ROLE OF CONTINUOUS EEG MONITORING IN PEDIATRIC INTENSIVE CARE UNIT

Objectives: Continuous electroencephalographic monitoring (CEEG) is frequently performed in tertiary care pediatric intensive care units (PICU) for wide variety of indications. There is little data regarding the usefulness of CEEG monitoring in critically ill pediatric patients. In this study we report the diagnostic utility of CEEG in patients requiring long-term monitoring (LTM). Methods: We retrospectively reviewed CEEG monitoring data of 96 patients admitted to a tertiary care PICU over a 4 year period (2000–2004). All patients had 16 Channel CEEG monitoring (XLTEK) utilizing the 10–20 system. Sixty-Eight patients had Video-EEG monitoring, and 28 patients had only EEG monitoring. Clinical histories were reviewed to determine indications for CEEG. CEEG findings were categorized into two major categories, a) epileptic and b) non-epileptic.

Results: Mean age at the time of CEEG monitoring was 8.6 years (range 11 days to 18 years). Mean duration of CEEG monitoring was 2.3 days (range 1–9 days). The indications for CEEG monitoring was, encephalopathy of undetermined etiology N=54 patients (57%), encephalopathy with seizures N=28 (29%), other behavior spells N=14 (13%). CEEG was abnormal in 91 patients (95%). Of these 91 patients, 43(47%) had an epileptic EEG, and 53 (58%) patients had a non-epileptic EEG. Of the patients with an epileptic EEG 13 (30%) patients had electroencephalographic pattern of nonconvulsive seizures. The two most common nonepileptic patterns were diffuse cerebral dysfunction N=39 (73%), severe attenuation N=9 (17%). Conclusion: Continuous EEG monitoring is an essential neurophysiologic modality in the diagnosis and management of critically ill pediatric patients. Identification of specific EEG patterns in this population has prognostic significance.