Neurological outcome in comatose children with bilateral loss of cortical somatosensory evoked potentials.
Bilateral loss of median nerve cortical somatosensory evoked potentials (SEP) in comatose patients is reported to be one of the most discriminating predictors of poor outcome. We reviewed 53 children with bilateral absent cortical SEP with respect to their outcome and their follow-up SEP. Brain injury was caused by global cerebral ischaemia in 18 children, severe head trauma (SHT) in 13, nervous system infections in 10, and other aetiologies in 12 children. Thirty of 53 children died within the first 4 weeks and another 8 children within 4 years after the event. Two children (both ischaemia) survived in a persistent vegetative state, 9 children (1 ischaemia, 2 SHT, 3 nervous system infections, 3 other aetiologies) survived with severe deficits and 4 children (all SHT) with mild or moderate deficits. In 30 children SEP were repeated and in 8 children (5 SHT, 2 nervous system infection, 1 other aetiology) unilateral or bilateral cortical responses reappeared. Although bilateral loss of cortical SEP predicted an unfavourable outcome in most patients, a few comatose children with SHT showed an outcome with mild or moderate neurological deficits.
Wohlrab
G
G
Department of Paediatric Neurology, University Children's Hospital, Zürich, Switzerland. gabriele.wohlrab@kispi.unizh.ch
Boltshauser
E
E
Schmitt
B
B
D000293:Adolescent; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D004292:Dominance, Cerebral / Q000502:physiology*; D004558:Electric Stimulation; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D009460:Neurologic Examination; D011379:Prognosis; D011930:Reaction Time / Q000502:physiology; D013003:Somatosensory Cortex / Q000503:physiopathology*; D015996:Survival Rate