Uluç Yiş, Müge Ayanoğlu, Gazi Arslan, Ayşe İpek Polat, Ayşe Semra Hız Kurul

Çocuk yoğun bakım ünitesinde izlenen olguların elektroensefalografi sonuçlarının geriye dönük olarak değerlendirilmesi

Amaç: Çocuk yoğun bakım ünitesinde izlenen ve elektroensefalogram (EEG) çekilen olguların, çekim nedenlerinin ve EEG sonuçlarının değerlendirilmesi. Gereç ve yöntem: Nisan 2013-Şubat 2015 tarihleri arasında çocuk yoğun bakım ünitemizde EEG çekilen 51 olgunun demografik özellikleri, yatış ve EEG istem nedenleri, sonuçları ve çekim süreleri geriye dönük olarak kaydedildi. Bulgular: Elli bir (32’si erkek) olguya toplam 72 EEG çekimi yapıldı. EEG’lerin 14’ünün (%19,4) uzun süreli monitorizasyon, 58’inin (%80,6) standart süreli (20dk) olarak çekildiği görüldü. EEG çekilen olguların en sık yatış nedenleri kardiyak cerrahi sonrası izlem (%23,5), sepsis (%13,7) ve bilinç değişikliğiydi (%17,6). Standart süre çekim endikasyonları nöbet ve sonrasında bilinç değişikliği (%36,2), akut nörolojik olay ve beraberinde bilinç değişikliği (%34,5), bilinmeyen nedenle birlikte bilinç değişikliği (%8,6), nöbet ya da santral sinir sistemi bulgusu olmaksızın daha önceden nöbet öyküsü olması (%20,7) idi. Uzun süreli monitorizasyon endikasyonlarının %35,7’si nöbet sonrası bilinç değişikliği, %50’si santral sinir sistemini akut etkileyen patoloji ve beraberinde bilinç değişikliği, %14,2’si nedeni bilinmeyen bilinç değişikliği idi. Uzun süreli monitorizasyonların 2’sinde nonkonvülzif status epileptikus (NKSE) ve 3’ünde non-konvülzif nöbet (NKN) saptandı. EEG anormalliği anlamlı olarak erkek cinsiyette daha fazla sıklıkta görülürken (p=0,035), yaş ile EEG sonuçları arasında anlamlı fark saptanmadı (p=0,32). Sonuç: EEG, motor fenomenin olmadığı NKN ve NKSE olgularının saptanmasında ve tedaviye yanıtlarını değerlendirmede önemli bir araçtır. EEG çekimi ve özellikle uzun süreli monitorizasyonlar çocuk yoğun bakım ünitelerinin vazgeçilmez bir parçası olmalıdır

Evaluation of electroencephalogram results in patients hospitalized in the pediatric intensive care unit

Purpose: To evaluate the electroencephalogram (EEG) monitoring reasons and the results of the EEG in patients hospitalized in the pediatric intensive care unit (PICU). Materials and methods: Demographic features, hospitalization and EEG monitoring indications, monitoring results, and durations were analyzed retrospectively in patients hospitalized in PICU between April 2013 and February 2015. Results: Seventy-two times EEG monitoring was performed for 51 patients (32 male). EEG abnormality was determined in males more than females (p=0.035). There was no significant difference between ages and EEG results (p=0.32). Fourteen (19.4%) of the EEG monitorings were performed as long-duration and 58 (80.6%) of them were performed as standard-duration (20 min). The most frequent hospitalization etiologies were postoperative follow-up after cardiac surgery (23.5%), sepsis (13.7%), and altered state of consciousness (17.6%). Standard-duration EEG monitoring indications were altered mental status after a seizure (36.2%), altered mental status with an acute primary neurological condition (34.5%), altered mental status of unknown etiology (8.6%), and history of a seizure without acute neurological condition (20.7%). Long-duration EEG monitoring indications were altered mental status after a seizure (35.7%), altered mental status with an acute neurological condition (50%), and altered mental status with unknown etiology (14.2%). Two EEGs were compatible with, non-convulsive status epilepticus (NCSE), 3 EEGs were compatible with non-convulsive seizure (NCS) among the long-duration EEG monitorings. Conclusion: EEG is a useful instrument for the diagnosis of NKSE and NKN as well as the evaluation of treatment responses. EEG monitoring rates in PICU should be increased and should be an essential part of PICU.

PDF

___

1. Phillips SA, Shanahan RJ. Etiology and mortality of status epilepticus in children: a recent update. Arch Neurol 1989;46:74-76. https://doi.org/10.1001/ archneur.1989.00520370076023
2. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004;62:1743-1748. https://doi. org/10.1212/01.wnl.0000125184.88797.62
3. Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of non convulsive status epilepticus in comatose patients. Neurology 2000;54:340-345. https://doi. org/10.1212/wnl.54.2.340
4. Hosain SA, Solomon GE, Kobylarz EJ. Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol 2005;32:162-165. https://doi.org/10.1016/j.pediatrneurol.2004.09.008
5. Abend NS, Topjian A, Ichord R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology 2009;72:1931-1940. https://doi.org/10.1212/ WNL.0b013e3181a82687
6. Abend NS, Chapman KE, Gallentine WB, et al. Electroencephalographic monitoring in the pediatric intensive care unit. Curr Neurol Neurosci Rep 2013;13:330. https://doi.org/10.1007/s11910-012- 0330-3
7. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015;56:1515-1523. https://doi.org/10.1111/ epi.13121
8. Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalography monitoring. J Neurosurg 1999;91:750-760. https://doi.org/10.3171/ jns.1999.91.5.0750
9. Sanchez SM, Carpenter J, Chapman KE, et al. Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. J Clin Neurophysiol 2013;30:156-160. https://doi. org/10.1097/WNP.0b013e31827eda27
10. Foreman B, Claassen J, Abou Khaled K, et al. Generalized periodic discharges in the critically ill: a case-control study of 200 patients. Neurology 2012;79:1951-1960. https://doi.org/10.1212/ WNL.0b013e3182735cd7
11. Bauer G, Trinka E, Kaplan PW. EEG patterns in hypoxic encephalopathies (post-cardiac arrest syndrome): fluctuations, transitions, and reactions. J Clin Neurophysiol 2013;30:477-489. https://doi. org/10.1097/WNP.0b013e3182a73e47
12. Anık A, Tekgül H, Yılmaz S, et al. The prognostic role of clinical, electroencephalographic and neuroradiological parameters in predicting outcome in pediatric non-traumatic coma. Pamukkale Tıp Derg 2020;13:509-518. https://doi.org/10.31362/ patd.685215
13. Abend NS, Arndt DH, Carpenter JL, et al. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology 2013;81:383-391. https://doi.org/10.1212/WNL.0b013e31829c5cfe
14. Abebe T, Girmay M, Michael G, Tesfaye M. The epidemiological profile of pediatric patients admitted to the general intensive care unit in an Ethiopian university hospital. Int J Gen Med 2015;8:63-67. https:// doi.org/10.2147/IJGM.S76378
15. Altındağ E, Okudan ZV, Özkan Tavukçu S, Krespı Y, Baykan B. Nöroloji yoğun bakım ünitesinde bilinç değişikliği nedeni ile izlenen hastaların devamlı EEG monitorizasyonunda saptanan elektroensefalografik paternler. Arch Neuro Psychiatry 2017;54:168-178. https://doi.org/10.5152/npa.2016.14822
16. Hyllienmark L, Amark P. Continuous EEG monitoring in a paediatric intensive care unit. Eur J Paediatr Neurol 2007;11:70-75. https://doi.org/10.1016/j. ejpn.2006.11.005
17. Ross C, Blake A, Whitehouse WP. Status epilepticus on the paediatric intensive care unit—the role of EEG monitoring. Seizure 1999;8:335-338 https://doi. org/10.1053/seiz.1999.0300
18. Meldrum BS, Vigouroux RA, Brierley JB. Systemic factors andepileptic brain damage: prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol 1973;29:82-87. https://doi.org/10.1001/ archneur.1973.00490260026003
19. Fujikawa DG. The temporal evolution of neuronal damage frompilocarpine-induced status epilepticus. Brain Res 1996;725:11-22. https://doi. org/10.1016/0006-8993(96)00203-x
20. Nevander G, Ingvar M, Auer R, Siesjö BK. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol 1985;18:281-290. https://doi. org/10.1002/ana.410180303
21. Rüegg SJ, Dichter MA. Diagnosis and treatment of nonconvulsive status epilepticus in an intensive care unit setting. Curr Treat Options Neurol 2003;5:93-110. https://doi.org/10.1007/s11940-003-0001-4