Intracranial Electroencephalography in Pediatric Severe Traumatic Brain Injury

Abstract

Objectives: Electroencephalography is used in neurocritical care for detection of seizures and assessment of cortical function. Due to limited resolution from scalp electroencephalography, important abnormalities may not be readily detectable. We aimed to identify whether intracranial electroencephalography allows for improved methods of monitoring cortical function in children with severe traumatic brain injury. Design: This is a retrospective cohort study from a prospectively collected clinical database. We investigated the occurrence rate of epileptiform abnormalities detected on intracranial electroencephalography when compared with scalp electroencephalography. We also investigated the strength of association of quantitative electroencephalographic parameters and cerebral perfusion pressure between both intracranial and scalp electroencephalography. Setting: This is a single-institution study performed in the Phoenix Children’s Hospital PICU. Patients: Eleven children with severe traumatic brain injury requiring invasive neuromonitoring underwent implantation of a six-contact intracranial electrode as well as continuous surface electroencephalography. Interventions: None. Measurements and Main Results: Visual detection of epileptiform abnormalities was performed by pediatric epileptologists. Association of intracranial and scalp electroencephalography total power, alpha percentage, and alpha-delta power ratio to cerebral perfusion pressure was performed using univariate dynamic structural equations modeling. Demographic data were assessed by retrospective analysis. Intracranial and scalp electroencephalography was performed in 11 children. Three of 11 children had observed epileptiform abnormalities on intracranial electroencephalography. Two patients had epileptiform abnormalities identified exclusively on intracranial electroencephalography, and one patient had seizures initiating on intracranial electroencephalography before arising on scalp electroencephalography. Identification of epileptiform abnormalities was associated with subsequent identification of stroke or malignant cerebral edema. We observed statistically significant positive associations between intracranial alpha-delta power ratio to cerebral perfusion pressure in nine of 11 patients with increased strength of association on intracranial compared with scalp recordings. Conclusions: These findings suggest that intracranial electroencephalography may be useful for detection of secondary insult development in children with traumatic brain injury.

Quantitative Electroencephalographic Changes Associated With Brain Tissue Hypoxia After Pediatric Traumatic Brain Injury: A Retrospective Exploratory Analysis

“…9,10 Reductions in ADR have been associated with delayed cerebral ischemia in adult patients with aneurysmal subarachnoid hemorrhage 11 and cerebral perfusion pressure in pediatric TBI patients. 12 Here, we identified that PbtO 2 values < 10 mm Hg are associated with reduced ADR (Fig. 1).…”

Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury

“…This can manifest as a color dense spectral array (CDSA) or rhythmic spectrogram, making detection of pathologic patterns such as seizures and ischemia easier to recognize for bedside clinicians. In the previously described study of pediatric TBI patients undergoing iEEG, both surface and intracortical alphadelta ratios, a qEEG measure, were associated with CPP (58).…”

“…Intracortical EEG (iEEG) has been increasingly utilized in adult neurocritical care (56) and is associated with improved signal-noise ratio, detection of seizures not captured on cEEG, clarification of equivalent cEEG patterns and detection of cortical spreading depolarizations (57). One pediatric TBI study utilized iEEG showing that 3/11 patients had epileptiform abnormalities not captured on scalp EEG (58). Quantitative EEG (qEEG) utilizes mathematical algorithms to compress raw cEEG into graphical data.…”

Continuous EEG of memories of Near-death and mystical experiences: Preliminary research

“…CEEG can detect changes in EEG over time, thereby enabling the early initiation of treatment, and can evaluate response to treatment, if administered, over time. 16,21,[74][75][76][77][78][79] Considering the high-resolution time of CEEG, 30-33, 46, 80-83 this method offers a unique possibility to demonstrate that the brain undergoes continuous and dynamic functional changes during NDE and SCE remembering.…”

“…CEEG is a rapidly evolving technology, and this statement addresses only current consensus-based recommendations for CEEG. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Hence, as the brain undergoes continuous and dynamic changes, CEEG should be an important method for real-time monitoring of the brain's functional changes during remembering NDE and SCE.…”