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[[Emergency pediatric EEG in mental confusion, behavioral disorders and vigilance disorders: a retrospective study]
Y Navelet1, H Nedelcoux, D Teszner
1Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Emergency electroencephalogram (EEG) effectively diagnoses childhood conditions like seizures and hepatic encephalopathy. A new 4-stage EEG scale aids prognosis in comatose children, identifying patterns indicating poor outcomes or brain death.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Electroencephalogram (EEG) is crucial for assessing vigilance states in children and adults.
- Emergency EEG plays a role in diagnosing and predicting outcomes for childhood neurological conditions.
Purpose of the Study:
- To evaluate the diagnostic and prognostic utility of emergency EEG in children presenting with mental confusion, behavioral, or vigilance disorders.
- To develop and validate a severity scale for EEG patterns in comatose children.
Main Methods:
- Retrospective study of 397 children (2 months to 16 years) undergoing emergency EEG within 24 hours of consultation or ICU admission.
- EEG recordings analyzed for diagnostic indications in acute confusion/behavioral disorders and comatose states.
- Development of a 4-stage EEG severity scale for comatose children, compared with existing literature scales.
Main Results:
- EEG provided key diagnostic insights for convulsive pathologies and hepatic encephalopathy.
- A 4-stage EEG scale for comatose children showed high similarity to established scales.
- Specific EEG patterns, including burst-suppression and isoelectric records, strongly correlated with poor prognosis and brain death.
Conclusions:
- Emergency EEG is valuable for diagnosing specific neurological conditions in children.
- The proposed 4-stage EEG scale aids in prognostication for comatose pediatric patients, particularly in identifying severe outcomes.
- While useful for extreme cases, continued clinical and EEG monitoring is essential as initial findings may evolve.
Abstract:
Recording of electroencephalogram (EEG) is of value to estimate vigilance states in children as in adults. In order to determine the diagnostic and prognostic value of emergency EEG in case of mental confusion, behavioral disorders and vigilance disorders in childhood, we conducted a retrospective study in 397 children (aged 2 months to 16 years). EEG was recorded less than 24 hours after an emergency consultation for acute confusion or acute behavioral disorder (n = 106) or after admission to the intensive care unit for comatose stage (n = 291). EEG gave diagnostic indications mainly in case of convulsive pathology or hepatic encephalopathy. In comatose children, we established a 4-stage EEG scale of increasing severity. This classification was compared to EEG scales already published in the literature and appeared very similar to that from Pampiglione and Harden, established in 150 children after cardiac arrest. A highly poor prognostic value was associated with burst-suppression post-anoxic patterns and with isoelectric records signaling brain death. Our classification of emergency EEG patterns is mainly helpful in these two situations, but does not exclude strict and repeated clinical and EEG follow-up in other cases, as a relatively preserved initial EEG may later deteriorate.