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Continuous EEG in Pediatric Critical Care: Yield and Efficiency of Seizure Detection
Arnold J Sansevere1, Elizabeth D Duncan, Mark H Libenson
1*Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; †Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and ‡Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Insights
Determining the optimal duration for continuous electroencephalogram (EEG) monitoring in pediatric intensive care units is crucial. A strategy using clinical history, initial EEG background, and early monitoring can guide individualized plans for better seizure detection.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Critical Care Medicine
Background:
- Continuous electroencephalogram (cEEG) monitoring is vital in pediatric intensive care units (PICUs) for detecting electrographic seizures and EEG status epilepticus.
- Optimizing cEEG duration is essential for efficient resource allocation and timely diagnosis in critically ill children.
Purpose of the Study:
- To define the necessary duration of cEEG monitoring in PICU patients to effectively capture electrographic seizures and EEG status epilepticus.
- To identify clinical and EEG background features that can inform decisions on cEEG monitoring duration.
Main Methods:
- Retrospective study of 414 pediatric patients (1 month to 21 years) admitted to a tertiary PICU.
- Analysis of cEEG recordings (duration >3 hours), clinical data, EEG background features, and time to first seizure.
- Identification of predictive features for seizure detection and a decision-making framework.
Main Results:
- Electrographic seizure or EEG status epilepticus was detected in 25% of patients with a median cEEG duration of 21 hours.
- Clinical history of acute encephalopathy was not predictive, but a history of seizures or status epilepticus was.
- Normal EEG background or absence of epileptiform discharges within 24 hours, and no ictal events in the first 4-6 hours, can inform discontinuation of cEEG.
Conclusions:
- Individualized cEEG monitoring plans are necessary to maximize seizure detection and improve resource utilization.
- A strategy incorporating clinical history, initial EEG background, and early monitoring (4-6 hours) can guide cEEG duration decisions in PICUs.
Purpose:
Our goal was to define the duration of continuous EEG (cEEG) monitoring needed to adequately capture electrographic seizures and EEG status epilepticus in the pediatric intensive care unit using clinical and background EEG features.
Methods:
Retrospective study of patients aged 1 month to 21 years admitted to a tertiary pediatric intensive care unit and undergoing cEEG (>3 hours). Clinical data collected included admission diagnosis, EEG background features, and time variables including time to first seizure after initiation of cEEG.
Results:
Four hundred fourteen patients aged 4.2 (0.75-11.3) years (median, interquartile range) were included. With a median duration of 21 (16-42.2) hours of cEEG monitoring, we identified electrographic seizure or EEG status epilepticus in 25% of subjects. We identified three features that could improve the efficiency of cEEG resources and provide a decision-making framework: (1) clinical history of acute encephalopathy is not predictive of detecting electrographic seizure or EEG status epilepticus, whereas a history of status epilepticus or seizures is; (2) normal EEG background or absence of epileptiform discharges in the initial 24 hours of recording informs the decision to discontinue cEEG; (3) failure to record electrographic ictal events within the first 4 to 6 hours of monitoring may be sufficient to predict the absence of subsequent ictal events.
Conclusions:
Individualized monitoring plans are necessary to increase seizure detection yield while improving resource utilization. A strategy using information from the clinical history, initial EEG background, and the first 4 to 6 hours of recording may be effective in determining the necessary duration of cEEG monitoring in the pediatric intensive care unit.
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