Reflex and Spontaneous Movements in Pediatric Patients with Brain Death

Abstract

Background Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death.

Methods Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared.

Results A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns.

Conclusion It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

Keywords

brain death - flexor/extensor response - isolated finger jerk - pediatric - reflex movements - spontaneous movements

Publication History

Received: 30 September 2021

Accepted: 05 April 2022

Accepted Manuscript online:
18 April 2022

Article published online:
28 August 2022

• References

• 1 American Academy of Pediatrics Task Force on Brain Death in Children. Report of special Task Force. Guidelines for the determination of brain death in children. Pediatrics 1987; 80 (02) 298-300
• 2 Wijdicks EF. Determining brain death in adults. Neurology 1995; 45 (05) 1003-1011
• 3 Ivan LP. Spinal reflexes in cerebral death. Neurology 1973; 23 (06) 650-652
• 4 Jorgensen EO. Spinal man after brain death. The unilateral extension-pronation reflex of the upper limb as an indication of brain death. Acta Neurochir (Wien) 1973; 28 (04) 259-273
• 5 Döşemeci L, Cengiz M, Yilmaz M, Ramazanoĝlu A. Frequency of spinal reflex movements in brain-dead patients. Transplant Proc 2004; 36 (01) 17-19
• 6 Saposnik G, Maurino J, Saizar R, Bueri JA. Spontaneous and reflex movements in 107 patients with brain death. Am J Med 2005; 118 (03) 311-314
• 7 Han SG, Kim GM, Lee KH, Chung CS, Jung KY. Reflex movements in patients with brain death: a prospective study in a tertiary medical center. J Korean Med Sci 2006; 21 (03) 588-590
• 8 Hosseini MS, Ghorbani F, Ghobadi O, Najafizadeh K. Factors affecting the occurrence of spinal reflexes in brain dead cases. Exp Clin Transplant 2015; 13 (04) 309-312
• 9 A definition of irreversible coma. Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. JAMA 1968; 205 (06) 337-340
• 10 Diagnosis of brain death. Statement issued by the honorary secretary of the Conference of Medical Royal Colleges and their Faculties in the United Kingdom on 11 October 1976. BMJ 1976; 2 (6045): 1187-1188
• 11 Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981; 246 (19) 2184-2186
• 12 Law Reform Commission of Canada. Report on the criteria for the determination of death. 1981 . Minister of Supply and Services Canada
• 13 Kim YS, Kim DH, Yang TW. et al. Factors affecting the time taken to determine brain death in patients with impending brain death. J Clin Neurol 2020; 16 (04) 668-673
• 14 Kim JY, Lee SB. Diagnostic criteria of brain death. J Korean Med Assoc 1999; 42: 349-356
• 15 Saposnik G, Bueri JA, Mauriño J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology 2000; 54 (01) 221-223
• 16 Jain S, DeGeorgia M. Brain death-associated reflexes and automatisms. Neurocrit Care 2005; 3 (02) 122-126
• 17 Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic review. Can J Neurol Sci 2009; 36 (02) 154-160
• 18 Conci F, Procaccio F, Arosio M, Boselli L. Viscero-somatic and viscero-visceral reflexes in brain death. J Neurol Neurosurg Psychiatry 1986; 49 (06) 695-698
• 19 Martí-Fàbregas J, López-Navidad A, Caballero F, Otermin P. Decerebrate-like posturing with mechanical ventilation in brain death. Neurology 2000; 54 (01) 224-227
• 20 Rodrigues W, Vyas H. Movements in brain death. Eur J Neurol 2002; 9 (06) 687-688