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Burst-suppression is reactive to photic stimulation in comatose children with acquired brain injury
Dragos A Nita1, Mihai Moldovan2, Roy Sharma1
1Division of Neurology and Program in Neurosciences and Mental Health, The Hospital for Sick Children, and Department of Paediatrics, University of Toronto, Toronto, Canada.
Insights
Burst-suppression pattern reactivity to photic stimulation was observed in comatose children with acquired brain injury. This reactivity, measured as burst ratio change, correlates with coma severity and may help monitor critically ill children.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Pediatric Neurology
Background:
- Burst-suppression is an electroencephalographic pattern seen in comatose patients.
- In healthy individuals under anesthesia, somatosensory stimulation can transiently increase burst activity.
- The reactivity of burst-suppression in pediatric acquired brain injury (ABI) is not well understood.
Purpose of the Study:
- To investigate the reactivity of the burst-suppression pattern to external stimuli in children with ABI.
- To determine if burst-suppression reactivity can serve as an indicator of coma severity in this population.
Main Methods:
- Electroencephalographic (EEG) recordings with burst-suppression patterns were analyzed from 5 comatose children with ABI.
- Intermittent photic stimulation (1 Hz for 1 minute) was applied to assess EEG reactivity.
- Burst ratio (fraction of time in burst) changes post-stimulation were quantified to determine standardized burst ratio reactivity.
Main Results:
- Photic stimulation consistently evoked bursts, leading to a transient increase in the burst ratio in all participants.
- No significant changes in mean heart rate were observed during photic stimulation.
- A correlation was found between the standardized burst ratio reactivity and the patients' Glasgow Coma Scale (GCS) scores.
Conclusions:
- Burst-suppression pattern reactivity to photic stimulation is present across various etiologies of coma in children with ABI.
- Standardized burst ratio reactivity appears to be a reliable indicator reflecting the severity of coma.
- Measuring burst ratio reactivity offers a potentially simple method for monitoring coma severity in critically ill children.
Objective:
Burst-suppression is an electroencephalographic pattern observed during coma. In individuals without known brain pathologies undergoing deep general anesthesia, somatosensory stimulation transiently increases the occurrence of bursts. We investigated the reactivity of burst-suppression in children with acquired brain injury.
Methods:
Intensive care unit electroencephalographic monitoring recordings containing burst-suppression were obtained from 5 comatose children with acquired brain injury of various etiologies. Intermittent photic stimulation was performed at 1Hz for 1min to assess reactivity. We quantified reactivity by measuring the change in the burst ratio (fraction of time in burst) following photic stimulation.
Results:
Photic stimulation evoked bursts in all patients, resulting in a transient increase in the burst ratio, while the mean heart rate remained unchanged. The regression slope of the change in burst ratio, referred to as the standardized burst ratio reactivity, correlated with subjects' Glasgow Coma Scale scores.
Conclusions:
Reactivity of the burst-suppression pattern to photic stimulation occurs across diverse coma etiologies. Standardized burst ratio reactivity appears to reflect coma severity.
Significance:
Measurement of burst ratio reactivity could represent a simple method to monitor coma severity in critically ill children.
