Neurological Outcome in Comatose Children with Bilateral Loss of Cortical Somatosensory Evoked Potentials

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Somatosensory evoked potentials - Children - Severe head trauma - Coma - Outcome

References

• 1 Beca J, Cox P N, Taylor M J, Bohn D, Butt W, Logan W J, Rutka J T, Barker G. Somatosensory evoked potentials for prediction of outcome in acute severe brain injury.  J Pediatr. 1995;  126 44-49
• 2 Carter B G, Taylor A, Butt W. Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs).  Intensive Care Med. 1999;  25 722-728
• 3 Chatrian G E, Somasundaram M, Foltz E L. EEG changes in subgaleal hematomas.  Electroencephalogr Clin Neurophysiol. 1969;  26 524-527
• 4 Guerit J M, de Tourtchaninoff M, Soveges L, Mahieu P. The prognostic value of three-modality evoked potentials (TMEPs) in anoxic and traumatic comas.  Neurophysiol Clin. 1993;  23 209-226
• 5 Jennett B, Bond M. Assessment of outcome after severe brain damage.  Lancet. 1975;  1 480-484
• 6 Judson J A, Cant B R, Shaw N A. Early prediction of outcome from cerebral trauma by somatosensory evoked potentials.  Crit Care Med. 1990;  18 363-368
• 7 Pohlmann-Eden B, Dingethal K, Bender H J, Koelfen W. How reliable is the predictive value of SEP (somatosensory evoked potentials) patterns in severe brain damage with special regard to the bilateral loss of cortical responses?.  Intensive Care Med. 1997;  23 301-308
• 8 Rumpl E, Prugger M, Gerstenbrand F, Hackl J M, Pallua A. Central somatosensory conduction time and short latency somatosensory evoked potentials in post-traumatic coma.  Electroencephalogr Clin Neurophysiol. 1983;  56 583-596
• 9 Schwarz S, Schwab S, Aschoff A, Hacke W. Favorable recovery from bilateral loss of somatosensory evoked potentials.  Crit Care Med. 1999;  27 182-187
• 10 Taylor M J, Farrell E J. Comparison of the prognostic utility of VEPs and SEPs in comatose children.  Pediatr Neurol. 1989;  5 145-150
• 11 Theilen H J, Ragaller M, von Kummer R, Pohlmann-Eden B, Schackert G, Albrecht M D. Functional recovery despite prolonged bilateral loss of somatosensory evoked potentials: report on two patients.  J Neurol Neurosurg Psychiatry. 2000;  68 657-660
• 12 Zandbergen E G, de Haan R J, Stoutenbeek C P, Koelman J H, Hijdra A. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma.  Lancet. 1998;  352 1808-1812