Objective

To determine features of paroxysmal events and background electroencephalographic (EEG) abnormalities associated with electroclinical seizures in critically ill children who undergo continuous video EEG to characterize clinical events.

Methods

This is a prospective study of critically ill children from July 2016 to October 2018. Non-neonates with continuous video EEG indication to characterize a clinical event were included. Patients with continuous video EEG to assess for subclinical seizures due to unexplained encephalopathy and those whose event of concern were not captured on continuous video EEG were excluded. The event to be characterized was taken from documented descriptions of health care providers and classified as motor, ocular, orobuccal, autonomic, and other. In patients with more than 1 component to their paroxysmal event, the events were classified as motor plus and nonmotor plus.

Results

One hundred patients met inclusion and exclusion criteria, with electroclinical seizures captured in 30% (30/100). The most common event to be characterized was an autonomic event in 32% (32/100). Asymmetry and epileptiform discharges were associated with electroclinical seizures (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.1-6.5, P = .03; and OR 12.5, 95% CI 4.4-35.6, P < .0001). Autonomic events alone, particularly unexplained vital sign changes, were not associated with electroclinical seizures (OR 0.3, 95% CI 0.11-0.93, P = .03).

Conclusions

Isolated autonomic events are unlikely to be electroclinical seizures. Details of the paroxysmal events in question can help decide which patient will benefit most from continuous video EEG based on institutional resources.

中文翻译：

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用于危重儿童事件表征的连续视频脑电图 (EEG)

客观的

确定与接受连续视频脑电图表征临床事件的危重病儿童的电临床癫痫发作相关的阵发性事件和背景脑电图 (EEG) 异常的特征。

方法

这是一项于 2016 年 7 月至 2018 年 10 月对危重儿童进行的前瞻性研究。包括具有连续视频脑电图指示以表征临床事件的非新生儿。连续视频脑电图评估由于不明原因脑病引起的亚临床癫痫发作的患者以及连续视频脑电图未捕获关注事件的患者被排除在外。要表征的事件取自对医疗保健提供者的记录描述，并分为运动、眼、口颊、自主和其他。在他们的阵发性事件中有超过 1 个组成部分的患者中，事件被分类为运动加和非运动加。

结果

100 名患者符合纳入和排除标准，其中 30% (30/100) 中有电临床癫痫发作。最常见的事件是 32% (32/100) 的自主事件。不对称和癫痫样放电与临床电发作相关（优势比 [OR] 2.7, 95% 置信区间 [CI] 1.1-6.5, P  = .03；和 OR 12.5, 95% CI 4.4-35.6, P  < .0001）。单独的自主神经事件，尤其是无法解释的生命体征变化，与电临床癫痫发作无关（OR 0.3，95% CI 0.11-0.93，P  = .03）。

结论

孤立的自主神经事件不太可能是电临床癫痫发作。所讨论的阵发性事件的详细信息可以帮助确定哪些患者将从基于机构资源的连续视频 EEG 中获益最多。