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Somatosensory Evoked Potentials for prediction of outcome in Pediatric Cardiac Intensive Care Unit
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Abstracts / Clinical Neurophysiology 130 (2018) e1–e19
ERPs are under study in preschool children with specific language impairment (SLI). To characterize auditory ERPs and EEG features in preschool children. We studied 14 female and 18 male children (mean age 4.2 yrs). ERPs were obtained off-line from a continuous EEG recordings and with three different odd-ball paradigma of stimuli: syllabic, musical and natural (animal voice); automatic and manual, single sweep, average were compared; in five were detected focal fronto-temporal EEG paroxysms. Control group ERP: with syllabic and musical stimuli four stable peak were recorded: P1, N1, N2 and P2; with natural sound only P1 and N1. SLI patients: P1 peak increased in latency (148 ms; control 124 ms), but the P2 latency (398 ms) was shortened and stable compared with controls (419 ms). ERPs abnormalities suggested primary sensory cortical process disturbances, while precognitive and cognitive ERPs components were less affected. ERPs of the five patients with EEG abnormalities did not differ with the other patients, surprisingly indicating that EEG focal abnormalities did not affect language function and development. Nonetheless, to clarify the role of EEG focal paroxysms on SLI further integrated investigations are suggested given the poor spatial resolution of the method we used. doi:10.1016/j.clinph.2018.09.058
Somatosensory Evoked Potentials for prediction of outcome in Pediatric Cardiac Intensive Care Unit S. Pro, F. Iodice, B. Alessandri, L. Di Chiara, M. Di Capua Roma, Italy Somatosensory Evoked Potentials (SEPs) have been shown to provide prognostic information in both adults and children with acute brain injury. Aim of this study is to evaluate SEPs prospectively as a predictor of neurological outcome in children with ischemic brain injury. We performed SEPs in 29 consecutive patients with acute ischemic injury. SEPs were classified as bilaterally normal (SEPs-N/ N), bilaterally absent (SEPs-A/A), unilaterally absent (SEPs-N/A). Ten pts have SEPs-N/N (outcome: 5 with normal outcome, 4 with epilepsy, 1 exitus); 3 pts have SEPs N/A (outcome: all with hemiparesis and one also with cognitive impairment); 15 pts with SEPs A/A (outcome: 9 exitus and 6 with tetraparesis and cognitive impairment). We suggest that SEPs may be a good predictor of neurological outcome in children with acute ischemic brain injury.
We used the STATA statistical software (version 14). The specificity value of the PES was 50% (90% CI 15.3–84.7) and of the VEEG = 16.7 (90% CI 0.851–58.2). The sensitivity of VEEG + PEScontinuous (1 h-MNM) was to 87.5% (90% CI 52.9–99.4) and specificity 66.7% (90% CI 27.1–93.7) with PPV of 89% (90% CI 34.3 99) and NPV equal to 77.8% (90% CI 45–95.9). The use of 1 h-MNM at an early stage increases the predictability of neurological impairment by not increasing costs and discomfort for the newborn. doi:10.1016/j.clinph.2018.09.060
Evoked potentials predict psychomotor development in neonates with normal MRI after hypothermia for hypoxic-ischemic encephalopathy E. Cainelli, D. Trevisanuto, F. Cavallin, A. Suppiej Padova, Italy Ferrara, Italy Therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) reduced severe outcomes, however, caution is warranted when prognosticating about neurodevelopment if magnetic resonance imaging (RMI) shows no or minor degrees of brain injury (Rollins et al., 2014). To assess the prognostic role of evoked potentials (EP) in neonates with normal MRI. Thirty-five neonates recruited for TH because of HIE, having normal neonatal MRI, performed neonatal somatosensory (SEP), visual (VEP) evoked potentials and electroencephalogram (EEG). The effect of SEP, VEP or EEG abnormalities on Griffith’s developmental scales at 12 and 24 months was measured; positive (PPV) and negative (NPV) predictive value, sensitivity, specificity and accuracy were calculated. At 24 months, VEP abnormality was associated with impaired hearinglanguage (p = 0.002) and performance score (p < 0.0001). VEP achieved best PPV (0.91) and specificity (0.93). The combination of neurophysiological tests achieved the best NPV (0.85), sensitivity (0.90), accuracy (0.83). Psychomotor sequelae may occur in survivors of neonatal HIE with normal MRI. VEP is the single best neurophysiological prognostic marker but the combination of neurophysiological tests has a better value. When facing the challenge of neurodevelopmental prognosis in infants with normal MRI after TH, EPs are useful prognostic tools, complementary to EEG. doi:10.1016/j.clinph.2018.09.061
doi:10.1016/j.clinph.2018.09.059
Early prognostic value of multimodal neurophysiological monitoring in asphyxiated infants undergoing hypothermia S. Lori, A. Krakowska-Kubiszewska, M. Bastianelli, S. Gabbanini, C. Cossu, G. Bertini, F. Lolli Firenze, Italy The prognostic correlation between the early lack of cortical and the development of cerebral palsy/neurodevelopmental impairment is reported.1,2. We utilized the ‘‘standardized 1-h multimodal neurophysiological monitoring” (1-hMNM: simultaneous VEEG-PEScontinuous recording3) in asphyxiated neonates undergoing hypothermia, to determine the early predictive prognostic value of VEEG and PES, individually and together (1-hMNM). The ‘‘Bayley for Infant and Toddler Development” Scales (BSID-III, 12–24 months) was used for neurological outcome. We evaluated, retrospectively, 28 term-neonates (mean GA 39 + 1, 13 F) with hypoxic brain damage studied with1-hMNM in the first weeks of life; the MRI and Ultrasound was also performed. 14 neonates completed the followup at 24 months (5 dead).
Steady-state flash VEPs in children with optic nerve atrophy: preliminary data E. Burattin, C. Ceccato, M. Ermani, V. Schoch, A. Suppiej Padova, Italy Ferrara, Italy Flash steady state visual evoked potentials (fSSVEPs) were introduced over 80 years ago. In infancy, fSSVEPs may be useful because of their rapid acquisition time and small variability. Few studies proved their utility in clinical setting.1,2. The aim of this study was to evaluate 33 Hz fSSVEPs in children with optic atrophy using standardized visual inspection analysis. Twenty-seven children (mean age 3.9 ± 3.2 years) diagnosed with optic nerve atrophy underwent transient and fSSVEPs in Robert Hollman Foundation. Stimuli consisted of white light flash at 1–33 Hz. Analysis: N1 and P2 waves of TVEP and visual inspection of fSSVEPs for presence/absence of the fundamental response or other harmonics. 3 subjects were excluded because of artifacts. 16/24 patients with abnormal TPEV had absence of fundamental frequency but presence of a subharmonic; 5 patients had an absent or markedly reduced response. All
Abstracts / Clinical Neurophysiology 130 (2018) e1–e19
ERPs are under study in preschool children with specific language impairment (SLI). To characterize auditory ERPs and EEG features in preschool children. We studied 14 female and 18 male children (mean age 4.2 yrs). ERPs were obtained off-line from a continuous EEG recordings and with three different odd-ball paradigma of stimuli: syllabic, musical and natural (animal voice); automatic and manual, single sweep, average were compared; in five were detected focal fronto-temporal EEG paroxysms. Control group ERP: with syllabic and musical stimuli four stable peak were recorded: P1, N1, N2 and P2; with natural sound only P1 and N1. SLI patients: P1 peak increased in latency (148 ms; control 124 ms), but the P2 latency (398 ms) was shortened and stable compared with controls (419 ms). ERPs abnormalities suggested primary sensory cortical process disturbances, while precognitive and cognitive ERPs components were less affected. ERPs of the five patients with EEG abnormalities did not differ with the other patients, surprisingly indicating that EEG focal abnormalities did not affect language function and development. Nonetheless, to clarify the role of EEG focal paroxysms on SLI further integrated investigations are suggested given the poor spatial resolution of the method we used. doi:10.1016/j.clinph.2018.09.058
Somatosensory Evoked Potentials for prediction of outcome in Pediatric Cardiac Intensive Care Unit S. Pro, F. Iodice, B. Alessandri, L. Di Chiara, M. Di Capua Roma, Italy Somatosensory Evoked Potentials (SEPs) have been shown to provide prognostic information in both adults and children with acute brain injury. Aim of this study is to evaluate SEPs prospectively as a predictor of neurological outcome in children with ischemic brain injury. We performed SEPs in 29 consecutive patients with acute ischemic injury. SEPs were classified as bilaterally normal (SEPs-N/ N), bilaterally absent (SEPs-A/A), unilaterally absent (SEPs-N/A). Ten pts have SEPs-N/N (outcome: 5 with normal outcome, 4 with epilepsy, 1 exitus); 3 pts have SEPs N/A (outcome: all with hemiparesis and one also with cognitive impairment); 15 pts with SEPs A/A (outcome: 9 exitus and 6 with tetraparesis and cognitive impairment). We suggest that SEPs may be a good predictor of neurological outcome in children with acute ischemic brain injury.
We used the STATA statistical software (version 14). The specificity value of the PES was 50% (90% CI 15.3–84.7) and of the VEEG = 16.7 (90% CI 0.851–58.2). The sensitivity of VEEG + PEScontinuous (1 h-MNM) was to 87.5% (90% CI 52.9–99.4) and specificity 66.7% (90% CI 27.1–93.7) with PPV of 89% (90% CI 34.3 99) and NPV equal to 77.8% (90% CI 45–95.9). The use of 1 h-MNM at an early stage increases the predictability of neurological impairment by not increasing costs and discomfort for the newborn. doi:10.1016/j.clinph.2018.09.060
Evoked potentials predict psychomotor development in neonates with normal MRI after hypothermia for hypoxic-ischemic encephalopathy E. Cainelli, D. Trevisanuto, F. Cavallin, A. Suppiej Padova, Italy Ferrara, Italy Therapeutic hypothermia (TH) for neonatal hypoxic-ischemic encephalopathy (HIE) reduced severe outcomes, however, caution is warranted when prognosticating about neurodevelopment if magnetic resonance imaging (RMI) shows no or minor degrees of brain injury (Rollins et al., 2014). To assess the prognostic role of evoked potentials (EP) in neonates with normal MRI. Thirty-five neonates recruited for TH because of HIE, having normal neonatal MRI, performed neonatal somatosensory (SEP), visual (VEP) evoked potentials and electroencephalogram (EEG). The effect of SEP, VEP or EEG abnormalities on Griffith’s developmental scales at 12 and 24 months was measured; positive (PPV) and negative (NPV) predictive value, sensitivity, specificity and accuracy were calculated. At 24 months, VEP abnormality was associated with impaired hearinglanguage (p = 0.002) and performance score (p < 0.0001). VEP achieved best PPV (0.91) and specificity (0.93). The combination of neurophysiological tests achieved the best NPV (0.85), sensitivity (0.90), accuracy (0.83). Psychomotor sequelae may occur in survivors of neonatal HIE with normal MRI. VEP is the single best neurophysiological prognostic marker but the combination of neurophysiological tests has a better value. When facing the challenge of neurodevelopmental prognosis in infants with normal MRI after TH, EPs are useful prognostic tools, complementary to EEG. doi:10.1016/j.clinph.2018.09.061
doi:10.1016/j.clinph.2018.09.059
Early prognostic value of multimodal neurophysiological monitoring in asphyxiated infants undergoing hypothermia S. Lori, A. Krakowska-Kubiszewska, M. Bastianelli, S. Gabbanini, C. Cossu, G. Bertini, F. Lolli Firenze, Italy The prognostic correlation between the early lack of cortical and the development of cerebral palsy/neurodevelopmental impairment is reported.1,2. We utilized the ‘‘standardized 1-h multimodal neurophysiological monitoring” (1-hMNM: simultaneous VEEG-PEScontinuous recording3) in asphyxiated neonates undergoing hypothermia, to determine the early predictive prognostic value of VEEG and PES, individually and together (1-hMNM). The ‘‘Bayley for Infant and Toddler Development” Scales (BSID-III, 12–24 months) was used for neurological outcome. We evaluated, retrospectively, 28 term-neonates (mean GA 39 + 1, 13 F) with hypoxic brain damage studied with1-hMNM in the first weeks of life; the MRI and Ultrasound was also performed. 14 neonates completed the followup at 24 months (5 dead).
Steady-state flash VEPs in children with optic nerve atrophy: preliminary data E. Burattin, C. Ceccato, M. Ermani, V. Schoch, A. Suppiej Padova, Italy Ferrara, Italy Flash steady state visual evoked potentials (fSSVEPs) were introduced over 80 years ago. In infancy, fSSVEPs may be useful because of their rapid acquisition time and small variability. Few studies proved their utility in clinical setting.1,2. The aim of this study was to evaluate 33 Hz fSSVEPs in children with optic atrophy using standardized visual inspection analysis. Twenty-seven children (mean age 3.9 ± 3.2 years) diagnosed with optic nerve atrophy underwent transient and fSSVEPs in Robert Hollman Foundation. Stimuli consisted of white light flash at 1–33 Hz. Analysis: N1 and P2 waves of TVEP and visual inspection of fSSVEPs for presence/absence of the fundamental response or other harmonics. 3 subjects were excluded because of artifacts. 16/24 patients with abnormal TPEV had absence of fundamental frequency but presence of a subharmonic; 5 patients had an absent or markedly reduced response. All