A simple and reliable electroencephalogram montage for detecting and managing electrographic seizures in children
Naohiro Yamamoto1, Ichiro Kuki1, Naoki Yamada1
1Division of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan.
Insights
A reduced EEG montage (RE-EEG) reliably detects electrographic seizures (ESz) in children with encephalitis. This method offers a practical alternative to full-electrode EEG (FE-EEG) in resource-limited settings.
Area of Science:
- Neurology
- Clinical Neurophysiology
Background:
- Continuous electroencephalogram (C-EEG) monitoring is vital for diagnosing electrographic seizures (ESz) in pediatric acute encephalitis and encephalopathy.
- Limited accessibility of full-electrode EEG (FE-EEG) due to specialized personnel hinders widespread C-EEG use in Japan and globally.
- A simplified, reliable reduced EEG montage is needed to improve diagnostic capabilities.
Purpose of the Study:
- To evaluate the efficacy of a simple reduced EEG montage for detecting ESz in children with acute encephalitis or encephalopathy.
- To compare the seizure detection rates of reduced EEG montages against full-electrode EEG.
Main Methods:
- Retrospective analysis of 42 pediatric patients with acute encephalitis/encephalopathy undergoing FE-EEG.
- Reformatting FE-EEG data into three reduced montages: double-distance reduced EEG (RE-EEG), Hairline, and amplitude-integrated EEG (aEEG).
- Comparing ESz detection rates using Poisson regression analysis.
Main Results:
- RE-EEG demonstrated comparable ESz detection rates to FE-EEG.
- RE-EEG showed significantly higher ESz detection rates than Hairline and aEEG montages.
- RE-EEG achieved over 90% seizure detection accuracy.
Conclusions:
- RE-EEG provides a reliable and effective method for detecting ESz in pediatric encephalitis.
- This reduced montage offers a practical, convenient, and temporary brain function monitoring tool.
- RE-EEG has significant potential for implementation in healthcare settings with limited resources.
Background:
Continuous electroencephalogram (EEG) monitoring (C-EEG) is crucial for the early diagnosis and treatment of electrographic seizures (ESz) in children with acute encephalitis and encephalopathy. However, in Japan, like many other countries, C-EEG is not widely accessible due to reliance on specialized physicians and technicians to apply the international 10-20 system for full-electrode EEG (FE-EEG). Therefore, this study aimed to evaluate a simple and reliable reduced EEG montage.
Methods:
We retrospectively analyzed 83 patients presenting with fever and status epilepticus or fever and impaired consciousness who underwent C-EEG using FE-EEG between 2015 and 2020. After excluding 41 patients diagnosed with febrile status epilepticus, 42 diagnosed with acute encephalitis or encephalopathy were included. Of these, two patients were excluded because their EEGs demonstrated an ictal-interictal continuum, precluding accurate seizure counting. Finally, 15 patients who had more than five ESz were included in this retrospective study. We re-formatted the EEG data recorded with FE-EEG into three reduced montages: double-distance reduced EEG (RE-EEG), Hairline, and amplitude-integrated EEG (aEEG), comprises 4, 3, and 1 EEG channel(s) on each hemisphere, respectively. The ESz detection rates of these reduced montages were compared using Poisson regression analysis.
Results:
Among 42 patients with acute encephalitis or encephalopathy, 15 exhibited ESz more than five times. RE-EEG detected ESz with no significant difference compared to FE-EEG. Furthermore, RE-EEG demonstrated a significantly higher ESz detection rate than the Hairline and aEEG montages.
Conclusion:
RE-EEG offered a reliable seizure detection rate exceeding 90 %, except for one case. Beyond detecting ESz, RE-EEG could serve as a quick, convenient, and temporary monitor for brain function, offering significant potential for implementation in resource-limited healthcare settings.
