Neuroimaging and neurophysiological diagnosis and prognosis in paediatric disorders of consciousness

Abstract

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.

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

“…Assessment of young children with DoC is difficult due to immature nervous systems and limited repertoire of developmental skills. 7 , 8 Although existing literature on DoC has focused primarily on adults, in 2022, a systematic search 9 on neuroimaging and neurophysiologic methods for the diagnosis and prognosis of children with DoC found preliminary evidence for the application of event-related potentials to support diagnosis. A commentary also reviewed treatments available to this population.…”

Proceedings of the First Pediatric Coma and Disorders of Consciousness Symposium by the Curing Coma Campaign, Pediatric Neurocritical Care Research Group, and NINDS: Gearing for Success in Coma Advancements for Children and Neonates

“…The effect of underlying cause of coma and many other factors when prognosticating or evaluation of coma in children is understudied. Supportively, the practice guidelines for diagnosis and management of DoC in children are lacking [44,45]. Of the 18 recommendations in the 2018 practice guideline update, three of them refer to pediatrics only to state that established therapies and prognostication tools for children are not established [14].…”

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

“…Assessment of young children with DoCs is difficult, due to immature nervous systems and limited repertoire of developmental skills. 7,8 Although existing literature on DoCs has focused primarily on adults, in 2022, a systematic search 9 on neuroimaging and neurophysiological methods for diagnosis and prognosis of children with DoCs found preliminary evidence for application of event-related potentials to support diagnosis.…”

“…(0) 3(5) 11(9) 0.072Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.…”