Diagnostic yield of continuous video electroencephalography for paroxysmal vital sign changes in pediatric patients

We aimed to determine the diagnostic yield of continuous monitoring with video electroencephalography (cVEEG) for pediatric inpatients with paroxysmal vital sign changes (PVSCs), and to identify risk factors for the PVSCs being seizures, based on clinical information available before cVEEG initiation. We hypothesized that PVSCs without nonautonomic symptoms (NAS) were unlikely to be seizures, and also that patients' clinical characteristics would alter the risk of recording seizures.

We performed a single-center chart review of 324 cVEEG studies that were obtained for differential diagnosis of PVSCs. We examined the type of PVSCs that prompted cVEEG, associated NAS, and patient characteristics, and whether the target events or seizures were recorded. We performed logistic regression analyses to determine which patient and semiologic features altered the risk of the PVSCs being seizures, and which patient characteristics altered the risk of recording any seizures.

Target PVSCs were recorded in 52% (N = 169). Seizures were recorded in 21% (N = 69) of the studies, often unrelated to the PVSCs (N = 39). When examining only PVSCs without NAS, only 4% (3/75) of studies obtained for apnea and 2.1% (1/48) of studies obtained for oxygen desaturation revealed the target events to be seizures. No studies recorded ictal hypertension (0/26), hypotension (0/16), or bradycardia (0/18). In univariate analysis, there was a decreased risk that the events were seizures when PVSCs lacked NAS (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.08-0.65). The risk was increased when the patient had received an antiseizure medication (2.9, 1.3-6.5), the target PVSC was apnea (3.5, 1.5-8.5), and in particular, apnea with NAS (8.7, 3.7-20.8). In adjusted analyses, only apnea with associated NAS independently increased the risk of the PVSCs being seizures (7.7, 3.2-18.5).

PVSCs in the absence of NAS are rarely due to seizures. Ideally, cVEEG should be reserved for children with additional risk factors for seizures, beyond isolated PVSCs.