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EEG sedation for children with autism
Uday C Mehta1, Indubhai Patel, Frank V Castello
1Neurodevelopmental Pediatrics, Children's Specialized Hospital, Mountainside, New Jersey 07092, USA. umehta@childrens-specialized.org
Insights
Clonidine effectively sedates children with autism and pervasive developmental disorder (PDD) for electroencephalograms (EEGs). This study found clonidine to be a safe and viable alternative for pediatric sedation when other agents fail.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Clinical Pharmacology
Background:
- Children with autism and pervasive developmental disorder (PDD) have a higher incidence of seizures.
- Diagnostic electroencephalograms (EEGs) are crucial for evaluating seizures in these children.
- Existing pediatric sedatives, such as chloral hydrate, are often ineffective for this population.
Purpose of the Study:
- To evaluate the efficacy and safety of clonidine as a conscious sedation agent for EEG recordings in children with autism and PDD.
- To compare clonidine's effectiveness against previous sedation attempts with other agents.
- To assess the impact of clonidine on vital signs and EEG technical quality.
Main Methods:
- A prospective study involving 27 children diagnosed with autism and PDD undergoing EEG.
- Oral administration of clonidine (0.05-0.2 mg) for conscious sedation.
- Continuous monitoring of pulse rate, respiration rate, blood pressure, and oxygen saturation by a registered nurse.
Main Results:
- Successful sedation was achieved in 85% (23/27) of patients, including 5 who previously failed chloral hydrate.
- An overall acceptable EEG quality was obtained in 93% (25/27) of participants.
- Minor, transient, and asymptomatic reductions in heart rate and blood pressure were observed in a small percentage of patients, requiring no intervention.
Conclusions:
- Clonidine is a safe, well-tolerated, and effective alternative for pediatric sedation in children with autism and PDD undergoing EEG.
- Advantages include ease of administration, shorter sedation duration, no "drug effect" on EEGs, and a high success rate.
- Clonidine facilitates essential diagnostic procedures for this vulnerable pediatric population.
Abstract:
Seizures are reported to occur more frequently among children with diagnoses of autism and pervasive developmental disorder (PDD), and some reports indicate a frequency as high as 30%. Sedation is often necessary to perform diagnostic electroencephalograms (EEGs) in these children, who are known to be difficult to sedate with current available pediatric sedating agents, including chloral hydrate. We used clonidine as a sedative agent in children with autism and PDD, and our findings are presented. In a prospective study, 27 children with autism and PDD diagnoses underwent conscious sedation for EEG recording. Informed consents were obtained, and clonidine was administered orally as a sedating agent in a dose ranging from 0.05 mg to 0.2 mg. Subjects were monitored for pulse rate, respiration rate, blood pressure, and oxygen saturation on a continuous basis by a registered nurse. Study parameters included time to induction, time to recovery, changes in vital signs, and technical quality of EEGs. Sedation was achieved in 23 of 27 patients (85%) per our sedation criteria, and this included five patients who had previously failed to be sedated with chloral hydrate. Two patients did not satisfy the sedation criteria but cooperated enough to allow acceptable EEG tracings, increasing the success rate to 93% (25/27). The mean time to achieve sedation was 58 minutes, and the mean time to recovery was 105 minutes. Two patients (0.07%) experienced an asymptomatic heart rate reduction up to 40%, which was not sustained and recovered promptly without any intervention. Two patients (0.07%) experienced systolic blood pressure reductions of 30% and 40%. They remained asymptomatic, had no changes in other cardiorespiratory parameters, and required no intervention. All EEGs were of good technical quality without any "drug effect." Clonidine is a viable alternative for sedation in children with autism and PDD. It is well tolerated without any significant side effects and is efficacious in children with autism and PDD. The advantages of clonidine include ease of administration, shorter duration of total sedation, lack of EEG drug effect, and high overall success rate.
