Usefulness of video-EEG in the paediatric emergency department

Over the past two decades the EEG has technically improved from the use of analog to digital machines and more recently to video-EEG systems. Despite these advances, recording a technically acceptable EEG in an electrically hostile environment such as the emergency department (ED) remains a challenge, particularly with infants or young children. In 1996, a meeting of French experts established a set of guidelines for performing an EEG in the ED based on a review of the available literature. The authors highlighted the most suitable indications for an emergency EEG including clinical suspicion of cerebral death, convulsive and myoclonic status epilepticus, focal or generalized relapsing convulsive seizures as well as follow-up of known convulsive patients. They further recommended emergency EEG in the presence of doubt regarding the epileptic nature of the presentation as well as during the initiation or modification of sedation following brain injury. Subsequently, proposals for expanding the use of EEG in emergency patients have been advocated including trauma, vascular and anoxic-ischemic injury due to cardiorespiratory arrest, postinfective encephalopathy and nonconvulsive status epilepticus. The aim of this review is to show the diagnostic importance of video-EEG, as well as highlighting the predictive prognostic factors for positive and negative outcomes, when utilized in the pediatric ED for seizures as well as other neurological presentations.