Association of Cerebral and Systemic Physiology With Quantitative Electroencephalographic Characteristics of Early
Brian L Appavu1,2, Jordana Fox1,2, Michael Kuwabara2,3
1Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A.
Insights
Early posttraumatic seizures in children are linked to changes in brain activity and body physiology. Quantitative EEG analysis reveals specific associations between seizure characteristics and measures like intracranial pressure and heart rate.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Critical Care Medicine
Background:
- Early posttraumatic seizures (EPTS) following pediatric traumatic brain injury (TBI) are linked to poor outcomes.
- Understanding the physiological impact of EPTS is crucial for managing TBI patients.
Purpose of the Study:
- To characterize the relationship between quantitative electroencephalogram (EEG) features of EPTS and concurrent cerebral and systemic physiological measures in children.
- To identify specific EEG parameters that correlate with intracranial pressure (ICP) and heart rate (HR) during seizures.
Main Methods:
- Retrospective analysis of 72 children with TBI, identifying 146 EPTS in 19 patients.
- Comparison of demographic, physiological, and neuroimaging data between patients with and without EPTS using Mann-Whitney U test or Fisher exact test.
- Multivariable dynamic structural equations modeling to assess time-series associations between quantitative EEG characteristics (amplitude, power, spectral edge frequency, peak frequency, complexity, periodicity) and ICP, arterial blood pressure, HR, and cerebral oximetry.
Main Results:
- EPTS were associated with younger age, increased HR, and improved Glasgow Outcome Scale-Extended scores.
- Group analysis showed ICP negatively correlated with spectral edge frequency (β=-0.12) and HR positively correlated with peak value frequency (β=0.16).
- In frontal lobe seizures, HR showed positive associations with peak value frequency (β=0.26) and complexity (β=0.14). Subject-specific variations in associations were noted.
Conclusions:
- Quantitative EEG characteristics of pediatric EPTS are associated with dynamic changes in cerebral and systemic physiology.
- Spectral edge frequency is negatively associated with ICP, while peak value frequency is positively associated with HR during EPTS.
- These findings highlight the complex interplay between seizure activity and physiological instability in pediatric TBI.
Purpose:
Early posttraumatic seizures (EPTS) occur after pediatric traumatic brain injury and have been associated with unfavorable outcomes. We aimed to characterize the relationship among quantitative EEG characteristics of early posttraumatic seizures, cerebral and somatic physiologic measures.
Methods:
Differences in baseline physiologic, neuroimaging, and demographic characteristics between those with and without early posttraumatic seizures were investigated using Mann-Whitney U test or Fisher exact test. Multivariable dynamic structural equations modeling was used to investigate time series associations between ictal quantitative EEG characteristics with intracranial pressure, arterial blood pressure, heart rate (HR), and cerebral regional oximetry. Quantitative EEG characteristics included amplitude, total power, spectral edge frequency, peak value frequency, complexity, and periodicity.
Results:
Among 72 children, 146 seizures were identified from 19 patients. Early posttraumatic seizures were associated with younger age ( P = 0.0034), increased HR ( P = 0.0018), and increased Glasgow Outcome Scale-Extended scores ( P = 0.0377). Group dynamic structural equations modeling analysis of the first seizure for patients demonstrated that intracranial pressure is negatively associated with spectral edge frequency (standardized regression coefficient -0.12, 99% credible interval [-0.21 to -0.04]), and HR is positively associated with peak value frequency (standardized regression coefficient 0.16, [0.00-0.31]). Among nine patients with seizures arising over the frontal lobe regions, HR was positively associated with peak value frequency (standardized regression coefficient 0.26 [0.02-0.50]) and complexity (standardized regression coefficient 0.14 [0.03-0.26]). Variation in strength and direction of associations was observed between subjects for relationships that were significant during group analysis.
Conclusions:
Quantitative EEG characteristics of pediatric early posttraumatic seizures are associated with variable changes in cerebral and systemic physiology, with spectral edge frequency negatively associated with intracranial pressure and peak value frequency positively associated with HR.
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