Continuous Video Electroencephalography (EEG) for Event Characterization in Critically Ill Children

Area of Science:

• Critical care medicine
• Pediatric neurology
• Clinical neurophysiology

Background:

• Continuous video electroencephalography (EEG) is crucial for diagnosing seizures in critically ill children.
• Characterizing paroxysmal events is essential for accurate diagnosis and management.

Purpose of the Study:

• To identify features of paroxysmal events and EEG abnormalities associated with electroclinical seizures in critically ill children.
• To characterize clinical events using continuous video EEG.

Main Methods:

• A prospective study included 100 critically ill children (non-neonates) undergoing continuous video EEG.
• Paroxysmal events were documented and classified (motor, ocular, orobuccal, autonomic, other).
• Events with multiple components were classified as motor-plus or nonmotor-plus.

Main Results:

• Electroclinical seizures were captured in 30% of patients.
• Autonomic events were the most common (32%), but isolated autonomic events were not associated with electroclinical seizures (OR 0.3).
• Asymmetry (OR 2.7) and epileptiform discharges (OR 12.5) were significantly associated with electroclinical seizures.

Conclusions:

• Isolated autonomic events in critically ill children are unlikely to represent electroclinical seizures.
• Detailed characterization of paroxysmal events aids in selecting patients who will benefit from continuous video EEG, optimizing resource allocation.