Utility and Prognostic Implications of Continuous Electroencephalogram Monitoring in Pediatric Intensive Care

Area of Science:

• Neuroscience
• Pediatric Critical Care
• Clinical Neurophysiology

Background:

• Continuous electroencephalography (cEEG) use is rising in pediatric intensive care units (PICUs), but its diagnostic and prognostic value in critically ill children needs more data.
• Understanding EEG monitoring practices, seizure detection rates, and treatment impacts is crucial for optimizing care in pediatric neurocritical settings.

Purpose of the Study:

• To evaluate EEG monitoring practices, including intermittent EEG and cEEG, in a tertiary PICU.
• To assess the diagnostic yield of EEG in detecting seizures, guiding antiseizure treatment modifications, and identifying nonconvulsive status epilepticus (NCSE).
• To determine the long-term outcomes, specifically the development of drug-resistant epilepsy (DRE), in critically ill children.

Main Methods:

• Retrospective analysis of 184 children (1 month-18 years) who underwent intermittent EEG or cEEG in a tertiary PICU from 2018 to 2022.
• Data collected included demographic and clinical features, EEG indications, findings, antiseizure treatment changes, and patient outcomes.
• Primary outcomes assessed were acute seizure control, occurrence of NCSE, and development of DRE during follow-up.

Main Results:

• Electrographic seizures were detected in 12.0% of patients, leading to antiseizure therapy modification in 77.3% of those cases.
• Previously unsuspected nonconvulsive seizures were identified in 2.7% of patients; acute seizure control was achieved in 98.0% of patients with documented seizures.
• Over a median follow-up of 8.0 months, 20.7% of patients were newly diagnosed with DRE, particularly those with acute encephalopathy, hypoxic-ischemic injury, or CNS infections.

Conclusions:

• EEG, especially cEEG in high-risk pediatric patients, provides valuable information for electrographic seizure detection and antiseizure management in the PICU.
• The study identified a significant long-term burden of DRE in this pediatric PICU cohort.
• Prospective multicenter studies are warranted to establish the optimal role of EEG in pediatric neurocritical care.