Description of Patterns in Reduced-Lead Electroencephalography Performed for Suspected Electrographic Seizures in...

Area of Science:

• Pediatric Neurology
• Clinical Neurophysiology
• Emergency Medicine

Background:

• Altered mental status (AMS) in pediatric emergency department (ED) patients often requires electroencephalographic (EEG) evaluation.
• Reduced-lead EEG offers a practical approach for diagnosing suspected electrographic seizures (ESz) in this critical setting.
• Standardized EEG terminology is crucial for consistent interpretation and comparison.

Purpose of the Study:

• To analyze and describe reduced-lead EEG data for suspected ESz in pediatric AMS patients using standardized terminology.
• To compare EEG patterns across febrile seizure (FS), acute encephalopathy/encephalitis (AE/AES), and epilepsy.
• To establish a baseline for interpreting reduced-lead EEG in common pediatric ED neurological emergencies.

Main Methods:

• Retrospective analysis of reduced-lead EEG in pediatric AMS patients (March 2019-February 2023).
• Fifty-one artifact-free EEG results analyzed using American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology 2021.
• Clinical diagnoses categorized into FS, AE/AES, and epilepsy for comparative analysis.

Main Results:

• No significant difference in clinical seizure types across the three diagnostic groups.
• Rhythmic delta activity was common in FS and AE/AES; spikes and waves were significantly more frequent in epilepsy.
• Electrographic seizures (ESz) occurred in 25 patients, with a significantly higher incidence in the epilepsy group.

Conclusions:

• This study provides the first description of reduced-lead EEG patterns for suspected ESz in pediatric AMS patients using standardized terminology.
• Distinct EEG morphology, particularly spikes and waves, can help differentiate epilepsy from FS and AE/AES in this population.
• Findings support the utility of reduced-lead EEG in the ED for evaluating pediatric neurological emergencies.