Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
Centre du Cerveau, University Hospital of Liège, Liège, Belgium.
Dev Med Child Neurol. 2022 Jun;64(6):681-690. doi: 10.1111/dmcn.15150. Epub 2022 Jan 28.
The diagnosis and prognosis of disorders of consciousness (DOC) such as coma, unresponsive wakefulness syndrome, or minimally conscious state are especially challenging in children. In some paediatric patients with severe acquired brain injury, medical comorbidities or developmental factors may obscure the detection of signs of consciousness via clinical assessments, thus leading to misdiagnosis. To circumvent these biases, patients benefit from multimodal assessments that combine behavioural, neuroimaging, and neurophysiological measures. In this review, we provide original data for such diagnostic procedures in children. Neuroimaging is largely underdocumented in children and most neurophysiological research consists of a cohort study design aimed at providing prognostic markers for clinical outcomes. The scarcity of available data on complementary diagnostic approaches in children makes it difficult to establish clear paediatric guidelines. Although there is preliminary evidence for the applicability of paradigms involving event-related potentials as support for diagnosis in children, more well-designed studies need to be conducted to promote evidence-based practices in paediatric DOC.
意识障碍（DOC）的诊断和预后，如昏迷、无反应觉醒综合征或最小意识状态，在儿童中尤其具有挑战性。在一些患有严重获得性脑损伤的儿科患者中，医疗合并症或发育因素可能会掩盖通过临床评估检测到意识迹象的能力，从而导致误诊。为了避免这些偏差，患者受益于多模态评估，该评估结合了行为、神经影像学和神经生理学测量。在这篇综述中，我们为儿童提供了这些诊断程序的原始数据。神经影像学在儿童中记录很少，大多数神经生理学研究都是基于队列研究设计，旨在为临床结果提供预后标志物。关于补充诊断方法的可用数据稀缺，使得难以制定明确的儿科指南。尽管有初步证据表明涉及事件相关电位的范式可作为儿童诊断的支持，但需要进行更多精心设计的研究，以促进儿科 DOC 的循证实践。
