Diagnostic value of amplitude-integrated electroencephalogram for epileptic seizures in pediatric intensive care unit

Abstract

Objective To assess the value of amplitude-integrated electroencephalogram(aEEG) in diagnose of epileptic seizure and status epilepticus in pediatric intensive care unit(PICU). Methods Thirty-five children admitted to Children's Hospital of Fudan University from January to December 2014 with severe neurologia situation in PICU were investigated, and bedside video-EEG(VEEG) findings were recorded for more than 4 hours.VEEG signals were transformed into aEEG signals by Galileo NT PMS software: one-channel aEEG (C3-C4), mutichannel aEEG(F3-F4; C3-C4; P3-P4; T3-T4) plus original EEG.Electrical seizure activity on VEEG was signed out with respect to its occurrence, duration and localization of seizure onset; while aEEG seizure was recorded only during its occurrence.The relationship between aEEG and VEEG was analyzed by Spearman analysis. Results A total of 61 traces in 35 cases were suitable for analysis.(1) gender: 24 male and 11 female; years of age: 12 cases of 2 months-1 year old, 13 cases >1-6 years old, 10 cases >6-12 years old; etiological factors: 15 cases associated with severe viral encephalitis, 6 cases associated with epilepsy, 6 cases associated with intracranial hemorrhage, 5 cases associated with hypoxic-ischemic encephalopathy(HIE), 3 cases with other factors.(2)The results were divided into 2 groups: status epilepticus (SE) group and epileptic seizures group.There were 37 traces in SE group, 19 traces of them were convulsive SE, and severe viral encephalitis and epilepsy were the most common causes.The other 18 traces were non-convulsive SE, the most common causes were severe viral encephalitis, HIE and intracranial hemorrhage.There were 24 traces in non-SE group, and 118 frequencies of epileptic seizures were monitored.(3)The diagnostic value of aEEG for SE and epileptic seizures: 37 traces with status epilepticus on VEEG were all diagnosed as SE on aEEG.For non-SE electrical seizures, the sensitivity of aEEG for detection of electrical seizures was as follows: 79.66%(94/118 traces)for one-channel aEEG, 91.53%(108/118 traces) for multichannel aEEG.Findings from one-channel aEEG and multichannel aEEG were all related to VEEG(ρ=0.837, 0.901, all P<0.01). Conclusions The aEEG is a simple and effective method for monitoring epileptic seizures and SE in PICU.One-channel aEEG is the best method to find SE.It is helpful to increase the numbers of channel in order to find epileptic seizures. Key words: Child; Severe neurology situation; Amplitude-integrated electroencephalogram; Status epilepti-cus; Seizure