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Continuous EEG monitoring in Kenyan children with non-traumatic coma
Samson Gwer1, Richard Idro, Gregory Fegan
1Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya. samgwer@gmail.com
Insights
Continuous EEG monitoring is crucial for detecting seizures in children with non-traumatic coma, as clinical observation misses many. Seizures and status epilepticus are linked to poor outcomes.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Non-traumatic coma in children presents diagnostic and prognostic challenges.
- Seizures are a common complication in critically ill children, impacting outcomes.
Purpose of the Study:
- To characterize the electroencephalogram (EEG) and clinical seizure patterns in children with non-traumatic coma.
- To compare the efficacy of clinical observation versus continuous EEG for seizure detection.
- To correlate EEG findings with patient outcomes.
Main Methods:
- Prospective observational study in a pediatric high-dependency unit in Kenya.
- EEG monitoring for up to 72 hours in children (9 months-13 years) with acute coma.
- Poor outcome defined as death or severe motor deficits at discharge.
Main Results:
- 82 children were enrolled. Initial medium EEG amplitude (100-300 mV) correlated with better outcomes (OR 0.2).
- 363 seizures were detected; 66% were electrographic and 31% electroclinical. Clinical observation missed 2/3 of seizures.
- Seizures and status epilepticus during monitoring were associated with poor outcomes (OR 3.2 and 4.5, respectively).
Conclusions:
- Initial EEG background amplitude is a significant prognostic indicator in pediatric non-traumatic coma.
- Continuous EEG is superior to clinical observation for detecting seizures in this population.
- Post-admission seizures and status epilepticus predict poor neurological outcomes.
Background:
The aim of this study was to describe the EEG and clinical profile of seizures in children with non-traumatic coma, compare seizure detection by clinical observations with that by continuous EEG, and relate EEG features to outcome.
Methods:
This prospective observational study was conducted at the paediatric high dependency unit of Kilifi District Hospital, Kenya. Children aged 9 months to 13 years presenting with acute coma were monitored by EEG for 72 h or until they regained consciousness or died. Poor outcome was defined as death or gross motor deficits at discharge.
Results:
82 children (median age 2.8 (IQR 2.0-3.9) years) were recruited. An initial medium EEG amplitude (100-300 mV) was associated with less risk of poor outcome compared to low amplitude (≤100 mV) (OR 0.2, 95% CI 0.1 to 0.7; p<0.01). 363 seizures in 28 (34%) children were observed: 240 (66%) were electrographic and 112 (31%) electroclinical. In 16 (20%) children, electrographic seizures were the only seizure types detected. The majority (63%) of electroclinical seizures had focal clinical features but appeared as generalised (79%) or focal with secondary generalisation (14%) on EEG. Occurrence of any seizure or status epilepticus during monitoring was associated with poor outcome (OR 3.2, 95% CI 1.2 to 8.7; p=0.02 and OR 4.5, 95% CI 1.3 to 15.3; p<0.01, respectively).
Conclusion:
Initial EEG background amplitude is prognostic in paediatric non-traumatic coma. Clinical observations do not detect two out of three seizures. Seizures and status epilepticus after admission are associated with poor outcome.
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