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Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
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Periodic and rhythmic patterns in critically ill children: Incidence, interrater agreement, and seizures

France W Fung1,2, Darshana S Parikh1, Shavonne L Massey1,2

  • 1Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Epilepsia
|October 13, 2021
PubMed

Insights

Periodic and rhythmic patterns (PRP) occur in 10% of critically ill children. Certain PRP types, like generalized periodic discharges (GPD) and lateralized periodic discharges (LPD), are associated with electrographic seizures (ES).

Area of Science:

  • Neurophysiology
  • Critical Care Medicine
  • Pediatric Neurology

Background:

  • Continuous electroencephalographic monitoring (CEEG) is crucial for critically ill children.
  • Periodic and rhythmic patterns (PRP) are common findings on CEEG.
  • The association between PRP and electrographic seizures (ES) requires further investigation.

Purpose of the Study:

  • To determine the incidence of PRP in critically ill children.
  • To assess interrater agreement for PRP scoring using standardized terminology.
  • To analyze the association between PRP and the occurrence of ES.

Main Methods:

  • Prospective observational study of critically ill children undergoing CEEG.
  • Independent scoring of PRP by two pediatric electroencephalographers using standardized terminology.
  • Evaluation of incidence, interrater agreement, and associations between PRP and ES.

Main Results:

  • PRP occurred in 10% of 1399 patients; ES occurred in 25%.
  • Generalized periodic discharges (GPD), lateralized periodic discharges (LPD), bilateral independent periodic discharges (BIPD), and lateralized rhythmic delta activity (LRDA) were significantly associated with ES (OR = 6.35-10.45).
  • Generalized rhythmic delta activity (GRDA) was not significantly associated with ES (OR = 1.34).

Conclusions:

  • PRP are observed in 10% of critically ill children.
  • Specific PRP types (GPD, LPD, BIPD, LRDA) and ictal-interictal continuum (IIC) patterns are associated with ES.
  • GRDA is not associated with ES, highlighting the importance of pattern-specific analysis.
Abstract

Keywords:
electroencephalogramictal-interictal continuumpediatricperiodicrhythmicseizure

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