Impact of Continuous EEG Monitoring on Clinical Management in Critically Ill Children

Abstract

Background Continuous EEG (cEEG) monitoring is being used with increasing frequency in critically ill patients, most often to detect non-convulsive seizures. While cEEG is non-invasive and feasible in the critical care setting, it is also expensive and labor intensive, and there has been little study of its impact on clinical care. We aimed to determine prospectively the impact of cEEG on clinical management in critically ill children. Methods Critically ill children (non-neonates) with acute encephalopathy underwent cEEG. Study enrollment and data collection were prospective. Results 100 children were studied. EEG monitoring led to specific clinical management changes in 59 children. These included initiating or escalating anti-seizure medications in 43 due to seizure detection, demonstrating that a specific event (subtle movement or vital sign change) was not a seizure in 21, or obtaining urgent neuroimaging that led to a clinical change in 3. In the remaining 41 children, cEEG ruled out the presence of non-convulsive seizures but did not lead to a specific change in clinical management. Conclusions EEG monitoring led to changes in clinical management in the majority of patients, suggesting it may have an important role in management of critically ill children. Further study is needed to determine whether the management changes elicited by cEEG improve outcome.

Nonconvulsive seizures are common in critically ill children

“…Seizures have been associated with worse outcome in critically ill adults [23][24][25] and neonates 15,26 -29 and seizure detection impacts anticonvulsant use in children 30 and adults. 31 While plausible mechanisms by which electrographic seizures may lead to brain injury have been described, 32,33 further study is needed to determine whether identification and treatment of NCS and NCSE improves outcome.…”

cEEG electrode-related pressure ulcers in acutely hospitalized patients

“…Neurol Clin Pract 2017;7:15-25 C ontinuous EEG monitoring (cEEG) in acutely hospitalized patients has increased dramatically throughout the last decade. [1][2][3][4][5][6] cEEG has been particularly helpful in acutely ill patients at risk for nonconvulsive seizures, 4,7,8 and has been reported to contribute to reduced inpatient mortality without additional charges to hospital stay. 9 In addition, cEEG is increasingly used to detect cerebral ischemia in patients at high risk, 5,[9][10][11] with ischemia monitoring protocols often involving monitoring at-risk patients for as long as 10 or more days.…”

Electrographic seizures in pediatric ICU patients

“…Data obtained from CEEG reportedly affect clinical management in 59% of monitored children, most often by affecting anticonvulsant utilization. 15 Several studies have reported an association between electrographic seizures or status epilepticus and worse outcome, 11,12,16,17 occurring independently of potential confounders related to acute etiology and critical illness severity.…”

“…26 Similarly, observational studies have reported that CEEG results in anticonvulsant medication changes in about half of critically ill children and adults who undergo CEEG. 15,27 A number of single-center studies have demonstrated an association between electrographic seizures or electrographic status epilepticus and worse outcome in critically ill children. 11,12,14,16,17,28 Our data also indicate that electrographic status epilepticus was associated with higher mortality, even after adjusting for the neurologic diagnosis category and initial EEG background category.…”