Brain-stem Auditory Evoked Potentials and Early Somatosensory Evoked Potentials in Neurointensively Treated Comatose Children

Lütschg, Jürg

doi:10.1001/archpedi.1983.02140310003001

Cited by 39 publications

(14 citation statements)

References 26 publications

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“…This observation is in accordance with previous studies, where absence of cortical peaks was the predictor of an unfavorable outcome in coma tose patients [ 1,2,9,12,13]. The amplitude abnormality and the overall abnormality in the tibial nerve SEPs cor related significantly with the occupational outcome and also nearly significantly with the presence of neurologic signs or symptoms 1 year after the stroke, but no signif icant correlations were observed with the ADL.…”

Section: Discussionsupporting

confidence: 92%

“…In several studies it has been established that the out come from both traumatic and nontraumatic coma can be predicted with SEPs [1][2][3][4][5][6][7][8][9][10][11][12][13][14], Absence of the cortical SEP components has been shown to be the best predictor of unfavorable outcome [1,2,9,12,13]. Some differ ences in the SEP findings between traumatic and non traumatic coma have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic significance of somatosensory poten tials evoked by stimulation of the median nerve (the median nerve SEPs) in coma has been proved in several studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Some studies have also been published suggesting that median nerve SEPs can be used to predict the outcome from cerebral infarction in the early stages [15][16][17] and after a follow-up period of about 1 '/2-7 months [18].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of Somatosensory Potentials Evoked by Stimulation of the Median and Posterior Tibial Nerves: A Prospective 1-Year Follow-Up Study in Patients with Supratentorial Cerebral Infarction

Kovala

1991

Eur Neurol

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A prospective 1-year follow-up examination was carried out in 35 patients with supratentorial cerebral infarction. The median nerve SEPs were performed 3–15 days and the tibial nerve SEPs 4–19 days after the stroke. The functional outcome was assessed 1 year after the stroke. The occupational outcome correlated most closely with the amplitude abnormalities (absence or attenuation) and with the overall abnormality in the tibial nerve SEPs. The ability to cope with activities of daily living was associated significantly with motor signs in the neurological examination performed during the acute stage, and nearly significantly with the presence or absence of the N60 wave in the median nerve SEPs. Both the tibial nerve SEPs and the motor signs correlated nearly significantly with the presence of neurologic signs or symptoms 1 year after the stroke. The prognostic information provided by the clinical examination and the SEPs is thus qualitatively different and complementary. More prognostic information could be gained by the use of both tibial nerve and median nerve SEPs than by the use of median nerve SEPs only; in the present series of patients the tibial nerve SEPs even had a greater prognostic value than the median nerve SEPs.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of Somatosensory Potentials Evoked by Stimulation of the Median and Posterior Tibial Nerves: A Prospective 1-Year Follow-Up Study in Patients with Supratentorial Cerebral Infarction

Kovala

1991

Eur Neurol

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“…Pourtant, dans leur travail, il était rappelé qu'il n'y a quasiment aucun cas de réveil après des PES abolis dans les comas anoxiques. Les seuls cas décrits étaient soit des TCG, soit des méningites avec collection sous-durale, soit des problèmes de classification en termes de mauvais devenir puisque dans l'étude de Lutschg et al, les six faux-positifs étaient en fait des états végétatifs, qui sont considérés par tous les auteurs comme un mauvais devenir neurologique [23].…”

Section: Intérêt Pronostique Des Pe Dans Le Coma En Réanimation Pédiaunclassified

Les explorations neurophysiologiques chez l’enfant cérébrolésé : quand, comment ?

2011

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Les explorations neurophysiologiques complètent l'évaluation clinique et radiologique d'un enfant cérébrolésé. Leur intérêt est à la fois diagnostique, quand il s'agit de mettre en évidence des crises convulsives ou une mort encépha-lique pour l'électroencéphalogramme (EEG) ou d'évaluer une dysfonction du tronc cérébral pour les potentiels évo-qués (PE) auditifs précoces, et pronostique pour prédire un mauvais devenir neurologique dans les comas anoxiques. À la phase aiguë d'un traumatisme crânien grave (TCG) et d'une méningite, il est utile de reconnaître et de traiter des convulsions ; néanmoins, la fréquence des états épilepti-ques non convulsifs est importante et variable selon les études (de 7 à 48 %). Bien que lourdes et coûteuses, les techniques d'EEG continues pourraient en améliorer la détection. D'où le développement de techniques d'EEG d'amplitude, dont l'intérêt reste encore à préciser en pédia-trie. Concernant le pronostic, certains tracés EEG comme des burst-suppression, un tracé nul ou un état de mal convulsif sont considérés comme mauvais. La valeur prédictive des EEG reste limitée et inférieure à celle des PE somesthésiques (PES). Les PES ont une excellente valeur prédictive dans les comas anoxiques de l'adulte et de l'enfant (de 94 à 100 %, selon les études), surtout en combinaison avec l'évaluation des réflexes pupillaires et des réponses motrices après 48 heures. En revanche, la prédiction d'un devenir neurologique favorable est moins performante. Pour les TCG et les méningites, la performance des PES est moins bonne. L'étude des PE cognitifs ou négativité de discordance (MMN) pourrait améliorer la prédiction du réveil. Pour citer cette revue : Réanimation 21 (2012). Mots clés Explorations neurophysiologiques · Potentiels évoqués · Électroencéphalogramme · Enfant cérébrolésé · PronosticAbstract Neurophysiological tests complete clinical and radiological assessments in brain-injured children. Electroencephalogram (EEG) is clearly helpful to diagnose seizures and brain death while auditory evoked potentials (EP) to assess brainstem dysfunction and predict poor neurological outcome in post-anoxic coma. During the acute phase of severe traumatic brain injury (TBI) and bacterial meningitis, early recognition and treatment of convulsive seizures is essential. The incidence of non-convulsive seizures remains, however, high, varying between 7 and 48%. Although costly and time consuming, continuous EEG monitoring techniques may allow improving seizure detection. Therefore, amplitude integrated EEG techniques have been developed; however, they still require assessment in paediatrics. Some EEG patterns are indicative of a final bad outcome, including burst suppression, isoelectric pattern, and status epilepticus. EEG predictive value remains limited and less useful than somatosensory EP (SEP). SEP have excellent predictive value in post-anoxic coma in adults as well as in children (94 to 100%), especially in combination to pupillary reflexes and motor responses assessed after 48 h. In contrast, their pre...

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“…Auditory, visual, somatosensory, and multimodality evoked potentials are potentially useful because they are not affected by the use of sedative/analgesic drugs and neuromuscular blockade, but brainstem auditory evoked potentials and visual evoked responses are not sensitive or specific indicators of either good or poor outcome [60,61]. Somatosensory evoked potentials (SEPs) were evaluated in a large (n ¼ 109) cohort of children who had brain injury resulting in GCS less than 8 [45].…”

Section: Evoked Potentialsmentioning

confidence: 99%

Outcome Following Cardiopulmonary Arrest

Haque

Udassi

Zaritsky

2008

Pediatric Clinics of North America

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Brain-stem Auditory Evoked Potentials and Early Somatosensory Evoked Potentials in Neurointensively Treated Comatose Children

Cited by 39 publications

References 26 publications

Prognostic Significance of Somatosensory Potentials Evoked by Stimulation of the Median and Posterior Tibial Nerves: A Prospective 1-Year Follow-Up Study in Patients with Supratentorial Cerebral Infarction

Prognostic Significance of Somatosensory Potentials Evoked by Stimulation of the Median and Posterior Tibial Nerves: A Prospective 1-Year Follow-Up Study in Patients with Supratentorial Cerebral Infarction

Les explorations neurophysiologiques chez l’enfant cérébrolésé : quand, comment ?

Outcome Following Cardiopulmonary Arrest

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