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[Systematic follow up study of posttraumatic EEG-abnormalities in children (author's transl)]
Insights
Electroencephalography (EEG) detects more traumatic brain injuries in children than neurological exams. Serial EEGs are crucial for identifying subtle changes, especially in infants, aiding diagnosis and prognosis.
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Trauma Care
Context:
- Head injuries in children require accurate diagnostic tools.
- Electroencephalography (EEG) is a key neurophysiological assessment.
- Early and follow-up EEG can reveal subtle cerebral disturbances.
Purpose:
- To evaluate the efficacy of serial EEG in diagnosing and monitoring cerebral disturbances after head trauma in children.
- To compare EEG findings with neurological examinations.
- To establish optimal timing for EEG assessments post-trauma.
Summary:
- EEG identified traumatic cerebral disturbances in 53% of children, nearly double the rate of neurological exams (30%).
- Focal EEG abnormalities, primarily temporal delta foci, were common (38%), and general slowing occurred in 47%.
- Serial EEGs are vital, as 45% of general slowing cases were detected through repeated examinations due to infant EEG variability. Skull fractures correlated highly with EEG changes (10/11).
- Amnesia duration correlated with EEG abnormalities; prolonged amnesia (>2 hours) always indicated abnormal EEGs.
- Optimal diagnostic yield is achieved with initial EEGs within 3 days and follow-up at 3 months, with focal abnormalities persisting longer than slowing.
Impact:
- Highlights the superior sensitivity of EEG over neurological exams for detecting pediatric head injury sequelae.
- Emphasizes the importance of serial EEG monitoring for accurate diagnosis and prognosis in pediatric head trauma.
- Recommends a broader definition of cerebral contusion based on EEG findings and suggests specific follow-up protocols.
Abstract:
A systematic follow up study of EEG in 116 children, who after head injury were admitted to a surgical ward and examined within 3 days, the following day and the 30., 90., and 180. day after the trauma gave the following results; 1. EEG examinations indicate traumatic cerebral disturbances (foci 38%, general slowing 47%) nearly twice as often (53%) as neurological examination (30%). 2. 45% of the cases with general slowing may be detected by repeated examinations only because of the variability of the EEG in infancy. 3. Focal signs consisted mainly in delta-foci, in 74% of temporal localisation. S.c. reduction foci without slowing were not found. 4. Skull fractures were mostly combined with EEG changes (10 from 11). 5. Variations in vigilance were significantly more frequent in contusions in the initial stages, hyperventilation changes in the later stages. The reduction of amplitudes was without diagnostic relevance. 6. Normalization of slowing preceeded that of foci in only 23% although focal abnormalities persisted for more than 6 months in 14% and slowing only in 4%. 7. In 60% of the patients with traumatic EEG changes amnesia had not lasted longer than 10 minutes. Amnesias lasting more than 2 hours were always accompanied by EEG abnormalities. 8. Traumatic EEG abnormalities are not missed, if recordings are performed within 3 days and controlled 3 months after the trauma. The problem of the diagnostic classification is discussed and it is recommended, that the notion of contusion is used in a broader sense.