Electrographic Seizures and Brain Injury in Children Requiring Extracorporeal Membrane Oxygenation
Robin J Cook1, Stephanie M Rau1, Shannon G Lester-Pelham1
1Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.
Insights
Pediatric electrographic seizures occurred in 22% of children on extracorporeal membrane oxygenation (ECMO). Interictal epileptiform discharges and high lactate levels were risk factors, with seizures linked to intracranial hemorrhage.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Electrographic seizures are common in pediatric extracorporeal membrane oxygenation (ECMO) patients, with single-center studies reporting up to 30% prevalence.
- Understanding seizure prevalence, risk factors, and associated brain injury is crucial for this vulnerable population.
Purpose of the Study:
- To characterize seizure prevalence in pediatric ECMO patients.
- To identify risk factors associated with seizures in this population.
- To determine the prevalence of brain injury in pediatric ECMO patients with seizures.
Main Methods:
- Retrospective review of medical records for 86 pediatric patients (neonates to 21 years) undergoing ECMO.
- Continuous video electroencephalography (EEG) monitoring was performed.
- Analysis of neurological and neuroimaging data in relation to ECMO parameters and outcomes.
Main Results:
- Continuous video EEG was initiated in 51% of ECMO patients; 22% (19 of 86) had electroencephalography-confirmed seizures.
- Seizures predominantly occurred within the first 48 hours of EEG monitoring.
- Significant risk factors for seizures included interictal epileptiform discharges (89% vs. 46%) and elevated pericannulation lactate levels (P=0.02).
- Seizures were associated with a higher incidence of intracranial hemorrhage (68% vs. 34%, P=0.01).
Conclusions:
- Electrographic seizures are prevalent (22%) in pediatric ECMO patients.
- Interictal epileptiform discharges and elevated lactate are key seizure risk factors.
- Seizures in this population are linked to increased risk of intracranial hemorrhage.
Background:
Single-center studies suggest that up to 30% of children undergoing extracorporeal membrane oxygenation have electrographic seizures. The aim of this study was to characterize seizure prevalence, seizure risk factors, and brain injury prevalence in the pediatric extracorporeal membrane oxygenation population at a tertiary care children's hospital.
Methods:
We performed a retrospective systematic review of medical records for 86 consecutive children (neonates to age 21 years) who received Neurology consults and continuous video electroencephalography while undergoing extracorporeal membrane oxygenation from November 2015 to September 2018.
Results:
Continuous video electroencephalography was initiated in 86 of 170 children who required extracorporeal membrane oxygenation (51%); median duration of continuous vodeo electroencephalography was four days. Nineteen of 86 had electroencephalography-confirmed seizures (22%). Sixteen of 19 had seizures within the first 48 hours on continuous video electroencephalography. Interictal epileptiform discharges were a significant risk factor for seizures; 89% of those with seizures versus 46% of those without had interictal epileptiform discharges (P < 0.001, Fisher's exact test). Children with seizures also had higher pericannulation lactate (median 6.7, interquartile range of 4.3 to 19.0 for those with, and median 4.0, interquartile range of 2.0 to 7.3 for those without; P = 0.02, Mann-Whitney U test). Seizures were associated with hemorrhage on neuroimaging (68% of children with seizures had intracranial hemorrhage versus 34% of those without, P = 0.01, chi-square test).
Conclusion:
Approximately half the children undergoing extracorporeal membrane oxygenation received continuous video electroencephalography during the study period, and 22% had seizures. Interictal epileptiform discharges and elevated pre-extracorporeal membrane oxygenation lactate levels were risk factors for seizures; seizures were associated with intracranial hemorrhage.
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