Continuous Dexmedetomidine Sedation Permits Long-term Intracranial Electrocorticography in Patients with Epilepsy and Comorbid Disruptive Behaviors
Abstract number :
3.311
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
868
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Andrew Widmer, MD, PhD – Cincinnati Children's Hospital
Francesco Mangano, DO – Neurosurgery – Cincinnati Children's Hospital; Hansel Greiner, MD – Neurology – Cincinnati Children's Hospital; Jesse Skoch, MD – Neurosurgery – Cincinnati Children's Hospital; Ravindra Arya, MD, DM – Neurology – Cincinnati Children's Hospital; Gewalin Aungaroon, MD – Neurology – Cincinnati Children's Hospital; Susan Fong, MD, PhD – Neurology – Cincinnati Children's Hospital; Katherine Holland, MD, PhD – Neurology – Cincinnati Children's Hospital; Kelly Kremer, MD – Neurology – Cincinnati Children's Hospital; S Katie Ihnen, MD, PhD – Neurology – Cincinnati Children's Hospital; Nan Lin, MD – Neurology – Cincinnati Children's Hospital; Wei Liu, MD – Neurology – Cincinnati Children's Hospital; Heather Wied, MD, PhD – Neurology – Cincinnati Children's Hospital; Jeffrey Tenney, MD, PhD – Neurology – Cincinnati Children's Hospital
Rationale: Therefore, we have used continuous dexmedetomidine sedation for select cases to enable safe long-term monitoring and to improve recording data quality. We present a series of patients with disruptive behaviors who underwent ECoG using continuous dexmedetomidine sedation.
Methods: Patients who underwent placement of stereotactic electroencephalography electrodes for ECoG monitoring with continuous dexmedetomidine sedation at Cincinnati Children's Hospital from February 2014 to June 2022 were included. Sedation was titrated to allow for awake sedation and the recording of typical ictal events. In addition to pharmacotherapy, behavioral support professionals and child life specialists were used to help manage aggressive behaviors or agitation. Semiology of seizures was reviewed to ensure that habitual seizures were captured during the recordings, and intracranial provide within-subjects comparison of electrophysiological data.
Results: This study included six patients (five male) with an average age of 7.2 years old (SD 4.0). Etiology of epilepsy was cortical dysplasia in three patients, tuberous sclerosis in two, and post-infectious structural changes in one. Recordings lasted an average of 6.7 days (SD 1.5), and sedation was utilized for an average of 4.8 days (SD 3.2). Early cases tended to use sedation for a shorter postoperative period, while later cases employed continuous sedation for the entire duration of the study. The range of doses used was 0.2- 1.5 mcg/kg/hr; the average steady state dose was 0.6 mcg/kg/hr (SD 0.34). The each patient’s sedated Phase II and unsedated Phase I studies (median within-subjects Phase II/Phase I ratio was 0.45and in all cases the habitual seizures were captured successfully, as evidenced by semiology. All patients completed the full duration of the monitoring period, and analysis of data regarding the duration and dose of continuous sedation, impact on vital signs, and clinical events related to sedation showed that no patient had a serious adverse effect from sedation or required significant intervention.
Conclusions: The use of continuous dexmedetomidine sedation allows for the safe completion of intracranial EEG monitoring in patients with aggressive or self-injurious behaviors. Disseminating this methodology may help these patients to access the standard of care for treatment of medically intractable epilepsy.
Funding: Internally funded by the Cincinnati Children’s Hospital Medical Center.
Surgery