RELATION BETWEEN ELECTROGRAPHIC SEIZURES DETECTED BY AMPLITUDE-INTEGRATED EEG AND SHORT-TERM OUTCOMES AFTER TRAUMATIC BRAIN INJURY IN CHILDREN | ||||
| Al-Azhar Journal of Pediatrics | ||||
| Article 1, Volume 24, Issue 4, October 2021, Page 2371-2391 PDF (173.72 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/azjp.2021.223328 | ||||
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| Abstract | ||||
| Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. After TBI, the brain is vulnerable to additional injuries (secondary injuries) because injury disrupts normal autoregulatory defense mechanisms. These secondary injuries play a crucial role in patient prognosis. Posttraumatic seizures are an important cause of secondary injuries leading to further damage to the injured brain. Continuous monitoring by electroencephalography (EEG) can detect both clinical and subclinical seizure. This will lead to early treatment of seizures and prevention of further brain damage. Objective: To assess the value of early detection of electrographic seizures by Amplitude-Integrated EEG (aEEG) in relation to short-term outcomes after TBI in children. Methods: This prospective study included thirty-two consecutive, nonrandomized patients with moderate and severe TBI were monitored with aEEG. Clinical and subclinical seizures were assessed for their relation to short-term outcome measures. Outcome measures included hospital stay and KOSCHI score (The King's Outcome Scale for Childhood Head Injury). Results: The main etiology of TBI was falling from height (62.5%), clinical seizures were observed in 43.7%, and subclinical seizures were detected by aEEG in 17 patients (53.1%). The mean days of hospital stay was 6.0 ± 4.0 of which 5.0 ± 3.0 days were in PICU. The median time from TBI onset to aEEG recording was 12 hours and the median duration of aEEG was 18 hours. The main CT findings were diffuse axonal injury, skull fracture, and subdural hematoma. One patient died (3.1%). Those with subclinical seizures significantly had more severe TBI, longer duration on mechanical ventilation and longer hospital stay. Their main CT findings was diffuse axonal injury and had KOSCHI score significantly lower than those without subclinical seizures. Patients with continuous normal voltage (CNV) on initial aEEG have good outcome, while those with burst suppression (BS) and flat trace (FT) have poor outcome. According to KOSCHI score, good outcome was significantly achieved in those without subclinical seizures compared to the other group (60 vs 29.4%, p=0.037). Conclusions: aEEG background patterns in acute stage after TBI (within the first 24 hrs.) can predict both good and poor outcomes in these patients. A favorable aEEG pattern (CNV) is a good indicator of a good outcome while unfavorable aEEG patterns (BS and FT) are associated with a poor outcome. Posttraumatic subclinical seizures were related to poor neurological outcomes. RELATION BETWEEN ELECTROGRAPHIC SEIZURES DETECTED BY AMPLITUDE-INTEGRATED EEG AND SHORT-TERM OUTCOMES AFTER TRAUMATIC BRAIN INJURY IN CHILDREN | ||||
| Keywords | ||||
| Amplitude-Integrated EEG; traumatic brain injury; subclinical seizures | ||||
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