Prolonged Background Suppression Induced by Anticonvulsants Misleading Amplitude-Integrated Electroencephalography's Interpretation: A Single Case Report

Falsaperla, Raffaele; Scalia, Bruna; Liotta, Emanuele A; Cimino, Carla; Ruggieri, Martino

doi:10.1089/ther.2022.0028

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…The differing discriminatory performance between adjusted and unadjusted regression models points out the importance of additional clinical information besides aEEG amplitudes. Of special importance in PICU patients, are sedation levels and neuroactive medication, which affect EEG activity ( McKeever et al, 2012 , 2014 ; Drohan et al, 2018 ; Schultz et al, 2022 ) and can induce severe amplitude suppression ( Bruns, 2022 ; Falsaperla et al, 2022 ). Hemodynamic changes also affect electrocortical activity ( Bruns et al, 2021 ), possibly via changes of oxygen supply and metabolic clearance.…”

Section: Discussionmentioning

confidence: 99%

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Paul,

Greve,

Hegemann

et al. 2024

Front. Neurosci.

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Background and objectivesAmplitude-integrated EEG (aEEG) is used to assess electrocortical activity in pediatric intensive care if (continuous) full channel EEG is unavailable but evidence regarding the meaning of suppressed aEEG amplitudes in children remains limited. This retrospective cohort study investigated the association of suppressed aEEG amplitudes in critically ill children with death or decline of neurological functioning at hospital discharge.MethodsTwo hundred and thirty-five EEGs derived from individual patients <18 years in the pediatric intensive care unit at the University Hospital Essen (Germany) between 04/2014 and 07/2021, were converted into aEEGs and amplitudes analyzed with respect to age-specific percentiles. Crude and adjusted odds ratios (OR) for death, and functional decline at hospital discharge in patients with bilateral suppression of the upper or lower amplitude below the 10th percentile were calculated. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were assessed.ResultsThe median time from neurological insult to EEG recording was 2 days. PICU admission occurred due to neurological reasons in 43% and patients had high overall disease severity. Thirty-three (14%) patients died and 68 (29%) had a functional decline. Amplitude suppression was observed in 48% (upper amplitude) and 57% (lower amplitude), with unilateral suppression less frequent than bilateral suppression. Multivariable regression analyses yielded crude ORs between 4.61 and 14.29 and adjusted ORs between 2.55 and 8.87 for death and functional decline if upper or lower amplitudes were bilaterally suppressed. NPVs for bilaterally non-suppressed amplitudes were above 95% for death and above 83% for pediatric cerebral performance category Scale (PCPC) decline, whereas PPVs ranged between 22 and 32% for death and 49–52% for PCPC decline.DiscussionThis study found a high prevalence of suppressed aEEG amplitudes in critically ill children. Bilaterally normal amplitudes predicted good outcomes, whereas bilateral suppression was associated with increased odds for death and functional decline. aEEG assessment may serve as an element for risk stratification of PICU patients if conventional EEG is unavailable with excellent negative predictive abilities but requires additional information to identify patients at risk for poor outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Paul,

Greve,

Hegemann

et al. 2024

Front. Neurosci.

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“…putting these patients at special risk for death and neurologic sequelae. [32][33][34][35] and can induce severe amplitude suppression [36,37]. Hemodynamic changes also affect electrocortical activity [13], possibly via changes of oxygen supply and metabolic clearance.…”

Section: Discussionmentioning

confidence: 99%

“…The differing discriminatory performance between adjusted and unadjusted regression models points out the importance of additional clinical information for aEEG interpretation. Of special importance in PICU patients are sedation levels and neuroactive medication, which affect EEG activity [32-35] and can induce severe amplitude suppression [36, 37]. Hemodynamic changes also affect electrocortical activity [13], possibly via changes of oxygen supply and metabolic clearance.…”

Section: Discussionmentioning

confidence: 99%

Bilaterally suppressed EEG amplitudes predict death and poor functional outcomes in critically ill children

Paul,

Greve,

Hegemann

et al. 2023

Preprint

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Background and objectivesContinuous full-channel EEG is the gold standard for electrocortical activity assessment in critically ill children, but its implementation faces challenges, leading to a growing use of amplitude-integrated EEG (aEEG). While suppressed aEEG amplitudes have been linked to adverse outcomes in preterm infants and adults after cardiac arrest, evidence for critically ill children remains limited. This retrospective study aimed to evaluate the association between suppressed aEEG amplitudes in critically ill children and death or poor functional neurological outcomes.Methods235 EEGs derived from individual patients < 18 years in the pediatric intensive care unit (PICU) at the University Hospital Essen (Germany) between 04/2014 and 07/2021 were retrospectively converted into aEEGs and amplitudes analyzed with respect to previously defined age-specific percentiles. Adjusted odds ratios for death and poor functional outcome at hospital discharge in patients with bilateral upper or lower amplitude suppression below the 10thpercentile were calculated accounting for neurological injuries, acute disease severity, sedation levels, and functional neurological status before acute critical illness.ResultsThe median time from neurological insult to EEG recording was 2 days. PICU admission occurred due to neurological reasons in 43 % and patients had high overall disease severity. Thirty-three (14 %) patients died and 68 (29 %) had poor outcomes. Amplitude depression below the 10thpercentile was frequent (upper amplitude: 27 %, lower amplitude: 34 %) with suppression of only one amplitude less frequent than bilateral suppression. Multivariable regression analyses yielded odds between 6.63 and 15.22 for death, neurological death, and poor neurological outcomes if both upper or both lower amplitudes were suppressed. Model discrimination was excellent with areas under the curve above 0.92 for all models.DiscussionThis study found a high prevalence of suppressed aEEG amplitudes in critically ill children early after PICU admission, with suppression being highly associated with death and poor functional outcomes at hospital discharge. These findings emphasize the potential of early identification of high-risk PICU patients through aEEG monitoring if conventional EEG is unavailable, potentially guiding neuroprotective therapies and early neurorehabilitation.

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2023

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Prolonged Background Suppression Induced by Anticonvulsants Misleading Amplitude-Integrated Electroencephalography's Interpretation: A Single Case Report

Cited by 5 publications

References 16 publications

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children

Bilaterally suppressed EEG amplitudes predict death and poor functional outcomes in critically ill children

Multiple drugs

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