Abstract TMP99: Pediatric Intracerebral Hemorrhage: Acute Symptomatic Seizures and Epilepsy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lauren A Beslow ◽  
Nicholas S Abend ◽  
Melissa C Gindville ◽  
Rachel A Bastian ◽  
Daniel J Licht ◽  
...  
Keyword(s):  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Tertiary Care ◽  
Rank Test ◽  
Eeg Monitoring ◽  
Free Survival ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

Background and Objectives: We aimed to define the incidence of acute symptomatic seizures and of remote symptomatic seizures and epilepsy after spontaneous pediatric intracerebral hemorrhage (ICH). Methods: Pediatric patients with spontaneous ICH presenting between 2007 and 2012 at three tertiary care centers were prospectively identified. Acute symptomatic seizures were defined as seizures occurring from presentation to 7 days after ICH. Survival analysis was used to assess development of a first remote symptomatic seizure and epilepsy (2 or more unprovoked seizures >7 days after ICH). Log-rank tests were used to examine putative risk factors for development of remote symptomatic seizures and epilepsy. Results: Seventy-three pediatric subjects with spontaneous ICH were identified, including 20 perinatal (≥37 weeks gestation to 28 days) and 53 childhood subjects (>28 days to <18 years). Acute symptomatic seizures occurred in 12 (60%) perinatal and 23 (43%) childhood subjects, p=.29, Fisher’s exact. Median age of childhood subjects with acute symptomatic seizures was younger than those without (2.2 versus 10.8 years, p=.006, rank-sum). Electrographic-only seizures occurred in 28% of 32 subjects who had continuous EEG monitoring. Follow-up was not different between perinatal and childhood subjects (median 371 versus 340 days), p=.68, rank-sum. One and two-year remote symptomatic seizure-free survival were 82% (95% CI 68-91%) and 67% (95% CI 46-82%). One and two-year epilepsy-free survival were 96% (95% CI 83-99%) and 87% (95% CI 65-95%). Elevated intracranial pressure (ICP) requiring urgent intervention was a risk factor for remote symptomatic seizures and epilepsy (p=.024 and p=.037, log-rank test). Conclusions: Acute symptomatic seizures are common in both perinatal and childhood ICH. Continuous EEG monitoring may identify electrographic-only seizures in some subjects. By two-years after ICH it is estimated that about one-third of patients will have a single remote symptomatic seizures and that about 13% will develop epilepsy. Elevated ICP requiring intervention is a risk factor for remote symptomatic seizures and epilepsy.

scholarly journals The yield of continuous EEG monitoring in the intensive care unit at a tertiary care hospital in Saudi Arabia: A retrospective study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 663
Author(s):  
Haythum O. Tayeb
Keyword(s):  
Intensive Care Unit ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Healthcare System ◽  
Tertiary Care ◽  
Convulsive Status Epilepticus ◽  
Care Hospital ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Background: The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has spread over the past decade. Building an effective ICU CEEG program demands adequate EEG equipment and human resources. This may not be available in developing healthcare systems. This study sought to shed light on the real-life utility of CEEG at a tertiary healthcare center in the developing healthcare system of Saudi Arabia,. Methods: This is a retrospective review of CEEG findings, along with mortality and duration of hospitalization of patients who had CEEG during a 12-month period at the adult ICU at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Results: A total of 202 CEEG records were identified. A total of 52 patients had non-convulsive seizures (NCS); 10 clearly fulfilled criteria for non-convulsive status epilepticus. There were 120 patients that had clinical seizures upon presentation. Among them, 36 (30%) had NCS on EEG. The proportion of patients who were deceased at 60 days was higher in patients with NCS than those who didn’t have NCS (42% vs 27%, χ2 = 4.4, df=2, p=0.03). The proportion with long hospitalization was higher in those who had periodic or rhythmic CEEG patterns (33.3% vs 28.1%, χ2 = 8.02, df=2, p=0.02) but there was no significant relationship with mortality at 60 days. Conclusion: This study demonstrates a real-world experience from a tertiary care center in Saudi Arabia, a developing healthcare system. Findings are consistent with prior experience that ICU CEEG is effective in detecting potentially harmful subclinical patterns, supporting the need to develop ICU CEEG programs. However, the incurred excesses in morbidity and mortality associated with CEEG patterns were relatively modest. Further studies are needed to delineate how the practice of CEEG may be developed to provide meaningful data to clinicians with regards to patient outcomes.

scholarly journals The yield of continuous EEG monitoring in the intensive care unit at a tertiary care hospital in Saudi Arabia: A retrospective study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 663
Author(s):  
Haythum O. Tayeb
Keyword(s):  
Intensive Care Unit ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Healthcare System ◽  
Tertiary Care ◽  
Convulsive Status Epilepticus ◽  
Care Hospital ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Background: The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has been spreading over the past decade. Building an effective ICU CEEG program with sufficient quality demands adequate EEG equipment and significant human resources. While this is available in large tertiary care centers where the practice of CEEG has developed, it may not be available in developing healthcare systems. This study sought to provide data generated from a CEEG program in the adult ICU at a tertiary healthcare center in Saudi Arabia, shedding light on the real-life utility of CEEG in a developing healthcare system. Methods: This is a retrospective review of CEEG findings, along with mortality and duration of hospitalization of patients who had CEEG during a 12-month period at the adult ICU at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Results: A total of 202 CEEG records were identified. A total of 52 patients had non-convulsive seizures (NCS); 10 clearly fulfilled criteria for non-convulsive status epilepticus. There were 120 patients that had clinical seizures upon presentation. Among them, 36 (30%) had NCS on EEG. The proportion of patients who were deceased at 60 days was higher in patients who had NCS (42%) than those who didn’t (26%, χ2  (2, n=200)= 4.4, p=0.03). The duration of hospital stay was longer for those who had periodic or rhythmic CEEG patterns (χ2 (2, n=200)= 7.6, p=0.02) but there was no significant relationship with mortality at 60 days. Conclusion: This study demonstrates a real-world experience from a tertiary care center in Saudi Arabia, a developing healthcare system. Findings are consistent with prior experience with ICU CEEG, demonstrating that finding ictal, rhythmic or periodic patterns is associated with morbidity and mortality. Further studies are needed to demonstrate how the practice of CEEG may alter patient outcomes.

scholarly journals The yield of continuous EEG monitoring in the intensive care unit at a tertiary care hospital in Saudi Arabia: A retrospective study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 663 ◽  
Author(s):  
Haythum O. Tayeb
Keyword(s):  
Intensive Care Unit ◽  
Saudi Arabia ◽  
Intensive Care ◽  
Retrospective Study ◽  
Healthcare System ◽  
Tertiary Care ◽  
Healthcare Systems ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

Background: The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has spread over the past decade. Building an effective ICU CEEG program demands adequate EEG equipment and human resources. This may not be available in developing healthcare systems. This study sought to shed light on the real-life utility of CEEG at a tertiary healthcare center in the developing healthcare system of Saudi Arabia. Methods: This is a retrospective review of CEEG findings, along with mortality and duration of hospitalization of patients who had CEEG during a 12-month period at the adult ICU at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Results: A total of 202 CEEG records were identified. A total of 52 records showed non-convulsive seizures (NCS); 10 clearly fulfilled criteria for non-convulsive status epilepticus. There were 120 patients that had clinical seizures upon presentation. Among them, 36 (30%) had NCS on EEG. The proportion of patients who were deceased at 60 days was higher in patients with NCS than those who didn’t have NCS (42% vs 27%, χ 2 = 4.4, df=2, p=0.03). There was no statistically significant association between having rhythmic or periodic patterns without NCS and mortality at 60 days or length of hospital stay. Conclusion: This retrospective study demonstrates a real-world experience from a tertiary care center in Saudi Arabia, a developing healthcare system. ICU CEEG was found to be effective in detecting potentially harmful subclinical patterns, supporting the need to develop ICU CEEG programs. However, the incurred excesses in morbidity and mortality associated with CEEG patterns were relatively modest. Further studies are needed to delineate how the practice of CEEG may be developed in similar healthcare systems to provide meaningful data to clinicians with regards to patient outcomes.

scholarly journals Seizure Control in Neonates Undergoing Screening vs Confirmatory EEG Monitoring

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012293
Author(s):  
Courtney J. Wusthoff ◽  
Vandana Sundaram ◽  
Nicholas S. Abend ◽  
Shavonne L. Massey ◽  
Monica E. Lemmon ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Treatment Success ◽  
Neonatal Seizure ◽  
Eeg Monitoring ◽  
Class Iii ◽  
Acute Seizures ◽  
Clinical Events ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Symptomatic Seizures

Objective:To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures.Methods:We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. We compared two cEEG approaches: (1) Screening cEEG, initiated for indications of encephalopathy or paralysis without suspected clinical seizures, and (2) Confirmatory cEEG, initiated for the indication of clinical events suspicious for seizures, either alone or in addition to other indications. The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of anti-seizure medicine. Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment.Results:Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. Neonates with screening cEEG had a higher proportion of successful initial seizure treatment than neonates with confirmatory cEEG (39% versus 18%; p<0.0001). After adjusting for covariates, there remained a greater odds ratio (OR) for successful initial seizure treatment in the screening vs. confirmatory cEEG groups (adjusted OR 2.44, 95% CI: 1.45-4.11, p=0.0008).Conclusions:These findings provide evidence from a large, contemporary cohort of neonates that a screening cEEG approach may improve odds of successful treatment of acute seizures.Classification of Evidence:This study provides Class III evidence that for neonates a screening CEEG approach, compared to a confirmatory EEG approach, increases the probability of successful treatment of acute seizures

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

Predictive Value of Early Continuous Electroencephalogram Monitoring in Ventilated Preterm Infants With Intraventricular Hemorrhage

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 337-343
Author(s):  
J. Connell ◽  
L. de Vries ◽  
R. Oozeer ◽  
R. Regev ◽  
L. M.S. Dubowitz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Eeg Monitoring ◽  
Mechanically Ventilated ◽  
Functional Correlation ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
A Prospective Study ◽  
Ultrasound Evidence ◽  
Significant Data

The contribution of early continuous fourchannel EEG monitoring to the evaluation of intraventricular hemorrhage in acutely ill preterm infants mechanically ventilated for acute respiratory distress was assessed in a prospective study of 54 infants of less than 34 weeks' gestation. Early abnormal EEG results correlated significantly with later outcome. They often preceded ultrasound evidence of hemorrhage and provided prognostically significant functional correlation with the grade of hemorrhage. Continuous EEG monitoring allows collection of significant data with minimal interference and could contribute to clinical management of high-risk preterm infants.

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