PERIODIC LATERALIZED EPILEPTIFORM DISCHARGES (PLEDs) IN PEDIATRIC EEG RECORDINGS
Abstract number :
1.160
Submission category :
Year :
2003
Submission ID :
3690
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Katherine M. Wambera, Mary B. Connolly, Peter K.H. Wong Pediatric Neurology, British Columbia CHildren[apos]s Hospital, Vancouver, BC, Canada; Clinical Neurophysiology, British Columbia Children[apos]s Hospital, Vancouver, BC, Canada
To describe the clinical, neuroimaging, EEG features and neurologic outcome in pediatric patients, outside of the neonatal period, with PLEDs on EEG.
Children were identified from the EEG database in the Department of Clinical Neurophysiology at British Columbia[rsquo]s Children[rsquo]s Hospital. Clinical records, neuroimaging, EEG data and outcome were reviewed.
From July 1st 1993 to Dec 31st 2002, 24,535 EEGs were performed. PLEDs were seen in 132 EEGs (0.5%). 113 of these recordings were performed in 74 children, 1 month of age or older (n = 42 male, n = 32 female). At the time of detection of PLEDs, the mean age of the patients was 4.3 years; range 6 weeks [ndash] 19 years. 31 patients had pre-existing developmental delay or learning problems. 23 patients had a pre-existing epilepsy; congenital brain abnormality or neurocutaneous syndrome n = 12, remote infarction n = 4, metabolic disorders n = 3, chromosomal disorders n = 2 and Dravet syndrome n = 2. 91% of patients presented with seizures, 80% had altered level of consciousness and 53% required ventilation. On examination 30% were hemiparetic and 10% had brainstem signs. Acute neuroimaging was obtained in 52 patients (CT only, n = 28, CT + MRI n = 20, MRI only n = 4). Neuroimaging demonstrated focal or diffuse cerebral edema (n = 58), and congenital brain abnormalities (n = 9).Underlying etiology was infectious or postinfectious encephalopathy (n = 29), a known seizure disorder with or without an acute exacerbation (n = 23), hypoxic ischemic encephalopathy (n = 9), cerebral infarction (n = 6) and tumour (n = 3). PLEDs were focal in 70 and multifocal in 43 EEG recordings. Focal neuroimaging changes were concordant with location of PLEDs in 14/16 (87%) and discordant in 2/16 (13%). Clinical and/or electrographic seizures (n = 37) were also seen during the EEGs. 18 patients had PLEDs detected on serial EEGs. The location of the PLEDs remained constant in each recording in 10 patients and varied in 8. Outcome data are available for 55 patients. Death occurred in 16 patients (21%) and 3 survivors were lost to follow-up. In 55 survivors, where follow-up is available, microcephaly was seen in 6, moderate to severe mental retardation in 21, cerebral palsy in 30 and epilepsy in 41.
PLEDs are rare in pediatric EEGs. They are associated with abnormal neuroimaging. The prognosis is poor with significant mortality and moderate to severe mental retardation, cerebral palsy and epilepsy in many survivors.