Neuropsychological assessment through Coma Recovery Scale-Revised and Coma/Near Coma Scale in a sample of pediatric patients with disorder of consciousness

Frigerio, Susanna; Molteni, Erika; Colombo, Katia; Pastore, Valentina; Fedeli, Claudia; Galbiati, Susanna; Strazzer, Sandra

doi:10.1007/s00415-022-11456-6

Cited by 14 publications

(10 citation statements)

References 32 publications

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“…22 Only 1 study explored the psychometric properties of the CRS-R in children. 23 Measures with some validation in pediatric DoC include the LOCFAS, [24][25][26] western neurosensory stimulation profile, 27 and CNCS. 21,28,29 Qualitative analysis of behavior was used to characterize DoC in children 7,19 based on accepted characteristics of DoC stages.…”

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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“…[302][303][304] The Coma Recovery Scale-Revised (CRS-R) is the gold standard tool in adults, but it has not been widely validated in pediatrics. 303,305 There is a need for pediatric-specific tools, especially for children younger than 4 years in whom language-based skills are less applicable. 303,306 Recent advances have enabled the recognition of states of covert consciousness, including cognitive motor dissociation (CMD), in which task-based fMRI or EEG data detect volitional brain activity in a patient without command following on clinical exam.…”

Section: Cardiac Arrestmentioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.

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“…Although electroencephalography (EEG), 10 positron emission tomography-computed tomography (PET-CT), 11 and functional magnetic resonance imagery (fMRI) 12 can be used as tools to assess consciousness, behavior evaluation is still the gold standard currently because of their expensive, time-consuming and inconvenient operation. Scales such as the Glasgow Coma Scale (GCS), 13 Full Outline of Un-responsiveness (FOUR), 14 and Coma Recovery Scale-revised (CRS-R) 15 are widely used in clinical diagnosis and treatment. There is still a lack of systematic research on the assessment tools for the state of consciousness of NHPs.…”

Section: Introductionmentioning

confidence: 99%

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study

Sun,

Dong,

et al. 2023

Science Progress

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Objective Nonhuman primates (NHPs) are suitable for being model animals in the study of consciousness and loss of consciousness (LoC) with a similar brain structure and function to humans. However, there is no effective consciousness assessment scale for them. This study aimed to develop a behavioral assessment scale of consciousness for NHPs. Methods We constructed an initial indicator framework based on the clinical consciousness disorder assessment scales and the physiological characteristics, consciousness, and arousal behavior of NHPs. A two-round online Delphi method was conducted by a multidisciplinary expert panel to construct a behavioral assessment scale of consciousness for NHPs. The indicators and descriptions were revised according to the experts’ feedback and then sent out for repeated consultations along with a summary of the results of the previous round of consultations. The accepted competencies of indicators were established with mean scores in two scoring criteria (importance and feasibility) ≥4.0, agreement rate with a rating of importance or essential ≥70.0%, and a coefficient of variation ≤0.25, as well as discussions of the research group. Results Consensus was achieved after the second round of consultations, which was completed by 28 experts who specialized in rehabilitation, neuroscience, psychology, neurosurgery, and neurology. A new behavioral assessment scale of consciousness for NHPs, including 37 items organized hierarchically within seven dimensions including visual function, auditory function, motor function, orofacial movements, arousal, brainstem reflexes, and respiration, was developed in this study. Conclusions This study has successfully developed a behavioral assessment scale for measuring the conscious state of NHPs or NHP models with LoC. This tool is expected to facilitate future research into the underlying mechanisms of consciousness by providing a detailed and comprehensive means of measurement.

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Neuropsychological assessment through Coma Recovery Scale-Revised and Coma/Near Coma Scale in a sample of pediatric patients with disorder of consciousness

Cited by 14 publications

References 32 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

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Behavioral assessment scale of consciousness for nonhuman primates: A Delphi study

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