EEG in the Pediatric Intensive Care Unit: An Irish Experience

Abstract

Introduction: Evidence for continuous EEG monitoring in the pediatric intensive care unit (PICU) is increasing. However, 24/7 access to EEG is not routinely available in most centers, and clinical management is often informed by more limited EEG resources. The experience of EEG was reviewed in a tertiary PICU where 24/7 EEG cover is unavailable. Methods: Retrospective EEG and clinical review of 108 PICU patients. Correlations were carried out between EEG and clinical variables including mortality. The role of EEG in clinical decision making was documented. Results: One hundred ninety-six EEGs were carried out in 108 PICU patients over 2.5 years (434 hours of recording). After exclusion of 1 outlying patient with epileptic encephalopathy, 136 EEGs (median duration, 65 minutes; range, 20 minutes to 4 hours 40 minutes) were included. Sixty-two patients (57%) were less than 12 months old. Seizures were detected in 18 of 107 patients (17%); 74% of seizures were subclinical; 72% occurred within the first 30 minutes of recording. Adverse EEG findings were associated with high mortality. Antiepileptic drug use was high in the studied population irrespective of EEG seizure detection. Prevalence of epileptiform discharges and EEG seizures diminished with increasing levels of sedation. Conclusions: EEG provides important diagnostic information in a large proportion of PICU patients. In the absence of 24/7 EEG availability, empirical antiepileptic drug utilization is high.

Amplitude-integrated EEG amplitudes differ between wakefulness and sleep states in children

“…This information is relevant for pediatric intensive care givers, because more than half of critically ill children undergoing continuous EEG monitoring in the PICU receive AEDs (23). Among those who later display seizures, 95 % are on AEDs at the time of EEG acquisition (23). We found no evidence in literature that sleep patterns are affected by AEDs, but children with epilepsy display sleep abnormalities more frequently than healthy children (24,25).…”

“…The sensitivity analysis showed no differences in amplitude values and bandwidths between the entire cohort and patients without AEDs. This information is relevant for pediatric intensive care givers, because more than half of critically ill children undergoing continuous EEG monitoring in the PICU receive AEDs (23). Among those who later display seizures, 95 % are on AEDs at the time of EEG acquisition (23).…”

The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

“…Seizures are a common complication of critical illness. The incidence of any seizure, including both clinical and nonconvulsive seizures, in critically ill children, has been reported in 16–46% of patients (mean 32%, median 36%) [ 4 , 5 , 6 , 7 , 8 , 23 , 24 , 25 , 26 , 27 , 28 ]. Furthermore, of patients with witnessed clinical seizures at hospital presentation, 22–33% will have seizure recurrence during their hospitalization [ 27 , 29 , 30 ].…”

“…Children with acute mental status changes during critical illness are often evaluated with EEG to understand if nonconvulsive seizures are contributing to depressed mental status. The incidence of nonconvulsive seizures in all children on continuous EEG monitoring is reported to be between 10% and 42% (mean 23%, median 16.3%) [ 5 , 6 , 7 , 8 , 9 , 24 , 26 ]. Given the high incidence of nonconvulsive seizures among critically ill children with acute mental status changes, EEG monitoring is recommended to quickly identify and treat seizures in this vulnerable group.…”

Artificial Intelligence Analysis of EEG Amplitude in Intensive Heart Care

“…At present, the commonly used clinical ECG is 12-lead, which is called “standard lead.” The Dutch physiologist MacDarby et al [ 22 ] proposed the concept of leads and the naming of ECG waveforms in 1903. In 1933, Wilson created unipolar limb leads VR, VL, and VF and precordial leads (thoracic leads) V1–V6, Akiyama et al [ 23 ] modified the central electrical terminal and designed the compression limb leads.…”