Visual evoked potentials in infants and children

Abstract

Visual evoked potential (VEP) studies are of great value in a wide variety of pediatric patients, including those with disorders of the sensory visual pathway and those at risk for visual pathway damage. VEPs are simple, non-invasive, and are particularly appropriate for infants and young children who cannot communicate visual symptoms or cooperate for standard vision assessment. VEPs in pediatric patients have the following main purposes: (1) detecting lesions causing dysfunction of the sensory visual pathways (the VEP is a sensitive indicator of subclinical lesions and can be used to differentiate visual impairment from visual inattention in young infants); (2) confirming functional loss when disorders of the visual system are present; (3) quantifying visual impairment in patients with known visual disorders, accomplished either empirically by noting the severity of the VEP abnormality to flash and pattern stimuli or by visual acuity estimation studies (early quantification of vision loss allows referral to early intervention programs, which can ameliorate the long-term consequences of the disability); (4) monitoring patients who are at risk for visual complications either from diseases (such as hydrocephalus or neurofibromatosis) or as a complication of therapeutic intervention (e.g., neurosurgery, chemotherapy) to help detect and avoid long-term sequelae of such therapies on the developing nervous system; (5) establishing prognosis for visual and systemic recovery based on flash VEPs for specific pediatric disorders including perinatal asphyxia in full-term neonates, acute-onset cortical blindness, and, to a fair extent, in comatose children; and (6) in some cases, contributing to the differential diagnosis. Abnormalities of flash and/or pattern VEPs are generally nonspecific to the type of exact location of the lesion, except in distinguishing prefrom postchiasmal lesions. However, in certain conditions, such as the hereditary ataxias of childhood, VEP abnormalities may help in the diagnosis. Similarly, deterioration in VEPs may help differentiate progressive from static encephalopathies. VEPs have become an indispensable tool in pediatric ophthalmology and neurology. They will probably play an increasingly important role in the future, primarily due to the difficulty in assessing visual system function in young or ill children and the VEP's sensitivity to subclinical damage in this aspect of the central nervous system.