Periodic lateralized epileptiform discharges in infants and children

PeBenito, Rhandy; Cracco, Joan B.

doi:10.1002/ana.410060111

Cited by 44 publications

(21 citation statements)

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“…They are most often associated with acute structural lesions, although they may also occur in the setting of metabolic derangements (1 3, [17][18][19]. We found that PEDs are also a marker of poor prognosis in SE, confirming the reports of Treiman (20) and Jaitly et al (21).…”

Section: Discussionsupporting

confidence: 88%

The EEG and Prognosis in Status Epilepticus

Nei

Shanker

et al. 1999

Epilepsia

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Summary:Purpose: To examine the relation between specific EEG features and clinical outcome, determine whether a predictable sequence of EEG patterns exists during status epilepticus (SE), and examine the relation between periodic epileptiform discharges (PEDs) and SE.Methods: EEG records of 50 patients with SE admitted to Graduate Hospital between January 1990 and July 1995 were reviewed. Ictal EEGs were available in 72%; 28% had only postictal EEGs. Poor outcome was defined as death or persistent vegetative state, and good outcome as all others. Fisher's Exact test, xz. and t tests were performed for data analysis.Results: Of 50 patients, 72% had a good outcome and 28%, a poor outcome. If PEDs were present at any time during or after SE, outcome tended to be worse (p = 0.053). With PEDs, eight (44%) of 18 had a poor outcome; without PEDs, six (19%) of 32 had a poor outcome. Etiologies for SE did not substantially differ in patients with or without PEDs, and structural abnormalities were not more associated with the presence of PEDs. PEDs were seen both early and late, during and after SE. Other EEG characteristics (lateralized vs. bilateral symmetric ictal EEG, discrete vs. continuous ictal activity, and postictal focal slowing) did not relate to outcome. No predictable sequence of EEG changes was found during SE.Conclusions: PEDs are the only EEG feature related to outcome in SE and are associated with poor outcome independent of etiology. Key Words: Status epilepticus-Periodic epileptiform discharge-PLEDs-Prognosis-EEG.Status epilepticus (SE) is a common medical emergency associated with significant morbidity and mortality. Recent estimates of the incidence of SE in the United States range from 50,000 (1) to 152,000 cases per year (1,2). Mortality in SE ranges from 2 to 27% and is higher in some subgroups (1,(3)(4)(5)(6).The EEG is an important tool in both diagnosing and managing patients with SE. Many types of EEG abnormalities can be seen during SE (7,8 nosis than the early stages of SE and that PEDs represent a late stage of SE. However, there is considerable controversy regarding the relation of PEDs to SE. PEDs, especially when lateralized, occur in the absence of seizures and have been associated with the presence of underlying structural lesions, including acute cerebral infarctions, tumors, and inflammatory conditions (8,ll). In contrast, some other studies found a close relation between seizures and PEDs (1 2,13). Although specific stages of SE have been described in an experimental model, human studies have not demonstrated any reliable EEG sequence during SE (4,14).The goals of this study were to determine whether any EEG features predict prognosis in human SE, to determine whether a predictable sequence of EEG patterns exists during SE, and to examine the relation between PEDs and SE. It is important to define which patients are at risk for poor outcome, so that new therapeutic measures can be developed on appropriate populations.

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Section: Discussionsupporting

confidence: 88%

The EEG and Prognosis in Status Epilepticus

Nei

Shanker

et al. 1999

Epilepsia

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“…83 The morphologic characteristics are similar to those of adults. 83 The morphologic characteristics are similar to those of adults.…”

Section: Periodic Lateralized Epileptiform Dischargesmentioning

confidence: 59%

“…83,86,87 The latter would be of particular concern if PLEDs developed during the convalescent phase of a child with a penetrating head wound. They have been reported with acute infarction due to sickle cell disease, metabolic imbalance, perinatal brain injury, cerebral cysticercosis, encephalitis, tumor, and brain abscess.…”

Section: Periodic Lateralized Epileptiform Dischargesmentioning

confidence: 99%

Head Trauma

Brunquell¹

2006

Clinical Neurophysiology of Infancy, Childhood, and Adolescence

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“…PLEDS, although a well known marker of stroke in adults, has only been infrequently reported in neonates with stroke [6,8]. PLEDS lacks specificity as it may be seen in neonatal herpes, structural and metabolic abnormalities [6,7].…”

Section: Discussionmentioning

confidence: 99%

Focal Seizures, a Manifestation of Stroke in an Unstressed Full Term Neonate

Singh

Khan

1993

Ann Saudi Med

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Focal cerebral infarction remains an uncommon diagnosis in full term unstressed babies despite advancement in radiological techniques. However, it is not rare in autopsy series. In 1979 Barmada et al [1] reported a 5.4% incidence of focal cerebral infarction acquired perinatally in full term neonates in an autopsy series. Review of current literature thus far has revealed around 35 full term babies with focal infarctions, mostly in the territory of the left middle cerebral artery. Most of these babies have experienced significant perinatal asphyxia. Thus far, only seven babies, unstressed and apparently normal with good Apgar scores, have developed focal cerebral infarction. PLEDS has not been reported in any of these babies. Prognosis of these babies, including ours, has been better as compared to those who suffered perinatal asphyxia [2]. Case ReportA full term female baby was delivered at Riyadh Armed Forces Hospital (RKH) to a 24-year-old gravida 4, para 3, whose pregnancy was uncomplicated. The baby's birth weight was 3.3 kg, OFC 34.5 cm, and Apgars were 9 and 10 at one and five minutes. No active resuscitation was required. The placenta looked grossly normal and weighed 600 gm. At 18 h of age, clonic movements of the right half of the body were noted which lasted for approximately one-half h. These seizures recurred four times within the ensuing 24 h. Physical examination revealed a baby in no apparent distress, pink on room air, who was well perfused. Fontanelles were normal. Pupils were equal and reactive. Doll's eye movements were normal. Tone was normal and equal in all extremities. Deep tendon reflexes (DTRs) were symmetrical. The infant had a symmetrical Moro reflex. Examination of the cardiovascular system did not reveal any murmurs. Laboratory investigations revealed hematocrit of 0.47. Septic screen including lumbar puncture was normal. Glucose was 4.5 mmol/L, calcium 2.24 mmol/L, and magnesium 0.72 mmol/L. Coagulation screen was normal. Protein C and S were normal. Electrocardiogram was normal for age. Echocardiogram was normal. Cranial ultrasound did not reveal any bleeds. Ventricle size was normal. There was no evidence of cerebral edema or focal lesions. Computerized tomographic (CT) scan performed at the age of five days revealed an area of low attenuation in the left parietal region (Figure 1). There was no mass effect. The lesion was suggestive of infarction in the distribution of left middle cerebral artery. Electroencephalogram revealed periodic lateralizing epileptiform discharges arising from the left side (Figure 2). The baby was loaded with phenobarbitone 20 mg/kg. She also required additional doses of diazepam 0.3 mg/kg within the first 24 h. The seizures did not recur after the first day. There was no sign of focal neurological deficit. She was gradually taken off the anticonvulsant without recurrence of symptoms. The baby has been seen in the follow-up clinic on several occasions. She has no neurological deficit or recurrence of seizures. Her development, including speech and langu...

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Periodic lateralized epileptiform discharges in infants and children

Cited by 44 publications

References 10 publications

The EEG and Prognosis in Status Epilepticus

The EEG and Prognosis in Status Epilepticus

Head Trauma

Focal Seizures, a Manifestation of Stroke in an Unstressed Full Term Neonate

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