Characterization of aEEG During Sleep and Wakefulness in Healthy Children

Abstract

IntroductionInterpretation of amplitude-integrated EEG (aEEG) is hindered by lacking knowledge on physiological background patterns in children. The aim of this study was to find out whether aEEG differs between wakefulness and sleep in children.MethodsForty continuous full-channel EEGs (cEEG) recorded during the afternoon and overnight in patients <18 years of age without pathologies or only solitary interictal epileptiform discharges were converted into aEEGs. Upper and lower amplitudes of the C3–C4, P3–P4, C3–P3, C4–P4, and Fp1–Fp2 channels were measured during wakefulness and sleep by two investigators and bandwidths (BW) calculated. Sleep states were assessed according to the American Academy of Sleep Medicine. Median and interquartile ranges (IQR) were calculated to compare the values of amplitudes and bandwidth between wakefulness and sleep.ResultsMedian age was 9.9 years (IQR 6.1–14.7). All patients displayed continuous background patterns. Amplitudes and BW differed between wakefulness and sleep with median amplitude values of the C3–C4 channel 35 μV (IQR: 27–49) for the upper and 13 μV (10–19) for the lower amplitude. The BW was 29 μV (21–34). During sleep, episodes with high amplitudes [upper: 99 μV (71–125), lower: 35 μV (25–44), BW 63 μV (44–81)] corresponded to sleep states N2–N3. High amplitude-sections were interrupted by low amplitude-sections, which became the longer toward the morning [upper amplitude: 39 μV (30–51), lower: 16 μV (11–20), BW 23 μV (19–31)]. Low amplitude-sections were associated with sleep states REM, N1, and N2. With increasing age, amplitudes and bandwidths declined.ConclusionaEEGs in non-critically ill children displayed a wide range of amplitudes and bandwidths. Amplitudes were low during wakefulness and light sleep and high during deep sleep. Interpretation of pediatric aEEG background patterns must take into account the state of wakefulness in in clinical practice and research.

Prophylactic Low-Dose Paracetamol Administration for Ductal Closure and Amplitude-Integrated Electroencephalography in Preterm Infants

“…The absence of sleep-wake cycles coheres with brain lesions, cerebral hemorrhages, higher CRIB scores and mortality rates in preterm infants ( 27 , 28 ). A correlation between sleep-wake cycles and neurodevelopmental outcome has been shown previously ( 29 , 30 ). We found higher numbers of sleep-wake cycles in the paracetamol group as compared to the control group in the first 4 weeks of life in the overall cohort, and in the first 3 weeks of life in the subgroup of extremely preterm infants.…”

Reference values for amplitude-integrated EEGs in children from 1 month to 17 years of age

“…Many children undergoing aEEG monitoring in the PICU receive sedatives, suffer from intracranial pathologies or fall asleep during part of the recording. We previously showed that amplitudes differ between deep and light sleep in healthy children (13, 29), making the establishment of reference values during sleep substantially more difficult. For this reason, we focused on awake aEEGs as a first step toward a systematic aEEG assessment.…”

“…aEEG has proven useful for the assessment of seizures and guiding antiepileptic treatment in critically ill children (3)(4)(5)(6)(7). There is incipient but growing evidence that physiological and pathological conditions induce changes in the background pattern, e.g., sleep states, sedation, cardiac arrest, central nervous system infections, and inflammation (4,5,(8)(9)(10)(11)(12)(13). Normalization of background patterns according to a neonatal classification (14) has been described to be predictive of outcome in neonates, children, and adults after hypoxic events (9,(15)(16)(17).…”

The impact of age and electrode position on amplitude-integrated EEGs in children from 1 month to 17 years of age

“…SG and NB measured the upper and lower amplitude borders manually with the integrated tool for amplitude measurement as previously described ( 13 ) ( Figure 1B ).…”

“…As an alternative, aEEG has proven useful for the assessment of seizures and guiding antiepileptic treatment in critically ill children, making it the preferred tool by pediatric intensive care givers ( 1 , 3 – 7 ). There is incipient but growing evidence that physiological and pathological conditions induce changes in the aEEG background pattern, e.g., sleep states, sedation, cardiac arrest, central nervous system infections, and inflammation ( 4 , 5 , 8 – 13 ). Normalization of background patterns according to a neonatal classification ( 14 ) is associated with outcome in neonates, children, and adults after hypoxic events ( 9 , 15 – 17 ).…”