Abstracts

Rationale: Children undergoing surgical treatment of congenital heart disease are at risk of neurological complications. Studies show the incidence of subclinical seizures after heart surgery in children ranges from 2% to 25%. Although continuous electroencephalographic (cEEG) monitoring is a valuable tool for real time detection of CNS dysfunction; its use is not widespread. This retrospective study was undertaken to determine the utility of continuous EEG (cEEG) monitoring in a cohort of pediatric patients undergoing cardiopulmonary bypass surgery for congenital heart disease to: 1. Determine the prevalence of EEG abnormalities (seizures, sharp waves, slowing) 2. Observe if cEEG findings resulted in a clinical interventionMethods: (IRB 11-105) From a database of all pediatric (<18 year) bedside cEEG studies (n= 478) between Jan 2009 and Dec 2010, 26 patients were identified who underwent cEEG studies in the perioperative period (16 had pre and post operative studies) for surgical correction of congenital heart disease. Demographic, clinical, imaging and electrophysiologic data was collected. Institutional IRB approval was obtained.Results: 44 cEEG studies were performed in 26 patients. 19 studies were done pre operatively (median EEG recording 32 hours) for screening (18/19), and/or events suspicious for seizures (5/19). 68% (13/19) studies were abnormal due to findings supporting one or more of the following: encephalopathy (11), sharp waves (4) or focal slowing (2); no EEG seizures were detected. EEG led to initiating AED in one patient. 25 studies were done post operatively (median EEG recording 55 hours) for screening (23/25) and/or presence of clinical seizures (2/25). EEG seizures were seen in 16% (4/25); overall 84% (21/25) studies were abnormal due to presence of one or more of the following: encephalopathy (20), sharp waves (6) or focal slowing (6). Two patients only showed EEG seizures; MRI showed focal abnormalities in 3/5 patients who underwent imaging and had focal slowing on EEG. AEDs were adjusted in three.Conclusions: This retrospective cEEG series in patients undergoing cardiopulmonary bypass surgery for congenital heart disease showed that EEG contributes valuable information and may be a useful tool in neurologic monitoring of this subset of patients.