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How to Obtain Reliable Visual Event-related Potentials in Newborns
Published on: October 24, 2019
Giant pattern VEPs in children
Dorothy A Thompson1, Oliver R Marmoy1, Katrina L Prise2
1Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; Ulverscroft Vision Research Group, UCL Great Ormond Street Institute for Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
Insights
Giant amplitude visual evoked potentials (VEPs) in children may indicate increased intracranial pressure (ICP). This study found 81% of children with giant VEPs had conditions risking raised ICP, suggesting VEPs as a potential diagnostic indicator.
Area of Science:
- Pediatric Ophthalmology
- Neurophysiology
- Pediatric Neurology
Background:
- Giant amplitude pattern reversal visual evoked potentials (VEPs) are uncommon in children.
- The clinical significance of these VEPs, particularly in relation to intracranial pressure, requires further elucidation.
Purpose of the Study:
- To investigate the clinical significance of giant amplitude VEPs in pediatric patients.
- To determine the association between giant VEPs and conditions associated with raised intracranial pressure (ICP).
Main Methods:
- Retrospective analysis of 2750 pattern VEPs from children aged 16 and under.
- Identification of 'giant' VEPs exceeding the 97.5th age-specific centile.
- Correlation of giant VEP findings with clinical diagnoses, neuroimaging, and ICP measurements.
Main Results:
- Twenty-seven children (median age 6 years) exhibited giant VEPs (P100 amplitude 65-163 µV).
- 81% (22/27) had conditions associated with a risk of raised ICP, including craniosynostosis and Idiopathic Intracranial Hypertension.
- Structural findings included increased optic disc retinal thickness and neuro-radiological signs of CSF effacement.
Conclusions:
- Sustained giant amplitude VEPs in children, especially at normal latency, warrant consideration for raised ICP.
- VEPs may serve as a non-invasive indicator for further investigation of elevated intracranial pressure in pediatric populations.
Abstract:
Our aim is to elaborate the clinical significance of giant amplitude pattern reversal visual evoked potentials (VEPs) in children. 'Giant' amplitude VEPs exceed the upper 97.5th centile, 90% CI for age. We scrutinised 2750 pattern VEPs recorded to international standards between Jan 2015 and 2017 from children aged 16 years and under, attending a specialist children's hospital. Twenty seven children, median age 6yrs, (range 1-16 yrs), were identified with giant VEPs (P100 amplitude range 65-163 microV). Most, 22/27 (81%), had conditions associated with a risk of raised ICP. Sixteen of these twenty two children had craniosynostosis; six multi-sutural and eight single suture disease. Others had Idiopathic Intracranial Hypertension, arachnoid cyst, NF1 with shunted hydrocephalus, chronic infantile neurological cutaneous and articular (CINCA) syndrome, nephrotic cystinosis and obstructive sleep apnoea. Five children presented with a range of conditions, some associated with seizures some symptomatic, but as yet undiagnosed. Frequent structural associations were optical coherence tomography measures of optic disc maximum anterior axial horizontal retinal thickness projection >160 microm and neuro-radiological findings of CSF effacement and copper beaten appearance. Ultrasonography measures of optic nerve sheath diameters varied, but in one child took 2 years to resolve after treatment for raised ICP. Optic disc gradings by fundoscopy were mostly normal, as were visual acuities. Raised ICP was confirmed by gold standard ICP bolt measurements in five of seven children tested. These data suggest that rICP should be considered if a child has sustained giant amplitude VEPs at normal latency.
