Periodic and Rhythmic Patterns in Critically Ill Children: Association with Seizures
Abstract number :
2.015
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2021
Submission ID :
1825676
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
France Fung, MD - Children's Hospital of Philadelphia / University of Pennsylvania; Sudha Kessler, MD - Children's Hospital of Philadelphia / University of Pennsylvania; Darshana Parikh, BA - Children's Hospital of Philadelphia; Lisa Vala, REEGT, RN - Children's Hospital of Philadelphia; Maureen Donnelly, REEGT - Children's Hospital of Philadelphia; Marin Jacobwitz, NP - Children's Hospital of Philadelphia; Alexis Topjian, MD - Children's Hospital of Philadelphia / University of Pennsylvania; Nicholas Abend, MD - Children's Hospital of Philadelphia / University of Pennsylvania
Rationale: We aimed to analyze associations between periodic and rhythmic patterns and seizures in critically ill children who underwent continuous EEG monitoring (CEEG).
Methods: This was a prospective single-center observational study of consecutive critically ill children undergoing CEEG between April 2017 and November 2020. A primary electroencephalographer identified the earliest portion of the EEG tracing which contained periodic or rhythmic patterns. Two pediatric electroencephalographers independently scored a one-hour EEG epoch using standardized American Clinical Neurophysiology Society critical care EEG terminology. Scoring disagreements were reviewed together to establish a final assessment by consensus. We evaluated associations between periodic and rhythmic patterns and electrographic seizures using the Chi-Square Test, logistic regression models, and multivariate logistic regression models (adjusted for age and acute diagnosis category).
Results: 1399 patients underwent CEEG. Electrographic seizures occurred in 345/1399 subjects (25%). Periodic or rhythmic patterns occurred in 142/1399 subjects (10%). Seizures and periodic or rhythmic patterns occurred in 81/1399 subjects (6%). Seizures were more common in subjects with (81/142, 57%) than without (264/1257, 21%) periodic-rhythmic patterns (p< 0.01). However, the risk of seizures varied by the type of periodic-rhythmic pattern (p< 0.01). Seizures occurred in 25/34 (74%) with LPD, 7/11 (64%) with LRDA, 9/14 (64%) with BIPD, 27/43 (63%) with GPD, 1/2 (50%) with MFPD, and 9/34 (26%) with GRDA. Electrographic seizure occurrence was associated with GPD (OR 6.35; p< 0.01; higher with plus features, higher frequency, or fluctuating modifiers), LPD (OR 10.45; p< 0.01; higher with plus features, higher frequency, greater prevalence, or greater duration), BIPD (OR 6.77; p< 0.01; higher with plus features, higher frequency, greater duration, or evolution), and LRDA (OR 6.58; p< 0.01; higher with plus features, higher frequency, greater prevalence, or greater duration). GRDA was not significantly associated with seizures (OR 1.34; p=0.44). All the IIC patterns were associated with a greater risk of seizures (OR 6.83-8.81; p< 0.01).
Neurophysiology