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Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

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Page 1: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Seizures and ComaStephen Deputy, MD, FAAP

LSU School of MedicineChildren’s Hospital,

New Orleans, LA

John K. Willis, MD

Page 2: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Seizures

● Lifetime Prevalence

Single seizure: 9%

Recurrent seizure: 0.5%** The definition of epilepsy is that of a chronic condition characterized by the occurrence of recurrent, unprovokedseizures

Page 3: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

International Classification of Seizures

Partial: local onset

- Simple: no LOC- Complex: LOC- Secondarily generalized

Generalized: bilateral onset

Page 4: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Classification of Epilepsies

Localization related

- Primary- Secondary

Generalized- Primary- Secondary

Page 5: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Classification of Epilepsies

FocalFocal SeizuresFocal EEG changesNormal EEG up to 60%“Narrow Spectrum AED”

GeneralizedGeneralized SeizuresEEG Abnormal “Always”Generalized Discharges“Broad Spectrum AED”

IdiopathicNormal DevelopmentNormal ExamNormal EEG BackgroundNormal NeuroimagingFamily History “Channelopathy”Easy to Treat

Rolandic Epilepsy Childhood AbsenceJuvenile MyoclonicEpilepsies

SymptomaticAbnormal +/- Exam, Development, EEG Background, NeuroimagingDifficult to Treat

“LesionalEpilepsies”

Infantile SpasmsLennox-Gastaut Syndrome

Page 6: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

EEG in Epilepsy

Usually only confirmatory

Treat patient, not EEG

Characteristic EEGs:- Absence- Lennox-Gastaut- Infantile spasms- Rolandic seizures

Page 7: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Seizure History

Aura, onset Eye movements Limb movements Duration Consciousness:

- To voice, pain- Injury- Incontinence- Amnesia

Page 8: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Simple Partial Seizure Features:“Focal motor seizure “/“Focal sensory seizure”

• Consciousness intact• Signs/symptoms variable Motor Somatosensory Autonomic Psychic• May have focal EEG abnormality

Page 9: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Partial Complex Seizures ● “Psychomotor,”

“temporal lobe”● Limbic origin: frontal

or temporal● Perceptual/emotional aura;

Carbamazepine to start● Ictal starring● Automatisms● Postictal confusion

Page 10: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Benign Rolandic seizures

● “BERS”● School age, normal child● Partial: face, arm

Generalized: tonic-clonic● Sleeping >waking● EEG: mid-temporal/central spikes ● Outgrown in adolescence● Rx: limit side effects

Carbamazepine, Benzodiazepines qhs

Page 11: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Rolandic Spikes

Page 12: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Classification of Epilepsies

FocalFocal SeizuresFocal EEG changesNormal EEG up to 60%

GeneralizedGeneralized SeizuresEEG Abnormal “Always”Generalized Discharges

IdiopathicNormal DevelopmentNormal ExamNormal EEG BackgroundNormal NeuroimagingFamily History “Channelopathy”Easy to Treat

Rolandic Epilepsy Childhood AbsenceJuvenile MyoclonicEpilepsies

SymptomaticAbnormal +/- Exam, Development, EEG Background, NeuroimagingDifficult to Treat

“LesionalEpilepsies”

Infantile SpasmsLennox-Gastaut Syndrome

Page 13: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Absence Seizures

• Hyperventilation for Dx • Often clinical: daydreams• Automatisms• Brief, frequent• No postictal state• Normal child: 4-10 y.o.• May resolve in adolescence• Later epilepsy: 30%• Rx: Ethosuximide, Lamotrigine,

valproic acid

Page 14: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

JME

Juvenile myoclonic epilepsy of Janz

Idiopathic/genetic: normal child

First convulsion after sleep loss/alcohol

Antecedent early-a.m. myoclonus:incoordination, jerking

90% relapse off meds

Page 15: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

JME Normal exam/image

EEG: Generalized spike and wave: 3-6 hertz

Prior absence: 1/3

Photosensitive: 1/3

Valproic acid: first choice (?)

- Lamotrigine - Benzodiazepines - Barbiturates - Felbamate- Ethosuximide - Topiramate

- Zonisamide

Page 16: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Classification of Epilepsies

FocalFocal SeizuresFocal EEG changesNormal EEG up to 60%“Narrow Spectrum AED”

GeneralizedGeneralized SeizuresEEG Abnormal “Always”Generalized Discharges“Broad Spectrum AED”

IdiopathicNormal DevelopmentNormal ExamNormal EEG BackgroundNormal NeuroimagingFamily History “Channelopathy”Easy to Treat

Rolandic Epilepsy Childhood AbsenceJuvenile MyoclonicEpilepsies

SymptomaticAbnormal +/- Exam, Development, EEG Background, NeuroimagingDifficult to Treat

“LesionalEpilepsies”

Infantile SpasmsLennox-Gastaut Syndrome

Page 17: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Infantile Spasms

• Flexor/extensor spasms• Hypsarrhythmic EEG• Mental retardation: 90%• Symptomatic versus idiopathic: • Treatment: R/O tuberous sclerosis

- ACTH- Steroids- Valproate- Vigabatrin

Page 18: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Lennox-Gastaut Syndrome

● “Minor motor seizures”- Akinetic- Myoclonic- Absence- Other

● Diverse etiologies● Mental retardation● Difficult control: try Valproate,

Lamotragine, Topiramate

Page 19: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

EEG: slow spike-wave

Page 20: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Classification of Epilepsies

FocalFocal SeizuresFocal EEG changesNormal EEG up to 60%“Narrow Spectrum AED”

GeneralizedGeneralized SeizuresEEG Abnormal “Always”Generalized Discharges“Broad Spectrum AED”

IdiopathicNormal DevelopmentNormal ExamNormal EEG BackgroundNormal NeuroimagingFamily History “Channelopathy”Easy to Treat

Rolandic Epilepsy Childhood AbsenceJuvenile MyoclonicEpilepsies

SymptomaticAbnormal +/- Exam, Development, EEG Background, NeuroimagingDifficult to Treat

“LesionalEpilepsies”

Infantile SpasmsLennox-Gastaut Syndrome

Page 21: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Anticonvulsants Attempt monotherapy

Follow levels?

Watch cognition:- Barbiturates- Phenytoin- Benzodiazepines- Topiramate- Valpoic - Levetiracetam

(Any AED!)

Page 22: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Drug Issues

Neuroleptics, antihistamines: seizures (?)Phenytoin/Carbamazepine toxicity

seizures

Interactions: □ Valproate: [barbiturates]

[lamotrigine] □ Enzyme inducers Levels (e.g., barbiturates, carbamazepine, phenytoin)

Page 23: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Drug IssuesDrugs that Lower Seizure Threshold• Anti-Histamines• Certain Psychotropic Meds• ? Stimulants

Drug-Drug Interactions• Cytochrome P450 Inducers (Pb, DPH,

CBZ, Warfarin OCP’s, etc)• Macrolide Antibiotics and Carbamazepine

Page 24: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Drug Discontinuation

1-2 years seizure free: 75% without seizures off drug

Taper over 6 weeks

Recurrence: □ severe prior seizures □ underlying disease □ severe EEG abnormality

Page 25: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Initial Drugs (I)

● Seizure: partial or generalized

● EEG: normal or focal spikes

Carbamazepine (CBC, Na+) (Trileptal)

Barbiturates (Lamotrigine)

Phenytoin (CBC, LFT’s) (Topiramate)

Valproic acid (CBC, LFT’s) (Zonisamide) (Keppra)

Page 26: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Initial Drugs (II)

● Seizure: generalized

● EEG: generalized spike-wave

Ethosuximide Felbamate (CBC, LFT’s)

Valproic acid Vigabatrin

Benzodiazepines Lamotrigine

Phenobarbital Topiramate

Zonisamide

Page 27: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Status Epilepticus

● Continual seizures

● May damage brain

● A medical emergency

● Remain calm:

- History, PE- BS, Na, Ca, Mg- Drug levels- Supportive care

Page 28: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Status Epilepticus: Drugs

Glucose IV Rectal Diastat 0.5 mg/kg

Lorazepam 0.05 mg/kg IV (Max 4mg)orDiazepam 0.3 mg/kg IV (Max 10mg)

Phenobarbital 20 mg/kg IV over 20 minutes

Page 29: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Status Epilepticus: Drugs

Phenytoin 20 mg/kg IV ≤50 mg/min(Fosphenytoin: up to 150 mg/min)

Infusions IV:

Midazolon 0.15 mg/kg bolus≥1 μg/kg/minPentobarbital 10-15 mg/kg bolus0.5-1.5 mg/kg/hREEG: burst-suppression

Page 30: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Neonatal Seizures

Fragmentary, multifocal,antonomic (apnea, HR)

Usually brief, not life-threatening

Etiology not pharmacology : structural, vascular, infectious, metabolic

EEG : rhythmic discharges

Page 31: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Febrile Seizures <5% incidence: 20% if familial

Age 6 month to 6 yearsBrief, generalized: “simple”Long, focal, repeated: “complex”

30% recurrence after One(Risk Factors for Recurrence: Early Age,

Family Hx, Low Fever, Multiple Prior FSz’s)

R/O meningitis(LP if altered MS, nuchal rigidity, prior

antibiotic use, age <12 months)

Page 32: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Febrile Seizures

? Treat if recurrent or prolonged

- Phenobarbital maintenance

(Concerns about Cognition)

- Valproate maintenance

(Concerns about hepatotoxicity)

- PRN Diazepam

(Concerns about tolerability and

timing of dose)

Page 33: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Febrile Seizures (II)

EEG: not useful

CT/MRI: not useful

Look for Cause of Illness

Page 34: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Febrile Seizures (III)

Later epilepsy:- 1%: no risk factors- 10%: two risk factors

Risk factors:Abnormal childComplex Febrile SeizuresFamily history of epilepsyMultiple Febrile Seizures

Page 35: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Epilepsy: Imaging

Ultrasound: poor

CT

MRI: better than CT

PET: glucose metabolism

- EEG correlation

Page 36: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Pertussis

Disease produces neurologic morbidity and disease

Vaccine poorly linked to neurologic morbidity

Defer vaccine only after a reaction: controversy (unjustified)

Page 37: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Breath-Holding Spells (I)

5% incidence

Familial: ? dominant

Anemia/iron deficiency

Resolve spontaneously: 5 years old

Sequel: neurocardiac syncope (17%)

Page 38: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Breath-Holding Spells (II)

Stereotyped sequence:

Pain/fright/anger

Cry briefly

Hold breath

Cyanosis or pallor (bradycardia)

Loss of consciousness

Limp/stiff/jerking

Rare lengthy seizure

Page 39: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Breath-Holding Spells (III)

If sequence atypical:

- R/O seizure: EEG

- R/O arrhythmia (long Q-T): EKG

Consider iron therapy

Horizontal position

Anticonvulsants for long seizure

Reassurance (“My kid did that.”)

Page 40: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Tics

● Rapid movements:

Stereotypic

in sleep

Brief voluntary suppression

● Rx: Haloperidol (usually unnecessary)

Page 41: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Masturbation(Infantile Gratification Syndrome)

● Boys: obvious

● Girls: rubbing legs together pelvic movements

● Dx often not welcome

Page 42: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Sleep Disorders

▪ Hypnic Jerks

▪ Sleep Apnea

▪ Parasomnias

•Night Terrors

•Sleep Walking/Talking

▪ ? polysomnogram

Page 43: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Syncope

▪ Brief LOC (< 2 min)

▪ No subsequent confusion

▪ Rare tonic-clonic movements

▪ May convulse if held upright

Page 44: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Syncope (Continued)

▪ Precipitants:

- Dehydration, fasting

- Prolonged standing/arising:

adolescents

- Noxious stimuli:

Ven. Puncture

Hair-pulling

▪ With exercise, swimming: R/O cardiac

▪ EKG appropriate

Page 45: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Pseudoseizures

▪ Psychogenic (Conversion Disorder)

▪ some may also have epilepsy

▪ 1/3 females had sexual abuse

▪ Dx:No EEG change during seizureInterrupt or Bring On with Distraction or Suggestion

Page 46: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Clinical Tips

• Continued crying ≠ seizure

• Continuing activity (feeding, play)

≠ seizure

• Interruption by pain (pinch finger)

≠ seizure

• Parental history (?): video

• Not post-ictal after generalized

shaking: ?? seizure

Page 47: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Coma

Coma Substrate Both cerebral hemispheres

and/orBrainstem (ARAS)

Page 48: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Basis for Coma Metabolic disease

versusStructural disease

Page 49: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Coma Exam I

Observe, document

Avoid jargon

Repeat

Think anatomy

Page 50: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Coma Exam II

Alertness:Spontaneous, induced

Movement:Spontaneous, induced

Respirations

Reflexes

Cranial nerves

Page 51: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Motor Patterns

Hemiparesis

Decorticate

Decerebrate

Decerebrate & flaccid legs

Page 52: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Respirations

Cheyne - Stokes: diencephalon

Central neurogenic HV: midbrain ─ rare

Apneustic/cluster: pons

Ataxic: medulla

Page 53: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Reflexes

DTRs

Plantars

Superficial

Page 54: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Cranial Nerves

▪ EOM:SpontaneousDoll's eyesCalorics

▪ Pupils:SizeReaction

▪ Corneal reflex▪ Facial movement

▪ Gag reflex

Page 55: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Uncal Herniation

Temporal lobe hits

▪ 3rd nerve

▪ Peduncle (midbrain) ▪ Post. cerebr. art.

Page 56: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Cerebellar Herniation

Uncommon

Brainstem signs

Cushing's triad

Page 57: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Metabolic Screens

Sugar ABG Sodium toxins Potassium drugs

BUN NH3

Calcium LFT

Page 58: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Structural Disease

Infarct Blood

Edema Demyelination

Tumor Inflammation/ Infection

Pressure Degeneration

Page 59: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Pitfalls

Metabolic needs

Evolving structural

Vital functions

Psychogenic: response to pain/airway occlusion

Page 60: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Lumbar Puncture

Indication: ? Meningitis

Defer with:

Structural disease

Increased intracranial pressure

Page 61: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Coma

EEG- Cerebral state- Metabolic state- Non-Convulsive Status

Evoked potentialsPredictive if insult diffuse

Intracranial pressure:Direct monitoring

Page 62: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

EEG: diffuse slowing suggests generalized cerebral dysfunction. EEG cannot identify etiology.

Page 63: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Intracranial Pressure Treatment

Hyperventilation (pCO2< 30)

Steroids

Hypothermia

Osmotic (mannitol)

Barbiturate coma

Surgical

Page 64: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Herpes Simplex Encephalitis

HSV I, HSV II

Fulminant

Temporal lobe after age 2 years;Anywhere in infants and newborns

Page 65: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Herpes Simplex Encephalitis

Diagnosis:

CSF: PCRCT/MRI →EEG →Biopsy →

Treatment: acyclovir

Biopsy usually unnecessary

Page 66: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Brain Death

Clinical criteria

No movement

No respiration (pCO2 = 60)

No brainstem reflexes

No sedative toxicity

No hypothermia (92°F)

Page 67: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Brain Death

Acceptable clinical events

Deep tendon reflexes

Limbs withdraw to pain

Agonal movement

Page 68: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Brain Death

Ancillary tests

EEG: activity may persist

Cerebral perfusion: may persist

Evoked potentials:

SEP: peripheral components

BAER: wave I only

VEP: absent

Page 69: Seizures and Coma Stephen Deputy, MD, FAAP LSU School of Medicine Children’s Hospital, New Orleans, LA John K. Willis, MD

Thank You

[email protected]


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