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A preliminary prospective neurophysiological study of coma in children
Insights
Electroencephalograms and evoked potentials aid in assessing comatose children. Unrecordable visual evoked potentials (FVEPs) indicate poor outcomes, while recordable FVEPs suggest survival with better neurological function.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Coma in children presents diagnostic and prognostic challenges.
- Early assessment is crucial for determining outcomes and guiding management.
Purpose of the Study:
- To evaluate the prognostic value of electroencephalograms (EEGs), brain-stem auditory evoked potentials (BAEPs), and diffuse flash visual evoked potentials (FVEPs) in comatose children.
- To correlate electrophysiological findings with clinical outcomes within 24 hours of coma onset and serially.
Main Methods:
- Seventeen comatose children underwent serial EEGs, BAEPs, FVEPs, and neurological examinations.
- Results were correlated with clinical outcomes, including mortality and neurological deficits.
Main Results:
- Children with initially unrecordable FVEPs had poor outcomes (5 deaths, 5 severe deficits).
- Initially recordable FVEPs were associated with survival (6/7 with mild/no deficits).
- Intact brain-stem function predicted survival, with the best outcomes in those with recordable FVEPs.
Conclusions:
- FVEPs and BAEPs are valuable tools for assessing comatose children.
- These evoked potentials provide critical prognostic information regarding the severity and consequences of the underlying insult.
Abstract:
Electroencephalograms, brain-stem auditory evoked potentials (BAEPs), visual evoked potentials to diffuse flash (FVEPs), and neurological examinations were performed on 17 comatose children within the first 24 hours of the onset of coma and serially thereafter; the results were correlated with clinical outcome. Children with initially unrecordable FVEPs had poor outcomes; of ten children, five died and five survived with severe neurological deficits. Initially recordable FVEPs in seven children were associated with survival; six of the seven had mild to no neurological residua. Impaired brain-stem function, determined on initial neurological examination, was associated with survival in children with normal BAEPs. All patients with intact brain-stem function survived, but the best outcome was seen in those with recordable FVEPs. Studies of FVEPs and BAEPs are useful in the assessment of coma in children and provide prognostic information concerning the consequences of the underlying insult.