Abstract
Objective: In the paediatric intensive care unit (PICU), seizures are challenging to detect given patient complexity, comorbidity and sedation. This has led to both over- and under-treatment of seizures. There is growing literature on the use of continuous electroencephalography in PICU, considered gold standard but not universally available, but little on standard electroencephalography (EEG).
This study aims to investigate the indications for EEG requests, their efficacy and the use of antiepileptic drugs (AED) in PICU, hypothesising a difficulty in clinically differentiating between epileptic and non-epileptic events and sub-optimal use of AEDs.
Methods: This retrospective study examined EEG reports over 2 years at a tertiary PICU. Data was collected on participant characteristics, EEG indications and findings and AED use.
Results: 185 EEG reports from 142 participants were included. Median age was 6 months (IQR 1mo–3y 6mo). Indications for EEG (often multiple per EEG) included suspected clinical seizures (64%), suspected subclinical seizures (21%), prognostication (28%) and suspected encephalopathy (8%). 63% of participants with suspected seizures were sedated and 43% of all participants were encephalopathic. Clinical episodes suspected to be seizures were captured in 41/141 EEGs. Only 22% of these were EEG-confirmed seizures. Captured movements shown not to be seizures are qualitatively described. 6% of patients with suspected seizures had electrographic seizures with no clinical correlate. Most confirmed seizures were in participants without pre-existing epilepsy. Antiepileptic(s) were changed prior to 25/35 captured events. Seizures were present in 28% of these cases, while 60% had neither clinical nor electrographic seizure activity. 7/8 participants with confirmed clinical seizures had AEDs changed.
Conclusion: It is challenging for clinicians to differentiate between seizure and non-seizure movements in PICU. Moreover, there are issues of over-medication and low event-capture rate with EEG. We propose a multidisciplinary education strategy and investment in cEEG to address these issues.
This study aims to investigate the indications for EEG requests, their efficacy and the use of antiepileptic drugs (AED) in PICU, hypothesising a difficulty in clinically differentiating between epileptic and non-epileptic events and sub-optimal use of AEDs.
Methods: This retrospective study examined EEG reports over 2 years at a tertiary PICU. Data was collected on participant characteristics, EEG indications and findings and AED use.
Results: 185 EEG reports from 142 participants were included. Median age was 6 months (IQR 1mo–3y 6mo). Indications for EEG (often multiple per EEG) included suspected clinical seizures (64%), suspected subclinical seizures (21%), prognostication (28%) and suspected encephalopathy (8%). 63% of participants with suspected seizures were sedated and 43% of all participants were encephalopathic. Clinical episodes suspected to be seizures were captured in 41/141 EEGs. Only 22% of these were EEG-confirmed seizures. Captured movements shown not to be seizures are qualitatively described. 6% of patients with suspected seizures had electrographic seizures with no clinical correlate. Most confirmed seizures were in participants without pre-existing epilepsy. Antiepileptic(s) were changed prior to 25/35 captured events. Seizures were present in 28% of these cases, while 60% had neither clinical nor electrographic seizure activity. 7/8 participants with confirmed clinical seizures had AEDs changed.
Conclusion: It is challenging for clinicians to differentiate between seizure and non-seizure movements in PICU. Moreover, there are issues of over-medication and low event-capture rate with EEG. We propose a multidisciplinary education strategy and investment in cEEG to address these issues.
| Original language | English |
|---|---|
| Title of host publication | Developmental Medicine & Child Neurology |
| Publisher | Mac Keith Press |
| Pages | 22 |
| Volume | 62 |
| DOIs | |
| Publication status | Published - Jan 2020 |