[Usefulness of EEG recording for delirium in children with high fever]
Sachiko Onoe1, Toshiki Nishigaki, Megumi Kosugi
1Department of Pediatrics, Osaka Police Hospital, Osaka.
Insights
Pediatric delirium, a temporary confusion linked to high fever, can be distinguished from more severe conditions like encephalitis using electroencephalograms (EEGs). EEGs reveal specific abnormal brain wave patterns in children with fever-induced delirium that resolve quickly.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Context:
- Delirium in children presents as an acute confusional state, often associated with high fever.
- Differentiating febrile delirium from encephalitis or encephalopathy is clinically crucial.
- Fever etiologies included common childhood infections like upper respiratory infections and exanthems.
Purpose:
- To evaluate the utility of electroencephalography (EEG) in distinguishing delirium from encephalitis/encephalopathy in children.
- To characterize EEG findings in children experiencing fever-associated delirium.
Summary:
- EEG recordings were performed on 17 children (2-13 years) with fever and delirium.
- While most EEGs showed normal alpha rhythm, some exhibited posterior slow waves or occipital delta activities, which were transient and blocked by eye-opening.
- Sleep EEGs revealed intermittent bursts of slow waves and spikes, also resolving quickly.
Impact:
- EEG can be a valuable tool in the differential diagnosis of acute confusional states in febrile children.
- Specific EEG patterns, such as eye-opening-sensitive occipital delta waves, support a diagnosis of delirium rather than encephalitis or encephalopathy.
- These transient EEG abnormalities underscore the distinct pathophysiology of delirium compared to more severe encephalopathic processes.
Abstract:
Delirium in children associated with high fever is defined as an acute and transient confusional state. Clinically it is most important to differentiate delirium from encephalitis or encephalopathy. Electroencephalographic (EEG) tracings were obtained from 17 children with fever and delirium, consisting of 12 boys and 5 girls, aged from 2 to 13 years. The initial recording was done from 2 to 36 hours (mean: 15 hours) after the last episode of delirium. The causes of fever were upper respiratory infections in 14 patients, acute bronchitis in 1, measles in 1 and exanthema subitum in 1. The body temperature ranged from 38.0 to 41.0 degrees C, when delirium was noticed by their parents. On 15 EEG tracings obtained during waking, the alpha rhythm showed a frequency normal for age, but it was interrupted by posterior slow waves in 2 of them. Eight tracings showed abnormal occipital delta activities. These slow waves were blocked by eye opening, and disappeared within 1 to 5 days. Two of the 6 tracings during sleep showed high voltage irregular slow wave bursts mixed with spikes lasting for 7 minutes, which also disappeared within 1 to 2 days. Our results indicate that EEG is useful in differentiating delirium from encephalitis or encephalopathy; in delirium, the occipital delta waves are blocked by eye opening and abnormal activities disappear within a few days.
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