Neurocritical care · 2026
Cognitive Processing of Novel Auditory Stimuli in Children with Acute Disorders of Consciousness.
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Appavu Brian L, Wykhoff Sarah, Burrows Brian, Chahal Geetika, Breton Manon, Naccache Lionel, Sitt Jacobo
Аннотация
BACKGROUND/OBJECTIVE: Prognostication of critically ill children appearing acutely comatose remains challenging. Event-related potentials (ERPs) using electroencephalography (EEG) offer a noninvasive method to detect covert consciousness. These include the mismatched negativity (MMN) and P300b responses. We investigated ERPs using the auditory local-global oddball paradigm to assess inattentive or attentive cortical processing in critically ill, clinically unresponsive children.
METHODS: We prospectively enrolled pediatric intensive care unit (PICU) patients undergoing continuous EEG with Glasgow coma scale scores < 8. Each patient underwent testing with the local-global oddball paradigm. In each trial, five brief tones were delivered; the fifth tone was either identical (local-standard) or different (local-deviant). In total, 80% of trials shared the same local structure (global-standard), and 20% deviated (global-deviant). MMN-like responses were assessed by contrasting local-deviant vs. local-standard trials (100-250 ms post-stimulus) at frontocentral electrodes; P300b-like responses were assessed by contrasting global-deviant vs. global-standard trials (250-700 ms post-stimulus) at centroparietal electrodes. Cluster-based permutation testing identified significant ERPs. Functional outcomes were assessed at 10-12 months using the Glasgow outcome scale extended-Pediatrics (GOSE-Peds), and ERP-outcome associations were analyzed using the Mann-Whitney U test.
RESULTS: Among 29 children, 6 (20.7%) showed reproducible ERPs-2 (6.9%) with MMN-like responses and 4 (13.8%) with P300b-like responses. Presence of either ERP response was associated with lower GOSE-Peds scores (p = 0.029), indicating more favorable outcomes.
CONCLUSIONS: ERPs can detect both inattentive and attentive cortical processing in critically ill clinically unresponsive children. The presence of reproducible responses resembling MMN or P300b may be associated with better long-term functional recovery.
METHODS: We prospectively enrolled pediatric intensive care unit (PICU) patients undergoing continuous EEG with Glasgow coma scale scores < 8. Each patient underwent testing with the local-global oddball paradigm. In each trial, five brief tones were delivered; the fifth tone was either identical (local-standard) or different (local-deviant). In total, 80% of trials shared the same local structure (global-standard), and 20% deviated (global-deviant). MMN-like responses were assessed by contrasting local-deviant vs. local-standard trials (100-250 ms post-stimulus) at frontocentral electrodes; P300b-like responses were assessed by contrasting global-deviant vs. global-standard trials (250-700 ms post-stimulus) at centroparietal electrodes. Cluster-based permutation testing identified significant ERPs. Functional outcomes were assessed at 10-12 months using the Glasgow outcome scale extended-Pediatrics (GOSE-Peds), and ERP-outcome associations were analyzed using the Mann-Whitney U test.
RESULTS: Among 29 children, 6 (20.7%) showed reproducible ERPs-2 (6.9%) with MMN-like responses and 4 (13.8%) with P300b-like responses. Presence of either ERP response was associated with lower GOSE-Peds scores (p = 0.029), indicating more favorable outcomes.
CONCLUSIONS: ERPs can detect both inattentive and attentive cortical processing in critically ill clinically unresponsive children. The presence of reproducible responses resembling MMN or P300b may be associated with better long-term functional recovery.