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A Reappraisal of Rhythmic Coma Patterns in Children

Published online by Cambridge University Press:  02 December 2014

Rajesh RamachandranNair ,
Rohit Sharma ,
Shelly K. Weiss ,
Hiroshi Otsubo  and
Miguel A. Cortez
Rajesh RamachandranNair
Affiliation:
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Rohit Sharma
Affiliation:
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Shelly K. Weiss
Affiliation:
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Hiroshi Otsubo
Affiliation:
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Miguel A. Cortez*
Affiliation:
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
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Abstract:

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Objective:

This study was designed to determine the prevalence of rhythmic coma patterns in comatose children and to ascertain the prognostic significance of reactive rhythmic coma patterns.

Methods:

We retrospectively analyzed and classified electroencephalogram (EEGs) in comatose children between two months and 18 years of age during the period 1996 - 2003 according to modified Young's classification. Outcome at one-year was scored according to the Paediatric Cerebral and Overall Performance Category Scale. Outcomes were compared using Fisher's exact test and Mann-Whitney test.

Results:

Analysis of 63 electroencephalogram (EEG) records in 38 patients showed rhythmic patterns in 19 records (30.2%; 9 alpha, 4 spindle, 4 theta and 2 beta coma patterns, total number of children = 14). Aetiology and outcome of alpha coma patterns and other rhythmic coma patterns were similar. In five children, one type of rhythmic pattern changed to another. Records with reactive rhythmic coma 66.7% (6/9), were associated with favourable outcome. Sixty percent of the records (6/10 records in seven children) with non-reactive pattern were associated with unfavourable outcome. This clinically significant difference did not reach statistical significance (lower Paediatric Cerebral and Overall Performance Category Scale score p= 0.14; favourable outcome p=0.19).

Conclusion:

Rhythmic coma patterns in comatose children are not uncommon. Aetiology, reactivity and outcome of individual patterns are similar and thus make the rhythmic coma patterns distinct EEG signatures in comatose children. There was a clinically significant better outcome with reactive rhythmic coma patterns.

Résumé:

RÉSUMÉ: Objectif:

Cette étude a été conçue pour déterminer la prévalence de l’activité rythmique chez les enfants comateux et pour évaluer la valeur pronostique de l’activité rythmique réactive chez ces enfants.

Méthodes:

Nous avons analysé et classifié de façon rétrospective les ÉEG d’enfants comateux âgés de 2 mois à 18 ans entre 1996 et 2003 selon la classification modifiée de Young. L’issue à 1 an était évaluée selon la Paediatric Cerebral and Overall Performance Category Scale (PCOPCS). Les résultats ont été analysés au moyen du test de Fisher et du test de Mann-Whitney.

Résultats:

L’analyse de 63 ÉEGs chez 38 patients a révélé la présence d’activité rythmique dans 19 enregistrements (30,2% dont la présence de rythme alpha chez 9, de fuseaux chez 4, de rythme thêta chez 4 et de rythme bêta chez 2, chez 14 enfants au total). L’étiologie et l’issue du coma étaient similaires quel que soit le rythme observé. Chez 5 enfants, un type d’activité rythmique a changé pour un autre. Chez 66,7% (6/9) des enregistrements de tracé de coma réactif l’issue a été favorable et chez 60% (6/10 enregistrements faits chez sept enfants) ayant un tracé de coma non réactif l’issue a été défavorable. Cette différence importante au point de vue clinique n’atteignait pas le seuil de la significativité statistique (score PCOPCS plus bas p= 0,14 ; issue favorable p = 0,19).

Conclusion:

On observe fréquemment différents types d’activité rythmique chez les enfants comateux. L’étiologie, la réactivité et l’issue de chaque type de rythme sont similaires, ce qui confère à ces rythmes une signification ÉEG distincte chez les enfants comateux. L’issue était bien meilleure au point de vue clinique pour les rythmes de coma réactif.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 518 - 523
Copyright
Copyright © The Canadian Journal of Neurological 2005

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