Hemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department

Abramo, Thomas J.; McKinney, S.; Moore, J.D.; Jacobs, Richard F.; Albert, Gregory W.; Meredith, Mark; Porter, Nicholas Hobart; Storm, Elizabeth; Willis, Errin; Gonzalez, Cruz Velasco; Hargrave, Hailey; Schneider, Bradley S.; Sharp, Gergory

doi:10.1097/pec.0000000000001354

Cited by 2 publications

(2 citation statements)

References 26 publications

(71 reference statements)

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“…The concurrent NIRS and vEEG multimodal monitoring approach were previously used to analyze the effect of seizures on AR [ 20 ]. Similarly, NIRS-based CBV changes at the seizure onset and with epileptogenic focus have been described in patients with various seizure types [ 21 , 22 , 23 ]. However, the effects of EEG abnormalities without clinical or electrographic seizures on AR have not been reported.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Electroencephalography Abnormalities on Cerebral Autoregulation in Sedated Ventilated Children

et al. 2022

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Purpose: To determine the effects of non-ictal electroencephalogram (EEG) changes on cerebrovascular autoregulation (AR) using the cerebral oximetry index (COx). Materials and Methods: Mean arterial blood pressure (MAP), cerebral tissue oxygenation (CrSO2), and EEG were acquired for 96 h. From all of the EEG recordings, 30 min recording segments were extracted using the endotracheal suction events as the guide. EEG recordings were classified as EEG normal and EEG abnormal groups. Each 30 min segment was further divided into six 5 min epochs. Continuous recordings of MAP and CrSO2 by near-infrared spectroscopy (NIRS) were extracted. The COx value was defined as the concordance (R) value of the Pearson correlation between MAP and CrSO2 in a 5 min epoch. Then, an Independent-Samples Mann-Whitney U test was used to analyze the number of epochs within the 30 min segments above various R cutoff values (0.2, 0.3, and 0.4) in normal and abnormal EEG groups. A p-value < 0.05 was considered significant, and all analyses were two-tailed. Results: Among 16 sedated, mechanically ventilated children, 382 EEG recordings of 30 min segments were analyzed. The proportions of epochs in each 30 min segment above the R cutoff values were similar between the EEG normal and EEG abnormal groups (p > 0.05). The median concordance values for CSrO2 and MAP in EEG normal and EEG abnormal groups were similar (0.26 (0.17–0.35) and 0.18 (0.12–0.31); p = 0.09). Conclusions: Abnormal EEG patterns without ictal changes do not affect cerebrovascular autoregulation in sedated and mechanically ventilated children.

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Section: Discussionmentioning

confidence: 99%

The Effect of Electroencephalography Abnormalities on Cerebral Autoregulation in Sedated Ventilated Children

et al. 2022

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“…It is still unclear how the neuronal system communicates to spontaneously achieve a synchronous signal change in all channels 8 – 11 notably the hemodynamic changes that surround the episodes of absence epilepsy, which are still debated. 12 – 14 Understanding the dynamics of neuronal and vascular networks that lead to the transition to seizures and identifying reliable signatures for this process is an area of active research. 15 An approach that may be promising to study the initiation of seizures is to study neuronal and vascular changes and the direct current (DC) shift immediately before the onset of a seizure, as hemodynamic changes related to neuronal activation, and DC shifts might concern the activation of not only the synchronized pyramidal cells but also nonsynchronized interneurons and glial cells, which are not monitored by electroencephalography (EEG) recordings.…”

Section: Introductionmentioning

confidence: 99%

Preictal neuronal and vascular activity precedes the onset of childhood absence seizure: direct current potential shifts and their correlation with hemodynamic activity

et al. 2023

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Significance, Aims: The neurovascular mechanisms underlying the initiation of absence seizures and their dynamics are still not well understood. The objective of this study was to better noninvasively characterize the dynamics of the neuronal and vascular network at the transition from the interictal state to the ictal state of absence seizures and back to the interictal state using a combined electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and diffuse correlation spectroscopy (DCS) approach. The second objective was to develop hypotheses about the neuronal and vascular mechanisms that propel the networks to the 3-Hz spikes and wave discharges (SWDs) observed during absence seizures.Approaches: We evaluated the simultaneous changes in electrical (neuronal) and optical dynamics [hemodynamic, with changes in (Hb) and cerebral blood flow] of 8 pediatric patients experiencing 25 typical childhood absence seizures during the transition from the interictal state to the absence seizure by simultaneously performing EEG, fNIRS, and DCS.Results: Starting from ∼20 s before the onset of the SWD, we observed a transient direct current potential shift that correlated with alterations in functional fNIRS and DCS measurements of the cerebral hemodynamics detecting the preictal changes.Discussion: Our noninvasive multimodal approach highlights the dynamic interactions between the neuronal and vascular compartments that take place in the neuronal network near the time of the onset of absence seizures in a very specific cerebral hemodynamic environment. These noninvasive approaches contribute to a better understanding of the electrical hemodynamic environment prior to seizure onset. Whether this may ultimately be relevant for diagnostic and therapeutic approaches requires further evaluation.

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Hemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department

Abstract: Supplemental digital content is available in the text.

Cited by 2 publications

References 26 publications

The Effect of Electroencephalography Abnormalities on Cerebral Autoregulation in Sedated Ventilated Children

The Effect of Electroencephalography Abnormalities on Cerebral Autoregulation in Sedated Ventilated Children

Preictal neuronal and vascular activity precedes the onset of childhood absence seizure: direct current potential shifts and their correlation with hemodynamic activity

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