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Short- and long-term prognostic value of the electroencephalogram in children with severe head injury
A Dusser1, Y Navelet, D Devictor
1Université Paris-Sud, Département de Pédiatrie, Kremlin-Bicêtre, France.
Insights
The slow monotonous (SM) electroencephalogram (EEG) pattern in severely head-injured children indicates a poor prognosis. This EEG pattern is linked to longer recovery and worse long-term outcomes.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Electroencephalogram (EEG) is crucial for assessing brain function in pediatric patients.
- Understanding EEG patterns during coma can aid in predicting outcomes after severe head injury.
Purpose of the Study:
- To evaluate the prognostic significance of EEG patterns in children with severe head injuries.
- To identify specific EEG characteristics associated with short- and long-term outcomes.
Main Methods:
- A longitudinal study of 24 severely head-injured children over 8-36 months.
- Analysis of EEG patterns during coma, including borderline, sleep-like, changeable, and slow monotonous (SM) patterns.
- Correlation of EEG findings with coma duration, awakening time, and long-term intellectual and motor outcomes.
Main Results:
- The slow monotonous (SM) EEG pattern was observed in 12 of 24 patients and was associated with longer coma and awakening periods.
- The SM pattern was present in all 3 patients who died from brain injury, indicating a poor short-term prognosis.
- A 'prewake' EEG pattern was identified in 11 of 22 survivors, consistently preceding complete awakening.
- Long-term outcomes revealed that only 50% of survivors with the SM pattern achieved good intellectual and motor function compared to other EEG patterns.
Conclusions:
- The slow monotonous (SM) EEG pattern is a significant indicator of poor short-term prognosis in severely head-injured children.
- The 'prewake' EEG pattern reliably predicts complete awakening in survivors.
- While other EEG features during coma lack prognostic value, the SM pattern impacts long-term intellectual and motor outcomes in survivors.
Abstract:
To determine the prognostic value of the EEG in severely head-injured children, 24 patients were studied for 8-36 months. During coma, 4 EEG patterns were found: borderline, sleep-like, changeable and slow monotonous (SM). For the short-term prognosis, we conclude that the SM pattern (12/24 patients) indicates a bad prognosis because it was associated with a longer coma and awakening period than that of other EEG patterns and because it was observed in the 3 patients who died from brain injury. In contrast, we describe a 'prewake' pattern (11/22 survivors) which, when it occurs, always announces the onset of a complete awakening. For the long-term prognosis, only 50% of the survivors who had an SM pattern during coma have as good an intellectual and motor outcome as the survivors who displayed other EEG patterns. No other EEG features recorded during coma have short- or long-term prognostic significance.