Amplitude-integrated electroencephalography in patients with acute encephalopathy with refractory, repetitive partial
Akihisa Okumura1, Mitsutaka Komatsu, Shinpei Abe
1Department of Pediatrics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan. okumura@juntendo.ac.jp
Insights
Amplitude-integrated EEG (aEEG) monitoring identified frequent subclinical seizures in children with acute encephalopathy and refractory epilepsy. This method aids in assessing seizure burden and treatment effectiveness.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Acute encephalopathy can present with refractory, repetitive partial seizures in children.
- Febrile illness often precedes the onset of these severe seizure episodes.
Observation:
- Two pediatric patients experienced decreased consciousness and seizures resistant to initial antiepileptic drugs.
- Seizure activity escalated to status epilepticus, with rapidly increasing frequency.
- Amplitude-integrated EEG (aEEG) monitoring detected frequent subclinical seizures not apparent through direct observation.
Findings:
- Seizure origins were multifocal and shifted between cerebral hemispheres.
- High-dose phenobarbital effectively controlled seizures in both patients.
- aEEG provided crucial insights into seizure burden and localization.
Implications:
- Continuous aEEG monitoring is valuable for accurate seizure burden estimation in pediatric acute encephalopathy.
- aEEG aids in evaluating the efficacy of antiepileptic drug treatments for refractory seizures.
- This technique enhances the management of complex pediatric epilepsy cases.
Abstract:
We report amplitude-integrated EEG findings in two children with acute encephalopathy with refractory, repetitive partial seizures. Both patients had a febrile illness one week before the onset of seizure. They had reduction of consciousness and repetitive seizures refractory to first-line antiepileptic drugs. Seizure frequency rapidly increased and evolved into status epilepticus. Continuous seizure monitoring with amplitude-integrated EEG revealed frequent subclinical seizures which were missed by direct observation. In addition, the site of origin of seizures was multifocal, and seizure foci shifted from one hemisphere to the other. Their seizures were controlled after an administration of high-dose phenobarbital. Continuous seizure monitoring with amplitude-integrated EEG will contribute to correct estimation of seizure burden and efficacy of antiepileptic drugs in children with acute encephalopathy with refractory, repetitive partial seizures.
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