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Pediatric Rehabilitation

Event Related Potentials and Outcomes in Children with Disorders of Consciousness Due to Non-Traumatic Brain Injury: A Case Series

(Kiosk 6) Event Related Potentials and Outcomes in Children with Disorders of Consciousness Due to Non-traumatic Brain Injury: A Case Series

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Francis A. Eusebio, MD

    Pediatric Rehabilitation Medicine Fellow
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania

    • Co-Author(s)

  • Chong-Tae Kim, MD, PhD

    professor
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania

Case Diagnosis: Six Children aged 2-16 years old with disorders of consciousness due to non-traumatic brain injury

Case Description or Program Description: Six children were admitted to the acute care hospital or inpatient rehabilitation for responsiveness trials in the setting of non-traumatic brain injuries (cardiac arrest, vasculitis, drowning, and hanging) with resultant disorders of consciousness. Four subjects in vegetative state and two who were minimally responsive. The presence of event related potentials (ERP) in relation to external auditory oddball stimuli were evaluated in each patient to assess for cognitive processing during their admission. Subsequent Glasgow Outcome Scale Extended (GOS-E) was evaluated.

Setting: Tertiary care pediatric hospital

Assessment/Results: ERP testing was performed, and two of the six patients had late peaks with latencies of 278.3 msec and 400 msec respectively (P300 event related potentials) indicative of intact auditory information processing. On subsequent follow up, the two patients with ERP present had GOS-E of two and three, while the four patients with absent ERP had GOS-E ranging from one to three. These findings are not statistically significant (Fisher’s exact test, p = 0.067), but show a tendency towards better prognosis of presence ERP than absence ERP.

Discussion (relevance): Event related potentials are small voltages generated in brain structures in response to specific events or stimuli, and they are time locked to sensory, motor, or cognitive events. There is limited evidence in the literature that event related potentials may assist with prognosis of DOC in children. These cases represent the value of ERP when evaluating disorders of consciousness in children with non-traumatic brain injury, which can inform rehabilitation goals.

Conclusions: Presence and absence of P300 event related potentials can be evaluated in children with DOC to predict prognosis by examination of information processing. Further studies with larger sample size are suggested.