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Periodic Discharges in Critically Ill Children: Predictors and Outcome

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

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

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|December 11, 2023
PubMed

Insights

Generalized periodic discharges (GPDs) and bilateral-independent periodic discharges (BIPDs) in critically ill children are linked to poor outcomes, including mortality. Lateralized periodic discharges (LPDs) were not associated with adverse outcomes.

Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Pediatric Neurology

Background:

  • Periodic discharges (PDs) are EEG patterns observed in critically ill patients.
  • Understanding the clinical and EEG characteristics of different PD types is crucial for prognostication.

Purpose of the Study:

  • To identify clinical and EEG features associated with generalized periodic discharges (GPDs), lateralized periodic discharges (LPDs), and bilateral-independent periodic discharges (BIPDs).
  • To determine the association of these EEG patterns with outcomes in critically ill children.

Main Methods:

  • Prospective observational study of critically ill children undergoing continuous EEG monitoring.
  • Standardized scoring of GPDs, LPDs, and BIPDs.
  • Assessment of associations with mortality, Glasgow Outcome Scale-Extended Pediatric version (GOS-E-Peds), and Pediatric Cerebral Performance Category (PCPC).

Main Results:

  • PDs occurred in 7% of subjects.
  • Coma and abnormal EEG background increased risk for GPDs.
  • GPDs associated with mortality; BIPDs associated with mortality and unfavorable GOS-E-Peds and PCPC outcomes.
  • LPDs were not associated with mortality or unfavorable outcomes; not seen in acute nonstructural encephalopathy.

Conclusions:

  • Coma and abnormal EEG background predict GPDs and BIPDs.
  • GPDs are linked to mortality, while BIPDs indicate mortality and poor neurological outcomes.
  • LPDs do not appear to be associated with adverse outcomes in this population.
Abstract

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