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Published on: June 21, 2019
Continuous electroencephalography in pediatric traumatic brain injury: Seizure characteristics and outcomes
Jarin Vaewpanich1, Karin Reuter-Rice2
1Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
Insights
Continuous EEG monitoring in pediatric traumatic brain injury (TBI) can detect seizures and predict poor neurocognitive outcomes, especially in nonaccidental trauma cases. Early detection and treatment are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) is a significant cause of death and disability in children.
- Secondary brain injury significantly impacts patient prognosis and is a target for management guidelines.
- Posttraumatic seizures are a sequela of TBI that can exacerbate brain damage.
Purpose of the Study:
- To investigate the association between continuous electroencephalography (cEEG) findings and neurocognitive/functional outcomes in pediatric TBI patients.
- To identify specific cEEG patterns indicative of poor prognosis in children with TBI.
Main Methods:
- A subgroup of 16 children admitted to a pediatric intensive care unit (PICU) with TBI underwent cEEG monitoring.
- Demographic data, cEEG reports, antiseizure medication use, and outcome scores (Glasgow Outcome Scale - Extended Pediatrics, neurocognitive/functional evaluations) were collected.
- Data were analyzed to correlate cEEG findings with short-term and longer-term outcomes.
Main Results:
- Nonaccidental trauma was the most common cause of TBI (75%) in the study group.
- Four patients (25%) experienced seizures, with 3 detected by cEEG (including subclinical seizures).
- Specific cEEG patterns (nonreactive, severe/burst suppression, absent sleep architecture) were linked to poor neurocognitive/functional outcomes.
Conclusions:
- Continuous EEG monitoring can identify seizure activity and predict poor outcomes in pediatric TBI, particularly in nonaccidental trauma cases.
- Implementing institutional TBI cEEG protocols may facilitate early seizure detection and improve patient outcomes.
- Further research into individual cEEG characteristics is recommended to refine outcome prediction and treatment strategies.
Background:
Traumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment.
Objective:
The aim of this study was to examine the relationship between cEEG findings in pediatric traumatic brain injury and neurocognitive/functional outcomes.
Methods:
This study focuses on a subgroup of a larger prospective parent study that examined children admitted to a level-1 trauma hospital. The subgroup included sixteen children admitted to the pediatric intensive care unit (PICU) who received cEEG monitoring. Characteristics included demographics, cEEG reports, and antiseizure medication. We also examined outcome scores at the time of discharge and 4-6weeks postdischarge using the Glasgow Outcome Scale - Extended Pediatrics and center-based speech pathology neurocognitive/functional evaluation scores.
Results:
Sixteen patients were included in this study. Patients with severe TBI made up the majority of those that received cEEG monitoring. Nonaccidental trauma was the most frequent TBI etiology (75%), and subdural hematoma was the most common lesion diagnosed by CT scan (75%). Fifteen patients received antiseizure medication, and levetiracetam was the medication of choice. Four patients (25%) developed seizures during PICU admission, and 3 patients had subclinical seizures that were detected by cEEG. One of these patients also had both a clinical and subclinical seizure. Nonaccidental trauma was an etiology of TBI in all patients with seizures. Characteristics of a nonreactive pattern, severe/burst suppression, and lack of sleep architecture, on cEEG, were associated with poor neurocognitive/functional outcome.
Conclusion:
Continuous electroencephalography demonstrated a pattern that associated seizures and poor outcomes in patients with moderate to severe traumatic brain injury, particularly in a subgroup of patients with nonaccidental trauma. Best practice should include institution-based TBI cEEG protocols, which may detect seizure activity early and promote outcomes. Future studies should include examination of individual cEEG characteristics to help improve outcomes in pediatric TBI.
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