Supplementary Table 1 – Comparative table of the criteria for PSG scoring in pediatric coma, unresponsive wakefulness syndrome,
vegetative and minimally conscious states. Criteria agreed by the AASM11 (2007) and including the visual rules for children, proposed by
Cologan et al.28 (2013), and indicated by Chéliout-Heraut et al.13 (2001) are compared.
Stage W
AASM criteria including the Visual Rules for Children11
One or more of the following items:
- Age related DPR
- Eye blink
- Reading eye movements
- REMs with high muscle tonus
Cologan et al.28
Chéliout-Heraut et al.13
The following items:
No characterization is given for this stage
- highest muscular, ocular and cardiac
activities
- Eye blink
- No sleep pattern
Stage N1
One or more of the following items:
The following items:
Stages N1 and N2 are grouped in one stage
- Vertex sharp waves
- decrease of muscular, cardiac and ocular characterized by:
- SEM
activities, according to visual and spectral - Light sleep
- Slowing of background frequencies towards 1-2 Hz lower than inspections.
those of stage W
- absence of eye blinks
- RAT
- absence of spindles, slow-wave sleep
- Hypnagogic hypersincronism
and REM sleep.
Stage N2
Spindles or K-complexes
Stage N3
SWA (0.5-2 Hz, amplitude>75µV, and duration> 20% of the epoch.
Stage N
All the following phenomena :
- SWA with duration <20% of the epoch
- no spindles and no K-complexes
All the following phenomena:
- Low amplitude mixed frequency
- Low chin EMG tone
- REMs
Stage R
One the following phenomena :
- Spindles (10-16 Hz)
- slow-spindles (6-9 Hz), with amplitude
<50 µV, and 0.5-2 s duration.
The following item:
SWA
- Slow-waves activity >20% of time.
(standard or attenuated Slow-waves
activity).
This stage is absent
This stage is absent
AASM criteria
AASM criteria OR M pattern.
M pattern is found when at least two of the
following criteria are found:
- EEG changes
- eye movements
- motor phasic activity without EEG arousal
LEGEND (in alphabetic order):
DPR: dominant posterior rhythm
EMG: electromyography
RAT: rhythmic theta anterior activity
REM: Rapid eye movements
SEM: Slow eye movements
SWS: slow-waves activity
CASE
Supplementary Table 2 – Duration ofRapid Eye Movement (REM) periods and spindle number for patients in SPPUWS 5 and 6.
1
3
4
9
11
12
13
15
16
17
18
19
20
Total Sleep Time
[min]
Total REM Time [min]
Number of REM periods
Number of spindles
500.0
48.0
3
73
585.5
60.5
7
1080
492.0
36.5
4
699
506.5
141.5
7
737
603.5
93.5
8
1380
446.0
55.5
4
2102
640.5
80.5
8
846
347.5
50.5
6
105
459.5
57.0
5
1441
475.0
55.0
4
637
473.0
57.0
2
272
518.0
64.5
6
48
465.5
32.5
3
26
22
23
26
377.0
11.5
2
193
330.5
48.0
3
188
643.5
49.0
5
54
CASE
Supplementary Table 3 – Radiological and neuropsychological characterization of the patients.
1
2
3
4
5
6
7
8
9
Radiological evidences (MRI)
Multifocal cortical lesions to the gray matter, localized
bilaterally in the frontal, pariental and temporal regions.
Bilateral alteration of the white matter in the frontal region.
Hemorragicsequelae in the corpus callosum, and left middle
cerebellar peduncle. Hydrocephalus. Moderate atrophy.
Subdural hematoma in the left frontotemporal region.Shift of
the medial line. Multifocal cortical lesions to the gray matter,
localized bilaterally in the frontal, parietal and temporal
regions. Cerebellar lesions. DAIto the PCC. Hydrocephalus.
Multifocal cortical lesions to the gray matter, localized in the
left frontal, parietal and occipital regions, and in the right
temporal area. Bilateral frontoparietal white matter damage.
Mild atrophy of the thalami and posterior putamen.
Mildcorticalatrophy.
Hemorragicexitus in the posterior fossa. Ependimoma at the
IV ventricle.
Multifocal parenchimal lesions in the right frontotemporal
region. Hemorragicexitus in the anterior median
mesencephalon. White matter damage to the splenium of the
corpus callosum and bilateral cortico-spinal tracts.
Multifocal lesions to the thalami and basal nuclei. DAI
(grade III).Moderate cerebellaratrophy.
Left frontal subdural hematoma. Multifocal parenchimal
lesions in the right fronto-temporal region and left
hemisphere.
Multifocal cortical lesions.
Bilateralsubdural
igroma.
Left
frontalcorticosubcorticalleucomalacia. Bilateral damage to the temporal
INTERHEMISPHERIC
ASYMMETRY
Other neurophysiological evidences
W+S
Moderately less ample and slower neuroelectrical activity
in the right derivations. Physiological sleep figures less
frequent at right.
W+S
Less ample neuroelectrical activity in the left derivations.
W+S
Slower neuroelectrical activity in the right derivations.
Physiological sleep figures less frequent at right.
W+S
Slower neuroelectrical activity in the right derivations.
-
-
W+S
Less ample neuroelectrical activity in the right
derivations.
W+S
Less ampleneuroelectrical activity in the left derivations
and in the temporo-occipital derivations at right.
W+S
Less ample and slower neuroelectrical activity in the right
derivations. Physiologicalsleepfiguresinfrequent over the
10
11
12
13
14
15
lobe and medial portion of the thalami.
Multifocal infra-tentorial damage. Hemorragicexitus in the
pons and mesencephalon. Cerebellar atrophy. Bilateral
thalamic damage (left>right). Right fronto-parieto-occipital
cortical damage. Cortical atrophy.
Subdural hematoma in the right fronto-parieto-temporal
region. Extensive bilateral parenchimalcortico-subcortical
damage (left>right). Severe multifocal damage of the frontal
lobes, degrading in milder damage towards the occipital
region. DAI with maximal severity at the frontal poles. Left
frontal leucomalacia. Cortical atrophy (left>right).
Multiple gliotic-malacic lesions. Bilateral temporal and
fronto-basal cortical-subcortical lesions. Atrophic damage of
putamen and caudatum. Mild cortical atrophy and moderate
atrophy of the cerebellum and brainstem. Mild axonal
damage in the genu and splenium of the corpus callosum.
DAI of the PCC and bilateral fronto-temporal cortex.
Mild atrophy of the cerebellum, pons and cerebral peduncle
at right. Multiple supra-tentorial necrotic-hemorragic lesions
in the right temporal lobe, insula, frontolateral and parietaloccipital regions. Multiple lesions in the left parietal lobe
and in the frontal lobe at vertex. Cavitation in the right
thalamus and left pallidum. Mild DAI. Multiple
focaldamages in the PCC and MCC.
Multifocal cortical-subcortical damage of the left hemisphere
and right frontal lobe, with underlying white matter damage
and gliosis. Focal damage in the right thalamus, internal
capsule and MCC.Left fronto-parietal extra-parenchimal
hematoma.
Left frontal-parietal-temporalsubgaleal
hematoma.Hemorragic lesions in the right frontal lobe, and
at left vertex, brainstem. Bilateral multifocal DAI in the
frontopolar regions, in the splenium of the corpus callosum
and MCC and in the capsulotalamic area at right.
Focal damage in the pons; moderate brainstem atrophy and
mild cerebellar atrophy. Moderate hydrocephalus. Subdural
igroma in the lefthemisphere.
right derivations.
W+S
Slower neuroelectrical activity in the central, temporal
and occipital derivations at right.
W+S
Slower neuroelectrical activity in the left derivations.
Physiological sleep figures infrequent over the left
derivations.
-
W+S
-
Less ample and slower neuroelectrical activity in the right
derivations. Physiological sleep figures absent at right.
S
Slower neuroelectrical activity in the right derivations.
-
-
16
17
18
19
20
21
22
23
24
25
Extensive damage in the pons and ponto-mesencephalic
tract, thalami and lenticular nuclei (left>right). Corticalsubcortical damage and gliosis in the left parietal lobe and
bilateral frontal-precentral area. Multiple bilateral focal
damage in the cerebellum.
Multiple focal hemorragic lesions in the brainstem and
corpus callosum, left temporal lobe and left frontal-parietal
area. Bilateral igroma.
Parasagittal mesencephalic lesion at left. Extensive damage
of the corpus callosum.Left frontobasal cortical damage.
Bialteral parietal-occipital damage (right>left).
DAI. Multiple hemorragic sub-cortical lesions in the corpus
callosum, basal nuclei and mesencephalon (left>right).
Diffuse supra-tentorial damage of the basal nuclei, thalami,
and hippocampi.
Multifocal cortical-subcortical damage in the right temporal
lobe and bilateral frontal lobes.Mild cerebellar and brainstem
atrophy. Multifocal hemorragic damage in the pons and
brainstem, thalami and basal nuclei (left>right).
DAI in the splenium of the corpus callosum.
Neoformation with parenchimal nodule and cystic
component, located in the IV ventricle. Bilateral
leucomalacia with associated gliosis, involving the vermis,
posterior brainstem, medulla oblongata and pons. Atrophy of
the brainstem and middle cerebellar peduncles.
Subdural hematoma in the right hemisphere.
Damage to the IV ventricle.
Multifocal lesions in the lenticular nuclei, and in the bilateral
caudatum to a lesser extent.Bialteral damage of both the
white and gray matter in the anterior-lateral thalami, right
temporal and bilateral occipital parenchimal
areas.Hydrocephalus.
Severe cortical atrophy. Diffuse parenchimal damage. DAI.
Multiple damage to the gray matter in the deep nuclei.
-
W+S
-
W+S
W+S
-
Slower neuroelectrical activity in the left derivations.
Physiological sleep figures infrequent over the left
derivations.
More ample and slower neuroelectrical activity in the
occipital
right
derivations.
Physiologicalsleepfiguresinfrequentover
the
left
derivations.
Less ample neuroelectrical activity in the frontal, central
and temporal derivations at right. Physiological sleep
figures infrequent at right.
Less ample neuroelectrical activity in the right
derivations.
W+S
-
-
-
-
-
-
W+S
Less ample and slower neuroelectrical activity in the left
derivations. Physiological sleep figures infrequent at left.
26
DAI. Multifocal cortical damage and severe lesion of the
basal nuclei, bilaterally.
W+S
27
Severe cortical atrophy. Bilateral atrophy of the putamen and
thalami. Atrophy of the cerebellum and brainstem.
Subthalamic lesions. DAI.
-
Less ample and slower neuroelectrical activity in the right
derivations. Physiological sleep figures infrequent at
right.
-
PCC=Posterior Corpus Callosum; MCC= Middle Corpus Callosum; DAI=Diffuse Axonal Injury.
Inter-hemispheric asymmetry of EEG activity: W=during wake, S= during sleep.