The Value Of Somatosensory Evoked Potentials In Predicting The Prognosis Of Severe Consciousness Disorder In Children

Objective: To explore the predictive value of somatosensory evoked potentials(SEP)for recovery of DOCs in children.Methods: DOCs children hospitalized in Children's Hospital of Chongqing Medical University from January 2014 to December 2018 were studied.According to the etiology,children were divided into three groups: immune encephalitis,traumatic brain injury and non-traumatic brain injury(excluding immune encephalitis).According to SEP,children were divided into three grades: grade I: bilateral central conduction time(CCT)was normal and symmetrical;Level II: bilateral or unilateral CCT asymmetry or extension;Level III: cortical potential disappears.CRS-R was used for evaluation every 3 months or after clinical observation of changes in the state of consciousness of the children.Functional communication or functional using objects were considered as consciousness recovery,and the end point of evaluation was consciousness recovery or death or follow-up for 12 months.Results: There were 233 cases in total.(1)In the traumatic brain injury and non-traumatic brain injury(excluding immune encephalitis)groups,the higher the SEP grade,the lower the rate of consciousness recovery(P<0.05).However,there was no significant correlation between SEP grading and consciousness recovery rate in the immune-encephalitis group(P>0.05).(2)There were 127 cases(54.5%)of children with consciousness recovery in the course of disease within 12 months,and the difference of consciousness recovery rate among the three groups was statistically significant(P<0.05).The consciousness recovery rate was the highest in the immune-encephalitis group(89.3%),followed by that in the traumatic brain injury group(64.4%),and the lowest in the other non-traumatic brain injury group(43.8%).(3)The recovery time of consciousness in the first 3 months(66.9%)was concentrated among the children who regained consciousness within 12 months.From 3 to 12 months,the recovery rates of consciousness in the immune-encephalitis group and the traumatic brain injury group were still high(39.3%?25.4%),and some children in the non-traumatic brain injury group(excluding the immune-encephalitis)regained consciousness(11.0%).Conclusion:(1)SEP can be used as an effective predictor of consciousness recovery in children with consciousness disorders caused by traumatic brain injury and non-traumatic brain injury(excluding immune encephalitis).The higher the grade of SEP,the lower the rate of consciousness recovery,but its sensitivity and specificity are lower than that of adults.One-time SEP grade did not predict the recovery of consciousness in children with immune-encephalitis.(2)The consciousness recovery rate of pediatric DOCs patients at 12 months is related to the etiology.The consciousness recovery rate of children with immunological encephalitis is higher than that of children with traumatic brain injury,and the consciousness recovery rate of children with traumatic brain injury is higher than that of children with non-traumatic brain injury(except for immunological encephalitis).(3)DOCs caused by non-traumatic brain injury,especially autoimmune encephalitis,still recovered consciousness 3 months after the course of disease.The plasticity of the developing children's nervous system is a big characteristic different from that of adults,and the evaluation of the prognosis of children's consciousness disorders has its particularity.The definition of permanent vegetative state after non-traumatic brain injury is not applicable to children.