Hemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department
Thomas J Abramo, Shane McKinney, James Moore1
1Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT.
Insights
Regional cerebral oxygen saturation (rcSO2) monitoring during seizures in pediatric patients shows significant changes, aiding in faster recognition and assessment of neurological emergencies. This tool can improve outcomes for children experiencing seizures.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Medical Devices
Background:
- Seizures cause neuronal damage and altered brain function, posing neurological emergencies.
- Delayed seizure recognition in pediatric and developmentally challenged patients exacerbates complications.
- Cerebral oximetry is a valuable tool for assessing brain physiology in emergencies.
Purpose of the Study:
- To evaluate regional cerebral oxygen saturation (rcSO2) trends in pediatric seizure patients.
- To assess the utility of rcSO2 as a neurological assessment tool in the pediatric emergency department.
Main Methods:
- An observational case series was conducted in a pediatric emergency department.
- Compared hemispheric rcSO2 readings in patients with seizures versus controls.
- Included first-time generalized, focal, and postseizure patients without seizures.
Main Results:
- Seizure patients (n=185) showed significant rcSO2 differences (P < 0.0001) compared to controls (n=115).
- rcSO2 levels were <60% or >80% in seizure patients, differing from controls (P < 0.0001).
- Focal seizures demonstrated ipsilateral rcSO2 decrease and significant interhemispheric discordance (>16, P < 0.0001).
Conclusions:
- Hemispheric during-seizure rcSO2 readings correlate with seizure activity and altered cerebral physiology.
- Focal seizures show side-specific rcSO2 changes and wide interhemispheric discordance.
- Postseizure rcSO2 normalized, indicating resolution of altered physiology, supporting rcSO2's utility in pediatric seizure management.
Background:
Sustained neuronal activity during seizures causes cellular perturbations, alterations in cerebral physiology, and potentially neurological injury, a neurological emergency. With variable clinical manifestations of seizures, frequent failure of seizure recognition by providers in pediatric and developmentally challenged patients can increase seizure complications. Neuroresuscitation should include rapid cerebral physiology assessment for increased seizure recognition and optimal neurological outcomes. In neurological emergencies, cerebral oximetry has demonstrated its utility in altered cerebral physiology and a standard combat neurological assessment tool. During adult seizures, cerebral oximetry (regional cerebral oxygen saturation [rcSO2]) has been shown as a useful neurological assessment tool, but research is lacking in pediatric emergency department (PED) seizure patients.
Objective:
The aim of this study was to identify trends in rcSO2 readings for patients presenting to the PED with seizure activity and in the postseizure state in order to evaluate usefulness of rcSO2 as a neurological assessment tool in pediatric seizure patients.
Methods:
This was a PED observational case series comparing hemispheric rcSO2 readings in first-time clinically evident generalized and focal seizure patients to first-time postseizure patients with no PED seizures.
Results:
Generalized or focal seizure (n = 185) hemispheric rcSO2 revealed significant differences compared with nonseizure and controls' rcSO2 readings (n = 115) (P < 0.0001). Generalized and focal seizure rcSO2's were either less than 60% or greater than 80% compared with nonseizure rcSO2 (P < 0.0001). Ipsilateral focal seizure rcSO2 correlated to seizure side (P < 0.0001) and was less than the contralateral rcSO2 (P < 0.0001), with interhemispheric rcSO2 discordance greater than 16 (P < 0.0001). Seizure to preseizure rcSO2 discordance was as follows: generalized 15.2, focal: left 19.8, right 20.3 (P < 0.0001).
Conclusions:
Hemispheric during-seizure rcSO2 readings significantly correlated with generalized and focal seizures and reflected altered cerebral physiology. Ipsilateral focal seizure rcSO2 readings correlated to the focal side with wide interhemispheric rcSO2 discordance. All postseizure rcSO2 readings returned to preseizure readings, showing altered cerebral physiology resolution. Overall, in generalized or focal seizure, rcSO2 readings were less than 60% or greater than 80%, and in focal seizure, interhemispheric rcSO2 discordance was greater than 10. During seizures, hemispheric rcSO2 readings demonstrated its potential pediatric seizure utility. Utilizing rcSO2 readings related to seizure activity could expedite pediatric and developmentally challenged patients' seizure recognition, cerebral assessment, and interventions especially in pharmacoresistant seizures.
