Incidence and Characterization of Rhythmic and Periodic Patterns in Pediatric ICU EEG
Abstract number :
1.225
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2025
Submission ID :
903
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Varun Sampat, MD – Lurie Children's Hospital
Elham Abushanab, MD – Medical College of Wisconsin
Pradeep Javarayee, MD MBA – The Medical College of Wisconsin, Milwaukee
Niyati Mehta, MD – Medical College of Wisconsin
Sarah Otterson, MD – Medical College of Wisconsin
Hema Patel, MD – Medical College of Wisconsin
Shannon Pollock, MD – Medical College of Wisconsin
Avantika Singh, MD – Medical College of Wisconsin
Raquel Farias-Moeller, MD – Medical College Wisconsin
Rationale: To describe the incidence and associated features of rhythmic and periodic patterns (RPPs) in patients monitored on electroencephalogram (EEG) in the pediatric/cardiac intensive care unit (P/CICU).
Methods: This single-center study presents data from EEG reports for patients monitored in the P/CICU at Children’s Wisconsin between 10/2024 and 04/2025. Data was stored, identified, and extracted using a REDCap database of pediatric neurocritical care EEG. Data was automatically downloaded to the database from EPIC EEG reporting flowsheets which, at our center, mirror ACNS 2021 nomenclature for patients over the age of 2 months. All EEGs at our institution are interpreted by board-certified epileptologists. All routine, short-term, and long-term monitoring EEGs were included. This study reports the incidence of RPPs and associated features in patients monitored on EEG in the P/CICU.
Results: 416 EEG reports were included, of which 399 were long-term monitoring (LTM) EEGs, 8 were short-term monitoring EEGs, and 9 were routine EEGs. 120 total EEG reports (29%) described RPPs, which included 19% with rhythmic patterns and 11% with periodic patterns. 5% of total EEGs described both rhythmic and periodic patterns. In further subset analysis of EEGs describing RPPs (n=120), 23% (n=27) had brief potentially ictal rhythmic discharges (BIRDs), 52% (n=62) had seizures, and 14% (n=17) had ictal-interictal continuum (IIC) patterns. Indications for EEG monitoring included: 54% (n=65) for encephalopathy, 51% (n=61) for seizures or concern for seizures, 13% (n=15) for neuromonitoring after cardiac arrest (CA), 9% (n=11) for known epilepsy with breakthrough seizures, 8% (n=10) for neuromonitoring for hemodynamic instability without CA, 5% (n=6) for neuromonitoring after cardiac procedure or extracorporeal membrane oxygenation without CA, and 3% (n=4) for neuromonitoring after traumatic brain injury. In EEGs with seizures (n=62), the RPP most commonly noted was rhythmic in 60% (n=37) followed by periodic in 47% (n=29). Of EEGs that had seizures, BIRDS and IIC patterns were detected in 37% (n=23) and 19% (n=12).
Conclusions: The presence of RPPs in ICU EEG is important in grading encephalopathy. It may also play a role in stratifying risk for seizures, which could factor in to duration of EEG monitoring and potential initiation of anti-seizure medications. RPPs in pediatric cohorts are scarcely described and may have important associations on the ictal spectrum. Adherence to standard nomenclature and automatization of EEG data storage will permit future larger scale studies.
Funding: There was no funding received in support of this abstract.
Neurophysiology