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Quantitative EEG during controlled hypoglycaemia in diabetic and non-diabetic children
1Faculty of Medicine, Norwegian University of Science and Technology, Trondheim.
Insights
Quantitative electroencephalography (EEG) detected brain changes in children at plasma glucose levels around 4 mmol/l. Diabetic children showed more pronounced EEG changes during hypoglycemia compared to non-diabetic peers.
Area of Science:
- Pediatric Neurology
- Endocrinology
- Neurophysiology
Background:
- Hypoglycemia, a common complication in children with diabetes, can affect brain function.
- Quantitative electroencephalography (qEEG) is a sensitive tool for assessing cerebral activity.
Purpose of the Study:
- To investigate EEG changes in diabetic and non-diabetic children during induced hypoglycemia.
- To compare the severity of EEG alterations and their correlation with hypoglycemic symptoms between the two groups.
Main Methods:
- 19 diabetic and 17 non-diabetic children underwent a glucose clamp to gradually lower plasma glucose levels.
- Quantitative EEG recordings were analyzed for changes in frequency band amplitudes at different glucose levels.
- Hypoglycemic symptom scores were recorded in non-diabetic subjects.
Main Results:
- EEG changes, including increased delta and theta activity, were observed at plasma glucose levels around 4 mmol/l in all children.
- Diabetic children exhibited more pronounced increases in delta, theta, and epileptiform activity compared to non-diabetic children at similar glucose nadirs.
- In non-diabetic children, increased low-frequency EEG activity correlated with hypoglycemic symptom severity, but this correlation was absent in diabetic children.
Conclusions:
- Cerebral disturbances, detectable by EEG, occur in children at plasma glucose levels as high as approximately 4 mmol/l.
- Hypoglycemia-induced EEG deterioration is more severe in diabetic children than in non-diabetic children.
- Diabetic children may experience increased cerebral disturbances during hypoglycemia without a corresponding increase in reported symptoms.
Abstract:
We investigated quantitative EEG in 19 diabetic children (mean age 14.2 (SD 1.4) years, mean HbA1c 9.8 (SD 1.2)% and 17 non-diabetic children (14.3 (1.1) years) during and after a gradual reduction in plasma glucose with the glucose clamp technique. The amplitudes of the EEG frequency bands at each glucose level were compared to the registration prior to hypoglycaemia. At plasma glucose approximately 4 mmol l(-1), a small increase in delta (p < 0.05) and theta (p < 0.01) amplitude appeared in the combined diabetic and control group. At approximately 3 mmol l(-1), and at glucose nadir, a further and widespread increase in low-frequency EEG activity was observed. In diabetic and non-diabetic subgroups with similar glucose nadirs, the diabetic children had more delta (p < 0.01) and theta (p < 0.01) activity, and more epileptiform activity (p < 0.05), than the non-diabetic children. In the non-diabetic subjects, but not in the diabetic subjects, the increase in delta and theta activity correlated with a hypoglycaemic symptom score (r = 0.75, p = 0.001 and r = 0.77, p < 0.0005, respectively). In conclusion, EEG changes are detectable already at plasma glucose approximately 4 mmol l(-1) in children. EEG deterioration during hypoglycaemia is more pronounced in diabetic than in non-diabetic children. The increase in cerebral disturbances is not accompanied by an increment in hypoglycaemic symptoms in diabetic children.