title: Reactive EEG patterns in pediatric coma.
abstract: This study was designed to determine whether the observed reactive electroencephalographic patterns in comatose children were associated with a better outcome. All electroencephalograms performed in comatose children aged 2 months to 18 years during the period 1996-2003 were retrospectively analyzed and classified according to modified Young's classification. Reactivity to painful/auditory stimuli and passive eye closure (at least two modalities) was checked in all electroencephalograms. The clinical outcome at 1 year or during the last clinic/inpatient follow-up was scored according to the Pediatric Cerebral and Overall Performance Category Scale. Outcomes were then compared using Fisher exact test and the Mann-Whitney test. Thirty-three patients had electroencephalography within 72 hours after the onset of coma. Fourteen of 33 electroencephalograms revealed reactive patterns. Outcome was unfavorable in 4 (28.6%) of these patients. Three children had no residual neurologic impairment. Among the 19 children with nonreactive electroencephalogram, 13 (65%) had unfavorable outcome, which included 10 deaths. All the survivors had residual neurologic impairment. Outcome was better in children with reactive electroencephalographic patterns (Fisher exact test; P = 0.023). Comatose children with reactive electroencephalographic patterns have better clinical outcome in terms of morbidity and mortality. A careful assessment of electroencephalographic reactive patterns in all comatose children is required for better understanding of the clinical outcome.
authors.affiliation: Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ramachandrannair
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Shelly K
authors.initials: SK
authors.lastname: Weiss
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cortez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D004569:Electroencephalography; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies