Distinct profiles of cerebral oxygenation in focal vs. secondarily generalized EEG seizures in children undergoing
Rouyi Lin1,2, Na Du1,3, Shuyao Ning4
1Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Seizures after cardiopulmonary bypass (CPB) in children are linked to brain injuries. Focal seizures showed distinct cerebral oxygenation (ScO2) profiles and higher injury rates, suggesting monitoring implications.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Cardiovascular Surgery
Background:
- Seizures are a known complication in pediatric patients following cardiopulmonary bypass (CPB).
- Cerebral oxygen saturation (ScO2) monitoring is common, but its relationship with brain injury in seizure types post-CPB is unclear.
- Understanding these relationships is crucial for managing brain injury in this vulnerable population.
Purpose of the Study:
- To investigate postoperative cerebral oxygenation (ScO2) and cerebral blood flow velocity (PSV) profiles in children experiencing different types of EEG seizures after CPB.
- To correlate these physiological parameters with the presence and severity of brain injuries detected by MRI.
Main Methods:
- Continuous EEG and ScO2 monitoring were performed on 337 children for 48 hours post-CPB.
- Cerebral blood flow peak systolic velocity (PSV) in the middle cerebral artery was measured daily via transcranial Doppler.
- Postoperative MRI was used to assess brain injuries before hospital discharge.
Main Results:
- Patients were categorized into no seizures (Group N), focal seizures (Group F), and secondarily generalized seizures (Group G).
- Group F exhibited the most severe brain injuries and highest incidence of white matter injuries on MRI.
- Focal seizures were associated with distinct ScO2 profiles, including 'overshooting' ScO2 with persistently low PSV, and more severe brain injury.
Conclusions:
- Postoperative cerebral oxygenation patterns differ significantly between seizure types in children after CPB.
- Focal seizures are linked to poorer outcomes, characterized by specific ScO2 and PSV dynamics and increased MRI-detected brain injuries.
- These findings highlight the clinical importance of ScO2 monitoring for detecting brain injuries in children post-CPB, especially those with focal seizures.
Objectives:
Seizures are common in children undergoing cardiopulmonary bypass (CPB). Cerebral oxygen saturation (ScO2) by near-infrared spectroscopy is routinely monitored in many centers, but the relations between the levels and changes of ScO2 and brain injuries remain incompletely understood. We aimed to analyze the postoperative profiles of ScO2 and cerebral blood flow velocity in different types of EEG seizures in relation to brain injuries on MRI.
Methods:
We monitored continuous EEG and ScO2 in 337 children during the first 48 h after CPB, which were analyzed in 3 h periods. Cerebral blood flow peak systolic velocity (PSV) in the middle cerebral artery was measured daily by transcranial Doppler. Postoperative cerebral MRI was performed before hospital discharge.
Results:
Based on the occurrence and spreading types of seizures, patients were divided into three groups as patients without seizures (Group N; n = 309), those with focal seizures (Group F; n = 13), or with secondarily generalized seizures (Group G; n = 15). There were no significant differences in the onset time and duration of seizures and incidence of status epilepticus between the two seizures groups (Ps ≥ 0.27). ScO2 increased significantly faster across Group N, Group G, and Group F during the 48 h (p < 0.0001) but its overall levels were not significantly different among the three groups (p = 0.30). PSV was significantly lower (p = 0.003) but increased significantly faster (p = 0.0003) across Group N, Group G, and Group F. Group F had the most severe brain injuries and the highest incidence of white matter injuries on MRI among the three groups (Ps ≤ 0.002).
Conclusion:
Postoperative cerebral oxygenation showed distinct profiles in secondarily generalized and particularly focal types of EEG seizures in children after CPB. A state of 'overshooting' ScO2 with persistently low PSV was more frequently seen in those with focal seizures and more severe brain injury. Information from this study may have important clinical implications in detecting brain injuries when monitoring cerebral oxygenation in this vulnerable group of children after CPB.
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