Electroencephalography monitoring in critically ill children: Current practice and implications for future study design

Sarah M. Sánchez, Daniel H. Arndt, Jessica L. Carpenter, Kevin E. Chapman, Karen M. Cornett, Dennis J. Dlugos, William B. Gallentine, Christopher C. Giza, Joshua L. Goldstein, Cecil D. Hahn, Jason T. Lerner, Tobias Loddenkemper, Joyce H. Matsumoto, Kristin McBain, Kendall B. Nash, Eric Payne, Iván Sánchez Fernández, Justine Shults, Korwyn Williams, Amy YangNicholas S. Abend*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Purpose Survey data indicate that continuous electroencephalography (EEG) (CEEG) monitoring is used with increasing frequency to identify electrographic seizures in critically ill children, but studies of current CEEG practice have not been conducted. We aimed to describe the clinical utilization of CEEG in critically ill children at tertiary care hospitals with a particular focus on variables essential for designing feasible prospective multicenter studies evaluating the impact of electrographic seizures on outcome. Methods Eleven North American centers retrospectively enrolled 550 consecutive critically ill children who underwent CEEG. We collected data regarding subject characteristics, CEEG indications, and CEEG findings. Key Findings CEEG indications were encephalopathy with possible seizures in 67% of subjects, event characterization in 38% of subjects, and management of refractory status epilepticus in 11% of subjects. CEEG was initiated outside routine work hours in 47% of subjects. CEEG duration was <12 h in 16%, 12-24 h in 34%, and >24 h in 48%. Substantial variability existed among sites in CEEG indications and neurologic diagnoses, yet within each acute neurologic diagnosis category a similar proportion of subjects at each site had electrographic seizures. Electrographic seizure characteristics including distribution and duration varied across sites and neurologic diagnoses. Significance These data provide a systematic assessment of recent CEEG use in critically ill children and indicate variability in practice. The results suggest that multicenter studies are feasible if CEEG monitoring pathways can be standardized. However, the data also indicate that electrographic seizure variability must be considered when designing studies that address the impact of electrographic seizures on outcome.

Original languageEnglish (US)
Pages (from-to)1419-1427
Number of pages9
JournalEpilepsia
Volume54
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • EEG monitoring
  • Nonconvulsive seizure
  • Pediatric
  • Seizure
  • Status epilepticus

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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