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Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
[Evaluation of the functional brain state in comatose children]
Rūta Liesiene1, Ingrida Uloziene, Rimantas Kevalas
1Department of Intensive Care, Clinic of Children's Diseases, Kaunas University of Medicine Hospital, Eiveniu 2, 50009 Kaunas, Lithuania. ruta_liesiene@yahoo.com
Insights
Evaluating functional brain state in comatose children requires assessing clinical status alongside neuroimaging and neurophysiological parameters like electroencephalography spectral analysis and evoked potentials for better prognosis.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Coma duration exceeding 30 days decreases chances of regaining consciousness.
- Hypoxic coma has a worse prognosis and higher incidence of vegetative state than traumatic coma.
- Vegetative state presents significant medical, psychological, and social challenges.
Purpose of the Study:
- To review and analyze methods for evaluating functional brain state in comatose children.
- To identify objective criteria for coma prognosis based on scientific literature.
Main Methods:
- Systematic review of scientific literature from the past decade.
- Analysis of electroencephalography (EEG) methods, including spectral analysis and evoked potentials.
- Review of neuroimaging studies and neurophysiological parameter evaluations.
Main Results:
- Coma duration and origin significantly impact outcomes.
- Objective coma prognosis is best achieved by combining clinical assessment with neuroimaging and neurophysiological data.
- Repeatable investigations and multi-parameter comparisons enhance functional brain state evaluation.
Conclusions:
- A combined approach using clinical status, neuroimaging, and neurophysiological parameters (EEG spectral analysis, evoked potentials) provides the most objective coma prognosis in children.
- Repeated, multi-parameter assessments are crucial for accurate evaluation and prognosis.
Abstract:
This article reviews scientific literature data of the last decade and analyses the possibilities to evaluate functional brain state in comatose children. Observations after the development of coma, its short-term and long-term outcomes show that when duration of coma is over 30 days, the chances to regain consciousness and autonomy are decreased. Coma of hypoxic origin has more complicated course, and its prognosis is worse compared to the one of a traumatic origin. Vegetative condition is observed more frequently as a consequence of hypoxic brain damage. Survival in vegetative condition without recovery of consciousness raises medical, psychological, social, and patient care problems. The article reviews different methodical approaches for the evaluation of functional brain state. Various methods of brain bioelectric evaluation are analyzed, including routine and qualitative methods of electroencephalography, possibilities of its spectral analysis and evoked potentials of various types. The results of the observation that evaluate the changes of brain structure and neurophysiological parameters are reviewed. The analysis of 48 articles draws a conclusion that the most objective criteria for evaluation the prognosis of coma can be achieved while following the clinical condition of the patient in parallel with the brain neuroimaging studies and evaluation of neurophysiological parameters, such as electroencephalography spectral analysis and evoked potentials of brainstem and cortex. The best evaluation of the functional brain state and prognosis of coma can be achieved with repeatable investigations during coma development and comparison of the results of several parameters.
