Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II

Herman, Susan T.; Abend, Nicholas S.; Bleck, Thomas P.; Chapman, Kevin; Drislane, Frank W.; Emerson, Ronald G.; Gerard, Elizabeth E.; Hahn, Cecil D.; Husain, Aatif M.; Kaplan, Peter W.; LaRoche, Suzette M.; Nuwer, Marc R.; Quigg, Mark; Riviello, James J.; Schmitt, Sarah; Simmons, Liberty A.; Tsuchida, Tammy N.; Hirsch, Lawrence J.

doi:10.1097/wnp.0000000000000165

Cited by 199 publications

(168 citation statements)

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“…[1–14,26,34–37] Since identifying and managing ES and ESE could reduce secondary brain injury and thereby improve patient outcomes, cEEG use in critically ill children is increasing,[19] guidelines mandate cEEG use in many critically ill patients to identify and manage ESE,[20–22] and anti-seizure medications are generally administered when ES or ESE are identified. [18,28]…”

Section: Discussionmentioning

confidence: 99%

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Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Abend

Wagenman

Blake

et al. 2015

Epilepsy & Behavior

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Purpose Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in children in the pediatric intensive care unit (PICU) with acute neurologic conditions, and ESE is associated with worse functional and quality of life outcomes. As an exploratory study, we aimed to determine if ESE was associated with worse outcomes using more detailed neurobehavioral measures. Methods Three hundred children with an acute neurologic condition and altered mental status underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We obtained follow-up data from subjects who were neurodevelopmentally normal prior to PICU admission. We evaluated for associations between ESE and adaptive behavior (Adaptive Behavior Assessment System-II, ABAS-II), behavioral and emotional problems (Child Behavior Checklist, CBCL), and executive function (Behavior Rating Inventory of Executive Function, BRIEF) using linear regression analyses. A p-value of <0.05 was considered significant. Results 137 of 300 subjects were neurodevelopmentally normal prior to PICU admission. We obtained follow-up data from 36 subjects for CBCL, 32 subjects for ABAS, and 20 subjects for BRIEF. The median duration from admission to follow-up was 2.6 years (IQR 1.2–3.8). There were no differences in the acute care variables (age, sex, mental status category, intubation status, paralysis status, acute neurologic diagnosis category, seizure category, EEG background category, or short-term outcome) between subjects with and without follow-up data for any of the outcome measures. On univariate analysis, significant differences were not identified for CBCL total problem (ES coefficient −4.1, p=0.48; ESE coefficient 8.9, p=0.13) or BRIEF global executive function scores (ES coefficient 2.1, p=0.78; ESE coefficient 14.1, p=0.06), although there were trends towards worse scores in subjects with ESE. On univariate analysis, ES was not associated with worse scores (coefficient −21.5, p=0.051) while ESE (coefficient −29.7, p=0.013) was associated with worse ABAS adaptive behavioral global composite scores. On multivariate analysis, when compared to subjects with no seizures, both ES (coefficient −28, p=0.014) and ESE (coefficient −36, p=0.003) were associated with worse adaptive behavioral global composite scores. Discussion Among previously normal children with acute neurologic disorders, ES and ESE were associated worse adaptive behavior and trends toward worse behavioral-emotional and executive problems. This was a small exploratory study, and the impact of ES and ESE on these neurobehavioral measures may be clarified by subsequent larger studies.

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Section: Discussionmentioning

confidence: 99%

“…[17] In the context of these data, physicians report rapidly increasing cEEG use in PICUs[18,19] and recent guidelines advocate for cEEG in many critically ill children with acute encephalopathy. [20–22]…”

Section: Introductionmentioning

confidence: 99%

Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Abend

Wagenman

Blake

et al. 2015

Epilepsy & Behavior

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“…The statement recognizes that some techniques are only available in specialized centers and aims to lay out an “idealized” system useful for program development and improvement. [29,30] The main indication for continuous EEG monitoring is to identify non-convulsive seizures or status epilepticus, and several specific cohorts of patients are described. First, continuous EEG monitoring is recommended in patients with persistently abnormal mental status following generalized convulsive status epilepticus or other clinically-evident seizures.…”

Section: Electrographic Seizure and Status Epilepticus Incidencementioning

confidence: 99%

Electrographic status epilepticus in children with critical illness: Epidemiology and outcome

Abend

2015

Epilepsy & Behavior

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“…The impedance of the dry sensors to the skin was 5 to 40 times larger than what is typically the maximum acceptable for wet electrodes (Herman et al, 2015). This observation confirms that the design of the dry sensors used in this study does allow acquisition of high-quality signals with less electromagnetic interference, despite high impedance to the skin (Matthews et al, 2006, 2007).…”

Section: Discussionmentioning

confidence: 96%

“…This is a significant delay since therapy can be less effective within hours of the start of a seizure (Castro Conde et al, 2005; Goodkin et al, 2005) and seizures after hypoxia ischemia can start as early as 6 hours of life (Wusthoff et al, 2011). While subdermal needle electrodes can be applied more quickly than wet scalp electrodes, they have inferior recording characteristics and are not recommended for prolonged recordings (Herman et al, 2015). Finally, there is risk of skin injury and infection from skin abrasion and application of conductive paste, which is especially problematic for the fragile skin of premature and critically-ill term neonates.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Dry Sensors for Neonatal EEG Recordings

Fridman

Cordeiro

Rais-Bahrami

et al. 2016

Journal of Clinical Neurophysiology

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Introduction Neonatal seizures are a common neurologic diagnosis in Neonatal Intensive Care Units (NICUs), occurring in approximately 14,000 newborns annually in the US. While the only reliable means of detecting and treating neonatal seizures is with an EEG recording, many neonates do not get an EEG or experience delays in getting them. Barriers to obtaining neonatal EEGs include: 1) lack of skilled EEG technologists to apply conventional wet electrodes to delicate neonatal skin, 2) poor signal quality due to improper skin preparation and artifact, 3) extensive time needed to apply electrodes. Dry sensors have the potential to overcome these obstacles but have not been previously evaluated on neonates. Methods Sequential and simultaneous recordings with wet and dry sensors were performed for one hour on 27 neonates from 35-42.5 weeks postmenstrual age. Recordings were analyzed for correlation and amplitude, and were reviewed by neurophysiologists. Performance of dry sensors on simulated vernix was examined. Results Analysis of dry and wet signals showed good time-domain correlation (reaching >0.8) given the non-superimposed sensor positions, and similar power spectral density curves. Neurophysiologist reviews showed no statistically significant difference between dry and wet data on most clinically-relevant EEG background and seizure patterns. There was no skin injury after 1 hr of dry sensor recordings. In contrast to wet electrodes, impedance and electrical artifact of dry sensors were largely unaffected by simulated vernix. Conclusions Dry sensors evaluated in this study have the potential to provide high-quality, timely EEG recordings on neonates with less risk of skin injury.

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Consensus Statement on Continuous EEG in Critically Ill Adults and Children, Part II

Cited by 199 publications

References 50 publications

Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Electrographic status epilepticus in children with critical illness: Epidemiology and outcome

Evaluation of Dry Sensors for Neonatal EEG Recordings

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