Frequency of Nonconvulsive Seizures among Pediatric Systemic Cancer Patients with Acute Encephalopathy: Emergent Bedside EEG in Resource Constrained Communities

Authors

  • Muhammad Akbar Malik Consultant pediatric neurologist and neurophysiologist, visiting consultant neurologist and neurophysiologist- The Brain Associates, Lahore, Pakistan
  • Saima Malik Director and Clinical Hematologist, visiting consultant neurologist and neurophysiologist- The Brain Associates, Lahore, Pakistan
  • Arshad Rafique Consultant pediatric neurologist, visiting consultant neurologist and neurophysiologist- The Brain Associates, Lahore, Pakistan
  • Ashraf Sultan visiting consultant pediatrician, visiting consultant neurologist and neurophysiologist- The Brain Associates, Lahore, Pakistan
  • Farrukh Ali Choudhary visiting consultant pediatrician, visiting consultant neurologist and neurophysiologist- The Brain Associates, Lahore, Pakistan

DOI:

https://doi.org/10.12974/2313-0946.2017.04.01.3

Keywords:

EEG, nonconvulsive seizures, encephalopathy, epileptiform discharges, neurointensive care units, systemic cancer

Abstract

Purpose: To determine the incidence of nonconvulsive seizures (NCSz) among children with systemic cancer, who underwent unexplained acute severe encephalopathy (GCS≤8) during admission in ICUs and Neuro-ICUs.

Study Design: Multicenter prospective observational study describing sub-clinical seizures and electroencephalographic (EEG) features of children (1-16 years) with acute unexplained encephalopathy who underwent emergent bedside EEG≥30min monitoring.

Material and Methods: We conducted a prospective longitudinal observational study design and EEG assessment of 40 systemic cancer patients age ≤16years, consecutively diagnosed and admitted in intensive care units (ICUs) and neurointensive care units (Neuro-ICUs) of different cancer hospitals with unexplained acute impaired consciousness (GCS≤08) within ≤6hr of such deterioration. Bed-side EEG recordings of ≥30min were done according to the clinical scenario and the requirements of the treating neurologist/intensivist. Patients with brain tumor, brain metastasis, seizures or those with known cause of coma were excluded. Data surrounding clinical, electrographic, and treatment factors were collected Via a prospective systematic review of medical records and EEGs for correlation with diagnosis, change in the diagnosis and management.

Results: Over a period of 2 years, 40 children, 22.5% 1-5yeras, 37.5% 6-10years, 40% 11-16years; boys 65% and girls 35%, who had systemic cancer with a median age of 9.8 years with unexplained acute deterioration of conscious level (GCS≤08). This cohort underwent bed-side EEG of ≥30 min, which was abnormal in 100% of the records. The main reasons for EEG requests were: 1) unexplained impaired consciousness 22(55%) and 2) reason one plus subtle convulsion 18(45%). The most common EEG abnormalities were invariant mixed theta-delta slowing (27.5%), followed by Low-amplitude delta pattern plus epileptiform discharges (20%) and there was electrographic evidence of EEG seizures in 17(42.5%) of the cohort. These electrographic seizures were present in 55.5% of 18 patients with subtle convulsions, whereas were documented only in 20% of the 22 patients without such movements. Electrographic seizures among patients with subtle convulsions responded to antiseizure drugs in 75% cases as compared 50% such response among patients without such convulsions.

Conclusion: Emergent bed-side EEG record of ≥30 min is useful in systemic cancer patients admitted in NCUs and Neuro-ICUs with acutely impaired consciousness with or without abnormal body movements. Neurology consultation and EEG studies in these comatose patients provide useful diagnostic information.

References

Zeman A. Consciousness Brain 2001; 124: 1263-1289.

Kaplan PW. The EEG in metabolic encephalopathy and coma. J Clin Neurophysiol 2004; 21: 307-318.4. 3. Husain AM. Electroencephalographic assessment of coma. J Clin Neurophysiol 2006; 23: 208-220

Shahwan A, Bailey C, Shekerdemian L and Harvey AS. The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia 2010; 51: 1198-1204. https://doi.org/10.1111/j.1528-1167.2009.02517.x

Kirkham FJ, Wade AM, Mcelduff F, Boyd SG, Tasker RC, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med 2012; 38: 853-862. https://doi.org/10.1007/s00134-012-2529-9

Abend NS, Dlugos DJ, Hahn CD, Hirsch LJ and Herman ST. Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care 2010; 12: 382-389. https://doi.org/10.1007/s12028-010-9337-2

Jette N, Claassen J, Emerson RG and Hirsch LJ. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 2006; 63: 1750-5. https://doi.org/10.1001/archneur.63.12.1750

Vespa PM, Nenov V and Nuwer MR. Continuous EEG monitoring in the intensive care unit: early findings and clinical efficacy. J Clin Neurophysiol 1999; 16: 1-13. https://doi.org/10.1097/00004691-199901000-00001

Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 2007; 35: 2830-6. https://doi.org/10.1097/00003246-200712000-00023

Kilbride RD, Costello DJ and Chiappa KH. How seizure detection by continuous electroencephalographic monitoring affects the prescribing of antiepileptic medications. Arch Neurol 2009; 66: 723-8. https://doi.org/10.1001/archneurol.2009.100

Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol 2013; 30(1): 1-27. https://doi.org/10.1097/WNP.0b013e3182784729

Pan IJ, Daniels JL and Zhu K. Poverty and childhood cancer incidence in the United States. Cancer Causes Control 2010; 21: 1139-1145. https://doi.org/10.1007/s10552-010-9528-3

ParkinDM, WhelanSL, FerlayJ, TeppoL, ThomasDB, eds. Cancer incidence in five continents, Lyon. International Agency for Research on Cancer. IARC Scientific Publication 2002; 8: 155.

American Cancer Society:(http://www.cancer.org/acs/ groups/content/@editorial/documents/document/acspc- 044552.pdf)

The Cancer Research UK. http://www.cancerresearchuk .org/cancer info/cancerstats/incidence/).

Jabeen S, Haque M, Islam MJ, et al. Profile of pediatric malignancies five years study. Dhaka Med Coll 2010; 19(1): 33-38.

Shochat JS, Fremgen MA, Sharon B, Murphy BS, et al. Childhood Cancer: Patterns of Protocol Participation in a National Survey. CA Cancer J Clin 2001; 51: 119-130 https://doi.org/10.3322/canjclin.51.2.119

Homes LJr, Vandenberg J, McClarin L, et al. Epidemiologic, Racial and Healthographic Mapping of Delaware Pediatric Cancer: 2004-2014. Int J Environ Res Public Health 2016; 13(49): 1-14.

Gwer S, Idro R, Fegan G. et al. Continuous EEG monitoring in Kenyan children with non-traumatic coma. Intensive Care Med 2012; 38(5): 853-862. https://doi.org/10.1136/archdischild-2011-300935

Fenella J, Kirkham JF, Wade MA and McElduff F. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med 2012; 38(5): 853-862. https://doi.org/10.1007/s00134-012-2529-9

Crawley J, Smith S, Muthinji P, et al. Electroencephalographic and clinical features of cerebral malaria. Arch Dis Child 2001; 84: 247-53. https://doi.org/10.1136/adc.84.3.247

Trinka EHJ. EEG in coma and brain death. Klin Neurophysiol 2011; 42(3): 141-8. https://doi.org/10.1055/s-0031-1276898

Bauer G, Trinka E and Kaplan PW. EEG patterns in hypoxic encephalopathies (postcardiac arrest syndrome): fluctuations, transitions, and reactions. J Clin Neurophysiol 2013; 30(5): 477-89. https://doi.org/10.1097/WNP.0b013e3182a73e47

Abend NS, Chapman KE, Gallentine WB, Goldstein J, Hyslop AE, 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

Tsuchida TN, Wusthoff CJ, Shellhaas RA, et al. American Clinical Neurophysiology Society Standardized EEG Terminology and Categorization for the Description of Continuous EEG Monitoring in Neonates: report of the American Clinical Neurophysiology Society Critical Care Monitoring Committee. J Clin Neurophysiol 2013; 30: 161-173. https://doi.org/10.1097/WNP.0b013e3182872b24

Shahwan A, Bailey C, Shekerdemian L, et al. The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia 2010; 51: 1198-204. https://doi.org/10.1111/j.1528-1167.2009.02517.x

Tay SK, Hirsch LJ, Leary L, et al. Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 2006; 47: 1504-9. https://doi.org/10.1111/j.1528-1167.2006.00623.x

Abend NS and Dlugos DJ. Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 2007; 37: 165-70. https://doi.org/10.1016/j.pediatrneurol.2007.05.012

Saengpattrachai M, Sharma R, Hunjan A, et al. Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia 2006; 47: 1510-18. https://doi.org/10.1111/j.1528-1167.2006.00624.x

Claassen J, Mayer AS, Kowalski GR, et al. 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

Abend SN, Gutierrez-Colina MA, Topjian AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology 2011; 76(12): 1071-1077. https://doi.org/10.1212/WNL.0b013e318211c19e

Kirkham FJ, Wade AM, Mcelduff F, Boyd SG, Tasker RC, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med 2012; 38: 853-862. https://doi.org/10.1007/s00134-012-2529-9

Nicholas S. Abend MD, l Sarah M Sanchez BS and 1 Robert A Berg MD. Current Treatment of Electrographic Seizures and Status Epilepticus in Critically Ill Children: a Single Center Experience. Seizure 2013; 22(6): 467-471. https://doi.org/10.1016/j.seizure.2013.03.008

Fernández SI, Abend SN, Arndt HD, et al. Electrographic seizures after convulsive status epilepticus in children and young adults. A retrospective multicenter study. J Pediatr 2014; 164(2): 339-346.e2. https://doi.org/10.1016/j.jpeds.2013.09.032

Eriksson K, Metsaranta P, Huhtala H, Auvinen A, Kuusela AL, et al. Treatment delay and the risk of prolonged status epilepticus. Neurology 2005; 65: 1316-8. https://doi.org/10.1212/01.wnl.0000180959.31355.92

Lewena S and Young S. When benzodiazepines fail: how effective is second line therapy for status epilepticus in children? Emergency Medicine Australasia 2006; 18: 45-50. https://doi.org/10.1111/j.1742-6723.2006.00807.x

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Published

2022-06-15

How to Cite

Malik, M. A., Malik, S., Rafique, A., Sultan, A., & Choudhary, F. A. (2022). Frequency of Nonconvulsive Seizures among Pediatric Systemic Cancer Patients with Acute Encephalopathy: Emergent Bedside EEG in Resource Constrained Communities. Global Journal Of Epidemiology and Public Health, 4(1), 19–26. https://doi.org/10.12974/2313-0946.2017.04.01.3

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