Feasibility and Usefulness of Rapid 2 Channel EEG Monitoring for Acute CNS Disorders in the Pediatric Emergency Ward

Aims: The aim of this study is to evaluate feasibility and usefulness of rapid 2 channel EEG monitoring in the management of patients with acute encephalopathy admitted to a pediatric emergency ward.

Methods: Standard monitoring of vital parameters was supplemented by 2-channel-recording of frontoparietal EEG activity in all the patients with manifest or suspected acute encephalopathy admitted to the emergency ward of Children's Hospital Lucerne/CH. Nursing staff was trained in applying EEG electrodes and in displaying the monitor settings of the signal for patients in all age categories; emergency physicians were trained in interpreting relevant findings (normal/abnormal background activity, ongoing epileptic discharges, relevant side difference, and artifacts). Consultant neuropediatricians helped assessing the patient and the EEG either directly if in-house or indirectly via smartphone video of patients symptoms and monitor display of EEG-signal. Impact of this information for further patient management was assessed prospectively.

Results: Within a 9 months' period, emergency EEG monitoring was applied to 16 patients with acute CNS disorders. The nurse staff soon became familiar with the placing of electrodes. An interpretable EEG signal could be achieved in a few minutes in every patient and proved to be very helpful in cases with suspected convulsive disorders. It was especially diagnostic in infants with occipital lobe seizure symptoms, in whom either ongoing subclinical epileptic discharges could be detected or abnormal body posturing could be classified as nonepileptic and anticonvulsive overtreatment could be avoided. A 2-channel-EEG gave sufficient information about cortical activity improving management of patients' cases with other acute CNS disorders.

Conclusion: Integrating 2-channel-EEG-monitoring in the pediatric emergency setting is feasible and proved to be very helpful for the management of acute encephalopathies. It turned out to be a suitable alternative to standard EEG recording and saved time and effort.