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Impact of Continuous EEG Monitoring on Clinical Management in Critically Ill Children

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Abstract

Background

Continuous EEG (cEEG) monitoring is being used with increasing frequency in critically ill patients, most often to detect non-convulsive seizures. While cEEG is non-invasive and feasible in the critical care setting, it is also expensive and labor intensive, and there has been little study of its impact on clinical care. We aimed to determine prospectively the impact of cEEG on clinical management in critically ill children.

Methods

Critically ill children (non-neonates) with acute encephalopathy underwent cEEG. Study enrollment and data collection were prospective.

Results

100 children were studied. EEG monitoring led to specific clinical management changes in 59 children. These included initiating or escalating anti-seizure medications in 43 due to seizure detection, demonstrating that a specific event (subtle movement or vital sign change) was not a seizure in 21, or obtaining urgent neuroimaging that led to a clinical change in 3. In the remaining 41 children, cEEG ruled out the presence of non-convulsive seizures but did not lead to a specific change in clinical management.

Conclusions

EEG monitoring led to changes in clinical management in the majority of patients, suggesting it may have an important role in management of critically ill children. Further study is needed to determine whether the management changes elicited by cEEG improve outcome.

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References

  1. Friedman D, Claassen J, Hirsch LJ. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009;109:506–23.

    Article  PubMed  Google Scholar 

  2. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–8.

    PubMed  CAS  Google Scholar 

  3. Hyllienmark L, Amark P. Continuous EEG monitoring in a paediatric intensive care unit. Eur J Paediatr Neurol. 2007;11:70–5.

    Article  PubMed  Google Scholar 

  4. Hosain SA, Solomon GE, Kobylarz EJ. Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol. 2005;32:162–5.

    Article  PubMed  Google Scholar 

  5. Jette N, Claassen J, Emerson RG, Hirsch LJ. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol. 2006;63:1750–5.

    Article  PubMed  Google Scholar 

  6. Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72:1931–40.

    Article  PubMed  CAS  Google Scholar 

  7. Abend NS, Dlugos DJ. Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol. 2007;37:165–70.

    Article  PubMed  Google Scholar 

  8. Saengpattrachai M, Sharma R, Hunjan A, et al. Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia. 2006;47:1510–8.

    Article  PubMed  Google Scholar 

  9. Alehan FK, Morton LD, Pellock JM. Utility of electroencephalography in the pediatric emergency department. J Child Neurol. 2001;16:484–7.

    PubMed  CAS  Google Scholar 

  10. Tay SK, Hirsch LJ, Leary L, Jette N, Wittman J, Akman CI. Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia. 2006;47:1504–9.

    Article  PubMed  Google Scholar 

  11. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.

    PubMed  CAS  Google Scholar 

  12. Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37:2051–6.

    Article  PubMed  Google Scholar 

  13. Carrera E, Claassen J, Oddo M, Emerson RG, Mayer SA, Hirsch LJ. Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections. Arch Neurol. 2008;65:1612–8.

    Article  PubMed  Google Scholar 

  14. Glass HC, Glidden D, Jeremy RJ, Barkovich AJ, Ferriero DM, Miller SP. Clinical neonatal seizures are independently associated with outcome in infants at risk for hypoxic-ischemic brain injury. J Pediatr. 2009;155:318–23.

    Article  PubMed  Google Scholar 

  15. McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome. Neurology. 2000;55:506–13.

    PubMed  CAS  Google Scholar 

  16. Coen RW, McCutchen CB, Wermer D, Snyder J, Gluck FE. Continuous monitoring of the electroencephalogram following perinatal asphyxia. J Pediatr. 1982;100:628–30.

    Article  PubMed  CAS  Google Scholar 

  17. Pisani F, Cerminara C, Fusco C, Sisti L. Neonatal status epilepticus vs. recurrent neonatal seizures: clinical findings and outcome. Neurology. 2007;69:2177–85.

    Article  PubMed  Google Scholar 

  18. Ronen GM, Buckley D, Penney S, Streiner DL. Long-term prognosis in children with neonatal seizures: a population-based study. Neurology. 2007;69:1816–22.

    Article  PubMed  Google Scholar 

  19. Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med. 2007;35:2830–6.

    Article  PubMed  Google Scholar 

  20. Vespa PM, Nuwer MR, Juhasz C, et al. Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring. Electroencephalogr Clin Neurophysiol. 1997;103:607–15.

    Article  PubMed  CAS  Google Scholar 

  21. Kull LL, Emerson RG. Continuous EEG monitoring in the intensive care unit: technical and staffing considerations. J Clin Neurophysiol. 2005;22:107–18.

    Article  PubMed  Google Scholar 

  22. Vespa PM, Nenov V, Nuwer MR. Continuous EEG monitoring in the intensive care unit: early findings and clinical efficacy. J Clin Neurophysiol. 1999;16:1–13.

    Article  PubMed  CAS  Google Scholar 

  23. Kilbride RD, Costello DJ, Chiappa KH. How seizure detection by continuous electroencephalographic monitoring affects the prescribing of antiepileptic medications. Arch Neurol. 2009;66:723–8.

    Article  PubMed  Google Scholar 

  24. Abend NS, Huh JW, Helfaer MA, Dlugos DJ. Anticonvulsant medications in the pediatric emergency room and intensive care unit. Pediatr Emerg Care. 2008;24:705–18 (quiz 19–21).

    Google Scholar 

  25. Claassen J, Hirsch LJ, Kreiter KT, et al. Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage. Clin Neurophysiol. 2004;115:2699–710.

    Article  PubMed  Google Scholar 

  26. de Vos CC, van Maarseveen SM, Brouwers PJ, van Putten MJ. Continuous EEG monitoring during thrombolysis in acute hemispheric stroke patients using the brain symmetry index. J Clin Neurophysiol. 2008;25:77–82.

    Article  PubMed  Google Scholar 

  27. Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91:750–60.

    Article  PubMed  CAS  Google Scholar 

  28. Bratton SL, Chestnut RM, Ghajar J. et al. Guidelines for the management of severe traumatic brain injury. XIII. Antiseizure prophylaxis. J Neurotrauma. 2007;24(Suppl 1):S83–6.

    PubMed  Google Scholar 

  29. Dichter MA. Emerging concepts in the pathogenesis of epilepsy and epileptogenesis. Arch Neurol. 2009;66:443–7.

    Article  PubMed  Google Scholar 

  30. Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22:79–91.

    Article  PubMed  Google Scholar 

  31. Ronner HE, Ponten SC, Stam CJ, Uitdehaag BM. Inter-observer variability of the EEG diagnosis of seizures in comatose patients. Seizure. 2009;18:257–63.

    Article  PubMed  CAS  Google Scholar 

  32. Gerber PA, Chapman KE, Chung SS, et al. Interobserver agreement in the interpretation of EEG patterns in critically ill adults. J Clin Neurophysiol. 2008;25:241–9.

    Article  PubMed  Google Scholar 

  33. Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007;118:1660–70.

    Article  PubMed  CAS  Google Scholar 

  34. Hirsch LJ, Brenner RP, Drislane FW, et al. The ACNS subcommittee on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol. 2005;22:128–35.

    Article  PubMed  Google Scholar 

  35. Scheuer ML, Wilson SB. Data analysis for continuous EEG monitoring in the ICU: seeing the forest and the trees. J Clin Neurophysiol. 2004;21:353–78.

    PubMed  Google Scholar 

  36. Abend NS, Dlugos D, Herman S. Neonatal seizure detection using multichannel display of envelope trend. Epilepsia. 2008;49:349–52.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study is supported by NIH K12-NS049453 to Dr. Abend.

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Authors and Affiliations

  1. Division of Neurology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Nicholas S. Abend, Ana M. Gutierrez-Colina, Maureen Donnelly, Robert R. Clancy & Dennis J. Dlugos

  2. Department of Neurology, The University of Pennsylvania School of Medicine, Philadelphia, PA, 19104, USA

    Nicholas S. Abend, Robert R. Clancy & Dennis J. Dlugos

  3. Division of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Alexis A. Topjian

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  1. Nicholas S. Abend
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  2. Alexis A. Topjian
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  3. Ana M. Gutierrez-Colina
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  4. Maureen Donnelly
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  5. Robert R. Clancy
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  6. Dennis J. Dlugos
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Correspondence to Nicholas S. Abend.

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Abend, N.S., Topjian, A.A., Gutierrez-Colina, A.M. et al. Impact of Continuous EEG Monitoring on Clinical Management in Critically Ill Children. Neurocrit Care 15, 70–75 (2011). https://doi.org/10.1007/s12028-010-9380-z

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