual evoked response impulse function, derived from 29 normal subjects, had the morphologic characteristics of the conventional flash visual evoked response and a major positive component (P100), whose latency mean and standard deviation closely matched that of our normative pattern visual evoked response. However, the P100 amplitude standard deviation was significantly greater than that produced by conventional pattern and flash stimulation. We investigated 140 patients by means of pattern, flash and pseudorandom binary sequence stimulation. The pseudorandom binary sequence visual evoked response proved to be almost 12 times more effective than flash visual evoked response in detecting lesions of the visual system.