EEG Assessment in a 2-Year-Old Child with Prolonged Disorders of Consciousness: 3 Years’ Follow-up

Xu, Gang; Sheng, Qianqian; Xin, Qinggang; Song, Yongchen; Zhang, Gaoyan; Ye, Lin; Zhao, Pengfei; Liang, Jun

doi:10.1155/2020/8826238

Cited by 5 publications

(7 citation statements)

References 45 publications

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“…(++) In children with VS/UWS, EEGs were used to confirm consciousness status when wide cortical damage presented with brain stem preservation 34 to detect residual cortical activity and connectivity, revealing potential for improvement and to study common DoC complications, such as epileptic abnormalities. 35 Stimulation paradigms combined with ERP recordings were used to assess responsiveness in children with DoC.…”

Section: Evidencementioning

confidence: 99%

Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness

Molteni,

Canas,

Briand

et al. 2023

Neurology

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Background and Objectives.Comprehensive guidelines for diagnosis, prognosis, and treatments of disorders of consciousness (DoCs) in pediatric patients have not yet been released. We aim to summarize available evidence for DoCs with >14 days duration, to support the future development of guidelines for children aged 6 months to 18 years.Methods.This scoping review was reported based on PRISMA-ScR guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3-blind reviews. Corresponding full-text articles rated as “in-scope” and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated.Results.On November 9, 2022, 2167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the last 5 years. Overall, 2161 individuals met the inclusion criteria; female patients were 527 of 1554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports, and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%), and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near Coma Scale, Level of Cognitive Functioning Assessment Scale and Post-Acute Level of Consciousness scale. Electroencephalography, event related potentials, structural computerized tomography and Magnetic Resonance Imaging were the most frequently used instrumental techniques. In 29/53 (54.7%) cases DoC improvement was observed, which was associated to treatment with amantadine.Discussion.The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence, and have limited validity, and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to diagnosis, prognosis and treatment of pediatric DoCs.

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Section: Evidencementioning

confidence: 99%

Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness

Molteni,

Canas,

Briand

et al. 2023

Neurology

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“…This technique is widely used in adults with DOC. In one case report, Xu et al 18 used resting‐state EEG recordings to repeatedly assess a 2‐year‐old female with prolonged DOC over 3 years. They performed EEG spectral analysis and showed that the delta‐band power spectrum continuously increased over the 3 years and was associated with a poor neurodevelopmental outcome, as assessed by the Gesell test measure.…”

Section: Resultsmentioning

confidence: 99%

“…decreased parietal SWA regulation), 22 or resting‐state EEG (i.e. increase in the delta‐band power spectrum) 18 could also be useful. However, they should be used carefully in clinical settings since poor prognosis decision‐making can lead to dramatic consequences.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging and neurophysiological diagnosis and prognosis in paediatric disorders of consciousness

Vitello

Szymkowicz

Laureys

et al. 2022

Develop Med Child Neuro

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The diagnosis and prognosis of disorders of consciousness (DOC) such as coma, unresponsive wakefulness syndrome, or minimally conscious state are especially challenging in children. In some paediatric patients with severe acquired brain injury, medical comorbidities or developmental factors may obscure the detection of signs of consciousness via clinical assessments, thus leading to misdiagnosis. To circumvent these biases, patients benefit from multimodal assessments that combine behavioural, neuroimaging, and neurophysiological measures. In this review, we provide original data for such diagnostic procedures in children. Neuroimaging is largely underdocumented in children and most neurophysiological research consists of a cohort study design aimed at providing prognostic markers for clinical outcomes. The scarcity of available data on complementary diagnostic approaches in children makes it difficult to establish clear paediatric guidelines. Although there is preliminary evidence for the applicability of paradigms involving event‐related potentials as support for diagnosis in children, more well‐designed studies need to be conducted to promote evidence‐based practices in paediatric DOC.

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“…(Multi)sensory stimulation is at the core of early intervention. It aims to generate a comprehensive set of environmental prompts by stimulating all the five senses and the motor system [ 32 , 33 ], and it is deemed to favour the re-organisation and the re-building of the behavioural repertoire [ 34 ]. The ultimate goal is to leverage residual activation to—at least ideally—reach out to the entire brain network and foster functioning in the damaged neural tissue through facilitation [ 35 ].…”

Section: Neurorehabilitationmentioning

confidence: 99%

“…Repetitive Nerve Stimulation aims at providing electrical stimulation to a primary nerve afferent to the brainstem (and cortex) ( Figure 1 A) [ 73 , 74 ]. A preliminary report on one child [ 32 ] showed both the short- and long-term positive effects on functional brain connectivity.…”

Section: Medical Technologies For Treatmentmentioning

confidence: 99%

Emerging Treatments for Disorders of Consciousness in Paediatric Age

et al. 2022

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The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0–4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.

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EEG Assessment in a 2-Year-Old Child with Prolonged Disorders of Consciousness: 3 Years’ Follow-up

Cited by 5 publications

References 45 publications

Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness

Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness

Neuroimaging and neurophysiological diagnosis and prognosis in paediatric disorders of consciousness

Emerging Treatments for Disorders of Consciousness in Paediatric Age

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