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J Pediatr Intensive Care 2017; 06(02): 136-141
DOI: 10.1055/s-0036-1587328
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Guiding Antiepileptic Therapy in a Pediatric Patient with Severe Meningoencephalitis and Decompressive Craniectomy with the Use of Amplitude-Integrated Electroencephalography

Karl F. Schettler
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
,
Beatrice Heineking
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
,
Silvia Fernandez-Rodriguez
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
,
Angelika Pilger
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
,
Nikolaus Alexander Haas
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
› Author Affiliations
Further Information

Publication History

03 April 2016

01 July 2016

Publication Date:
08 August 2016 (online)

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Abstract

Introduction Amplitude-integrated electroencephalography (aEEG) is one of the most widely used neuromonitoring tools in neonatology today. However, little is known about its clinical indications and potential benefits in pediatric intensive care patients. Based on limited experience, its impact on therapeutic decision-making in this patient population is unclear.

Case Description We report the case of a 16-year-old boy who, after a pansinusitis, developed a severe meningoencephalitis and intracranial empyema with increased intracranial pressure that required drainage and decompressive craniectomy. He subsequently developed status epilepticus despite a combination of various anticonvulsants. Only after the initialization of an aEEG, we were able to adequately diagnose and continuously monitor his seizure activity and titrate the effect of the antiepileptic drugs. During his hospital stay, we were able to clearly monitor and guide our therapy by accurately identifying the termination of status epilepticus and the recurrence of seizures.

Discussion With the help of aEEG, it was easy to identify the nonconvulsive status epilepticus (NCSE) and the ongoing seizure activity in this teenage patient. NCSE is a clinical problem with an effect on the outcome of the patient and is often underdiagnosed. AEEG enabled a rapid detection and management of seizure activity and thereby reduced the overall seizure burden, which was associated with better neurologic outcome.

Keywords

amplitude-integrated EEG - antiepileptic therapy - meningoencephalitis - neuromonitoring - nonconvulsive status epilepticus
 

  • References

  • 1 Maynard D, Prior PF, Scott DF. Device for continuous monitoring of cerebral activity in resuscitated patients. BMJ 1969; 4 (5682): 545-546
    PubMedGoogle Scholar
  • 2 Toet MC, Lemmers PMA. Brain monitoring in neonates. Early Hum Dev 2009; 85 (2) 77-84
    CrossrefPubMedGoogle Scholar
  • 3 Yin X-J, Wei W, Han T , et al. Value of amplitude-integrated electroencephalograph in early diagnosis and prognosis prediction of neonatal hypoxic-ischemic encephalopathy. Int J Clin Exp Med 2014; 7 (4) 1099-1104
    PubMedGoogle Scholar
  • 4 Zhang D, Ding H, Liu L , et al. The prognostic value of amplitude-integrated eeg in full-term neonates with seizures. PLoS ONE 2013; 8 (11) e78960 . Doi: 10.1371/journal.pone.0078960
    CrossrefPubMedGoogle Scholar
  • 5 Sohn JA, Kim HS, Lee EH , et al. Developmental change of amplitude-integrated electroencephalographic activity in preterm infants with intraventricular hemorrhage. Early Hum Dev 2013; 89 (12) 961-966
    CrossrefPubMedGoogle Scholar
  • 6 Olischar M, Klebermass K, Kuhle S, Hulek M, Messerschmidt A, Weninger M. Progressive posthemorrhagic hydrocephalus leads to changes of amplitude-integrated EEG activity in preterm infants. Childs Nerv Syst 2004; 20 (1) 41-45
    CrossrefPubMedGoogle Scholar
  • 7 Olischar M, Shany E, Aygün C , et al. Amplitude-integrated electroencephalography in newborns with inborn errors of metabolism. Neonatology 2012; 102 (3) 203-211
    CrossrefPubMedGoogle Scholar
  • 8 Song J, Xu F, Wang L , et al. Early amplitude-integrated electroencephalography predicts brain injury and neurological outcome in very preterm infants. Sci Rep 2015; 5: 13810 . Doi: 10.1038/srep13810
    CrossrefPubMedGoogle Scholar
  • 9 Igarashi A, Okumura A, Komatsu M , et al. Amplitude-integrated EEG revealed nonconvulsive status epilepticus in children with non-accidental head injury. Eur J Paediatr Neurol 2014; 18 (6) 806-810
    CrossrefPubMedGoogle Scholar
  • 10 Mittnacht AJ, Rodriguez-Diaz C. Multimodal neuromonitoring in pediatric cardiac anesthesia. Ann Card Anaesth 2014; 17 (1) 25-32
    CrossrefPubMedGoogle Scholar
  • 11 Galgano MA, Tovar-Spinoza Z. Multimodality neuromonitoring in pediatric neurocritical care: review of the current resources. Cureus 2015; 7 (11) e385 . Doi: 10.7759/cureus.385
    PubMedGoogle Scholar
  • 12 Glass HC, Wusthoff CJ, Shellhaas RA. Amplitude integrated EEG: the child neurologist's perspective. J Child Neurol 2013; 28 (10) 1342-1350
    Google Scholar
  • 13 Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M ; Neurointensive Care Section of the European Society of Intensive Care Medicine. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med 2013; 39 (8) 1337-1351
    CrossrefPubMedGoogle Scholar
  • 14 Walker M, Cross H, Smith S , et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord 2005; 7 (3) 253-296
    PubMedGoogle Scholar
  • 15 Korff CM, Nordli Jr DR. Diagnosis and management of nonconvulsive status epilepticus in children. Nat Clin Pract Neurol 2007; 3 (9) 505-516
    PubMedGoogle Scholar
  • 16 Mallick AA, Ganesan V, Kirkham FJ , et al. Outcome and recurrence one year after paediatric arterial ischaemic stroke in a population-based cohort. Ann Neurol 2016; DOI: 10.1002/ana.24626.
    PubMedGoogle Scholar
  • 17 Lingappa L, Konanki R, Patel R, Vooturi S, Jayalakshmi S. Clinical profile and outcome of refractory convulsive status epilepticus in older children from a developing country. Seizure 2016; 36: 31-35
    CrossrefPubMedGoogle Scholar
  • 18 Kim YS, Jung KH, Lee ST , et al. Prognostic value of initial standard EEG and MRI in patients with herpes simplex encephalitis. J Clin Neurol 2016; 12 (2) 224-229
    CrossrefPubMedGoogle Scholar
  • 19 Singh A, Lomash A, Pandey S, Kapoor S. Clinical, biochemical and outcome profile of biotinidase deficient patients from tertiary centre in Northern India. J Clin Diagn Res 2015; 9 (12) SC08-SC10
    PubMedGoogle Scholar
  • 20 Pardo AC. Impact of seizure burden in hypoxic ischemic encephalopathy. Pediatr Neurol Briefs 2015; 29 (10) 74 . Doi: 10.15844/pedneurbriefs-29-10-1
    CrossrefPubMedGoogle Scholar
  • 21 Hocker SE, Britton JW, Mandrekar JN, Wijdicks EF, Rabinstein AA. Predictors of outcome in refractory status epilepticus. JAMA Neurol 2013; 70 (1) 72-77
    CrossrefPubMedGoogle Scholar
  • 22 Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 2001; 57 (6) 1036-1042
    PubMedGoogle Scholar
  • 23 Hyllienmark L, Amark P. Continuous EEG monitoring in a paediatric intensive care unit. Eur J Paediatr Neurol 2007; 11 (2) 70-75
    PubMedGoogle Scholar
  • 24 Friberg H, Westhall E, Rosén I, Rundgren M, Nielsen N, Cronberg T. Clinical review: continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest. Crit Care 2013; 17 (4) 233 . Doi: 10.1186/cc12699
    CrossrefPubMedGoogle Scholar
  • 25 Dericioglu N, Yetim E, Bas DF , et al. Non-expert use of quantitative EEG displays for seizure identification in the adult neuro-intensive care unit. Epilepsy Res 2015; 109: 48-56
    CrossrefPubMedGoogle Scholar
  • 26 Karakis I, Montouris GD, Otis JA , et al. A quick and reliable EEG montage for the detection of seizures in the critical care setting. J Clin Neurophysiol 2010; 27 (2) 100-105
    CrossrefPubMedGoogle Scholar
  • 27 Young GB, Sharpe MD, Savard M, Al Thenayan E, Norton L, Davies-Schinkel C. Seizure detection with a commercially available bedside EEG monitor and the subhairline montage. Neurocrit Care 2009; 11 (3) 411-416
    CrossrefPubMedGoogle Scholar