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Scoping Review on the Diagnosis, Prognosis, and Treatment of Pediatric Disorders of Consciousness

Molteni E 1 , Canas LDS 2 , Briand MM 2 , Estraneo A 2 , Font CC 2 , Formisano R 2 Show all authors , Fufaeva E 2 , Gosseries O 2 , Howarth RA 2 , Lanteri P 2 , Licandro GI 2 , Magee WL 2 , Veeramuthu V 2 , Wilson P 2 , Yamaki T 2 , Slomine BS 2 , as the Special Interest Group on DoC of the International Brain Injury Association (IBIA-DoC SIG)

Affiliations 

  • 1 From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD. erika.molteni@kcl.ac.uk
  • 2 From the School of Biomedical Engineering & Imaging Sciences (E.M., L.S.S.C.), Faculty of Life Science & Medicine, King's College London, United Kingdom; Department of Physical Medicine and Rehabilitation (M.-M.B.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; IRCCS Fondazione Don Gnocchi (A.E.), Florence, Sant'Angelo dei Lombardi, Italy; NEURORHB-Neuro Rehab Human Brain (C.C.F.), Fundación Hospitales Vithas, Valencia, Spain; IRCCS Santa Lucia Foundation (R.F.), Rome, Italy; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) (E.F.), Moscow, Russia; Coma Science Group (O.G.), GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liège, Belgium; Department of Neuropsychology (R.A.H.), Children's Healthcare of Atlanta, GA; Neurophysiology Unit (P.L.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Centro de Rehabilitación Infantil CRI CETNA (G.I.L.), Fleni, Buenos Aires, Argentina; Boyer College of Music and Dance (W.L.M.), Temple University, Philadelphia, PA; Division of Clinical Neuropsychology (V.V.), Subang Jaya Medical Center, Selangor; Division of Clinical Neuropsychology (V.V.), Thompson Hospital Kota Damanasara, Selangor, Malaysia; Department of Physical Medicine and Rehabilitation (P.W.), University of Colorado, Children's Hospital Colorado, Aurora; Division of Neurosurgery (T.Y.), Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Japan; and Department of Neuropsychology (B.S.S.), Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences (B.S.S.), Johns Hopkins University, School of Medicine, Baltimore, MD
Neurology, 2023 Aug 08;101(6):e581-e593.
PMID: 37308301 DOI: 10.1212/WNL.0000000000207473

Abstract

BACKGROUND AND OBJECTIVES: Comprehensive guidelines for the diagnosis, prognosis, and treatment of disorders of consciousness (DoC) in pediatric patients have not yet been released. We aimed to summarize available evidence for DoC with >14 days duration to support the future development of guidelines for children, adolescents and young adults aged 6 months-18 years.

METHODS: This scoping review was reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses-extension for Scoping Reviews guidelines. A systematic search identified records from 4 databases: PubMed, Embase, Cochrane Library, and Web of Science. Abstracts received 3 blind reviews. Corresponding full-text articles rated as "in-scope" and reporting data not published in any other retained article (i.e., no double reporting) were identified and assigned to 5 thematic evaluating teams. Full-text articles were reviewed using a double-blind standardized form. Level of evidence was graded, and summative statements were generated.

RESULTS: On November 9, 2022, 2,167 documents had been identified; 132 articles were retained, of which 33 (25%) were published over the past 5 years. Overall, 2,161 individuals met the inclusion criteria; female patients were 527 of 1,554 (33.9%) cases included, whose sex was identifiable. Of 132 articles, 57 (43.2%) were single case reports and only 5 (3.8%) clinical trials; the level of evidence was prevalently low (80/132; 60.6%). Most studies included neurobehavioral measures (84/127; 66.1%) and neuroimaging (81/127; 63.8%); 59 (46.5%) were mainly related to diagnosis, 56 (44.1%) to prognosis, and 44 (34.6%) to treatment. Most frequently used neurobehavioral tools included the Coma Recovery Scale-Revised, Coma/Near-Coma Scale, Level of Cognitive Functioning Assessment Scale, and Post-Acute Level of Consciousness scale. EEG, event-related potentials, structural CT, and MRI were the most frequently used instrumental techniques. In 29/53 (54.7%) cases, DoC improvement was observed, which was associated with treatment with amantadine.

DISCUSSION: The literature on pediatric DoCs is mainly observational, and clinical details are either inconsistently presented or absent. Conclusions drawn from many studies convey insubstantial evidence and have limited validity and low potential for translation in clinical practice. Despite these limitations, our work summarizes the extant literature and constitutes a base for future guidelines related to the diagnosis, prognosis, and treatment of pediatric DoC.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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