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Chapter 6 - Abnormal EEG in the Intensive Care Unit

from Part I - General Considerations in Neuromonitoring

Published online by Cambridge University Press:  08 September 2022

By
Jessica Carpenter  and
Tammy Tsuchida
Edited by
Cecil D. Hahn  and
Courtney J. Wusthoff
Cecil D. Hahn
Affiliation:
The Hospital for Sick Children, University of Toronto
Courtney J. Wusthoff
Affiliation:
Lucile Packard Children’s Hospital, Stanford University
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Summary

The abnormal electroencephalogram (EEG) that attracts the most attention is that showing a seizure. In the intensive care unit (ICU), EEG monitoring is most commonly used for seizure detection; however, EEG can provide additional useful information. The background pattern can be used to evaluate encephalopathy and to assess cerebral function in patients who are sedated and paralyzed. EEG background can inform prognostication after hypoxic ischemic injury. EEG can serve as an ancillary investigation in the determination of brain death. Finally, EEG changes guide titration of treatments, such as continuous infusions administered for status epilepticus or increased intracranial pressure. Quantitative EEG (QEEG) is increasingly used by bedside clinicians for rapid assessment of cerebral function and facilitation of rapid interventions for critically ill patients.

Keywords

Electroencephalogram (EEG)monitoringintensive care unit (ICU)pediatric intensive care unit (PICU)neonatal intensive care unit (NICU)seizurequantitative EEG (QEEG)aEEGCDSAprognostication
Type
Chapter
Information
Neuromonitoring in Neonatal and Pediatric Critical Care , pp. 76 - 102
Publisher: Cambridge University Press
Print publication year: 2022

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References

Hussain, E, Nordli, D. EEG patterns in acute pediatric encephalopathies. J Clin Neurophysiol. 2013 Oct;30(5):539–44.CrossRefGoogle ScholarPubMed
Clancy, RR, Chung, HJ. EEG changes during recovery from acute severe neonatal citrullinemia. Electroencephalogr Clin Neurophysiol. 1991 Mar;78(3):222–7.Google Scholar
Tsuchida, TN, Wusthoff, CJ, Shellhaas, RA, et al.; American Clinical Neurophysiology Society Critical Care Monitoring Committee. 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 Apr;30(2):161–73.Google Scholar
Stecker, MM, Sabau, D, Sullivan, L, et al. American Clinical Neurophysiology Society Guideline 6: minimum technical standards for EEG recording in suspected cerebral death. J Clin Neurophysiol. 2016 Aug;33(4):324–7.CrossRefGoogle ScholarPubMed
Nakagawa, TA, Ashwal, S, Mathur, M, et al. clinical report-guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics 2011;128:e730–e40.CrossRefGoogle ScholarPubMed
Rose, AL, Lombroso, CT. A study of clinical, pathological, and electroencephalographic features in 137 full-term babies with a long-term follow-up. Pediatrics. 1970 Mar;45(3):404–25.CrossRefGoogle ScholarPubMed
Monod, N, Pajot, N, Guidasci, S. The neonatal EEG: statistical studies and prognostic value in full-term and pre-term babies. Electroencephalogr Clin Neurophysiol. May 1972;32(5):529–44.CrossRefGoogle ScholarPubMed
Watanabe, K, Miyazaki, S, Hara, K, Hakamada, S. Behavioral state cycles, background EEGs and prognosis of newborns with perinatal hypoxia. Electroencephalogr Clin Neurophysiol. 1980;49(5–6):618–25.CrossRefGoogle ScholarPubMed
Holmes, G, Rowe, J, Hafford, J, et al. Prognostic value of the electroencephalogram in neonatal asphyxia. Electroencephalogr Clin Neurophysiol. 1982 Jan;53(1):60–72.CrossRefGoogle ScholarPubMed
Pezzani, C, Radvanyi-Bouvet, MF, Relier, JP, Monod, N. Neonatal electroencephalography during the first twenty-four hours of life in full-term newborn infants. Neuropediatrics. Feb 1986;17(1):11–18.CrossRefGoogle ScholarPubMed
Sinclair, DB, Campbell, M, Byrne, P, Prasertsom, W, Robertson, CM. EEG and long-term outcome of term infants with neonatal hypoxic-ischemic encephalopathy. Clin Neurophysiol. 1999 Apr;110(4):655–9.Google Scholar
Holmes, GL, Rowe, J, Hafford, J. Significance of reactive burst suppression following asphyxia in full term infants. Clin Electroencephalogr. 1983 Jul;14(3):138–41.Google Scholar
Hamelin, S, Delnard, N, Cneude, F, Debillon, T, Vercueil, L. Influence of hypothermia on the prognostic value of early EEG in full-term neonates with hypoxic ischemic encephalopathy. Neurophysiol Clin. 2011 Feb;41(1):19–27.CrossRefGoogle ScholarPubMed
Nash, KB, Bonifacio, SL, Glass, HC, et al. Video-EEG monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neurology. 2011 Feb 8;76(6):556–62.CrossRefGoogle ScholarPubMed
Sarnat, HB, Sarnat, MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct;33(10):696–705.CrossRefGoogle ScholarPubMed
Takeuchi, T, Watanabe, K. The EEG evolution and neurological prognosis of neonates with perinatal hypoxia [corrected]. Brain Dev. 1989;11(2):115–20.Google Scholar
Holmes, GL, Lombroso, CT. Prognostic value of background patterns in the neonatal EEG. J Clin Neurophysiol. Jul 1993;10(3):323–52.Google Scholar
Pressler, RM, Boylan, GB, Morton, M, Binnie, CD, Rennie, JM. Early serial EEG in hypoxic ischaemic encephalopathy. Clin Neurophysiol. Jan 2001;112(1):31–7.CrossRefGoogle ScholarPubMed
Murray, DM, Boylan, GB, Ryan, CA, Connolly, S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics. Sep 2009;124(3):e459–467.Google Scholar
Mathieson, SR, Livingstone, V, Low, E, et al. Phenobarbital reduces EEG amplitude and propagation of neonatal seizures but does not alter performance of automated seizure detection. Clin Neurophysiol. 2016 Oct;127(10):3343–50.Google Scholar
Obeid, R, Tsuchida, TN. Treatment Effects on Neonatal EEG. J Clin Neurophysiol. 2016 Oct;33(5):376–81.CrossRefGoogle ScholarPubMed
Tharp, BR, Cukier, F, Monod, N. The prognostic value of the electroencephalogram in premature infants. Electroencephalogr Clin Neurophysiol. Mar 1981;51(3):219–36.CrossRefGoogle ScholarPubMed
Hayashi-Kurahashi, N, Kidokoro, H, Kubota, T, et al. EEG for predicting early neurodevelopment in preterm infants: an observational cohort study. Pediatrics. 2012 Oct;130(4):e891–7.Google Scholar
Le Bihannic, A, Beauvais, K, Busnel, A, de Barace, C, Furby, A. Prognostic value of EEG in very premature newborns. Arch Dis Child Fetal Neonatal Ed. 2012 Mar;97(2):F106–9.Google Scholar
Selton, D, Andre, M, Debruille, C, Deforge, H, Hascoët, JM. Cognitive outcome at 5 years in very premature children without severe early cerebral abnormalities. Relationships with EEG at 6 weeks after birth. Neurophysiol Clin. 2013 Dec;43(5–6):289–97.Google Scholar
Nunes, ML, Khan, RL, Gomes Filho, I, Booij, L, da Costa, JC. Maturational changes of neonatal electroencephalogram: a comparison between intra uterine and extra uterine development. Clin Neurophysiol. 2014 Jun;125(6):1121–8.CrossRefGoogle ScholarPubMed
Périvier, M, Rozé, JC, Gascoin, G, et al. Neonatal EEG and neurodevelopmental outcome in preterm infants born before 32 weeks. Arch Dis Child Fetal Neonatal Ed. 2016 May;101(3):F253–9.Google Scholar
Wusthoff, CJ, Bonifacio, SB, Van Meurs, KP. The use of EEG and aEEG in assessing the term and preterm brain. In Stevenson, DK, Benitz, WE, Sunshine, P, Hintz, SR and Druzin, M, editors. Fetal and Neonatal Brain Injury, 5th ed. New York: Cambridge University Press; 2018.Google Scholar
Clancy, RR, Tharp, BR. Positive Rolandic sharp waves in the electroencephalograms of premature neonates with intraventricular hemorrhage. Electroencephalogr Clin Neurophysiol. 1984 May;57(5):395–404.CrossRefGoogle ScholarPubMed
Laroia, N, Guillet, R, Burchfiel, J, McBride, MC. EEG background as predictor of electrographic seizures in high-risk neonates. Epilepsia. 1998;39(5):545–51.CrossRefGoogle ScholarPubMed
Shellhaas, RA, Clancy, RR. Characterization of neonatal seizures by conventional and single channel EEG. Clin Neurophysiol. 2007;118:2156–61.CrossRefGoogle ScholarPubMed
Pisani, F, Copioli, C, Di Gioia, C, Turco, E, Sisti, L. Neonatal seizures: relation of ictal video-electroencephalography (EEG) findings with neurodevelopmental outcome. J Child Neurol. 2008 Apr;23(4):394–8.CrossRefGoogle ScholarPubMed
Glass, HC, Wusthoff, CJ, Shellhaas, RA, et al. Risk factors for EEG seizures in neonates treated with hypothermia: a multicenter cohort study. Neurology. 2014 Apr 8;82(14):1239–44.Google Scholar
Ostendorf, AP, Hartman, ME, Friess, SH. Early electroencephalographic findings correlate with neurologic outcome in children following cardiac arrest. Pediatr Crit Care Med. 2016 Jul;17(7):667–76.CrossRefGoogle ScholarPubMed
Pampiglione, G, Harden, A. Prognostic value of neurophysiological studies in the first hours following resuscitation: a review of 120 children after cardiac arrest. Electroencephalogr Clin Neurophysiol. 1968 Jul;25(1):91.Google Scholar
Tasker, RC, Boyd, S, Harden, A, Matthew, DJ. Monitoring in non-traumatic coma. Part II: Electroencephalography. Arch Dis Child. 1988 Aug;63(8):895–9.Google Scholar
Mandel, R, Martinot, A, Delepoulle, F, et al. Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr. 2002 Jul;141(1):45–50.Google Scholar
Ramachandrannair, R, Sharma, R, Weiss, SK, Cortez, MA. Reactive EEG patterns in pediatric coma. Pediatr Neurol. 2005a Nov;33(5):345–9.Google Scholar
Nishisaki, A, Sullivan, J, 3rd, Steger, B, et al. Retrospective analysis of the prognostic value of electroencephalography patterns obtained in pediatric in-hospital cardiac arrest survivors during three years. Pediatr Crit Care Med. 2007 Jan;8(1):10–7.Google Scholar
Topjian, AA, Sánchez, SM, Shults, J, et al. Early electroencephalographic background features predict outcomes in children resuscitated from cardiac arrest. Pediatr Crit Care Med. 2016 Jun;17(6):547–57.CrossRefGoogle ScholarPubMed
Hirsch, LJ, LaRoche, SM, Gaspard, N, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol. 2013 Feb;30(1):1–27.CrossRefGoogle ScholarPubMed
Lowenstein, DH, Aminoff, MJ, Simon, RP. Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology. 1988 Mar;38(3):395–400.CrossRefGoogle ScholarPubMed
Davidson, AJ, Sale, SM, Wong, C, et al. The electroencephalograph during anesthesia and emergence in infants and children. Paediatr Anaesth. 2008 Jan;18(1):60–70.CrossRefGoogle ScholarPubMed
Mundi, JP, Betancourt, J, Ezziddin, O, et al. Dilated and unreactive pupils and burst-suppression on electroencephalography due to bupropion overdose. J Intensive Care Med. 2012 Nov-Dec;27(6):384–8.Google Scholar
Ramachandrannair, R, Sharma, R, Weiss, SK, Otsubo, H, Cortez, MA. A reappraisal of rhythmic coma patterns in children. Can J Neurol Sci. 2005b Nov;32(4):518–23.CrossRefGoogle ScholarPubMed
Abend, NS, Arndt, DH, Carpenter, JL, et al. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology. 2013 Jul 23;81(4):383–91.Google Scholar
Mewasingh, LD, Christophe, C, Fonteyne, C, et al. Predictive value of electrophysiology in children with hypoxic coma. Pediatr Neurol. 2003 Mar;28(3):178–83.CrossRefGoogle ScholarPubMed
Abend, NS, Licht, DJ. Predicting outcome in children with hypoxic ischemic encephalopathy. Pediatr Crit Care Med. 2008 Jan;9(1):32–9.Google ScholarPubMed
Shellhaas, RA, Chang, T, Tsuchida, TN, et al. American Clinical Neurophysiology Society’s guideline on continuous EEG monitoring in neonates. J Clin Neurophysiol. 2011;28(6):611–17.Google Scholar
Herman, ST, Abend, NS, Bleck, TP, et al.; Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015 Apr;32(2):87–95.CrossRefGoogle ScholarPubMed
Young, GB, Jordan, KG, Doig, GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996 Jul;47(1):83–9.Google Scholar
Holden, KR, Mellits, ED, Freeman, JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982 Aug;70(2):165–76.Google Scholar
Legido, A, Clancy, RR, Berman, PH. Neurologic outcome after electroencephalographically proven neonatal seizures. Pediatrics. 1991 Sep;88(3):583–96.Google Scholar
Boylan, GB, Pressler, RM, Rennie, JM, et al. Outcome of electroclinical, electrographic, and clinical seizures in the newborn infant. Dev Med Child Neurol. 1999 Dec;41(12):819–25.CrossRefGoogle ScholarPubMed
Brophy, GM, Bell, R, Claassen, J, et al.; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3–23.CrossRefGoogle ScholarPubMed
Payne, ET, Zhao, XY, Frndova, H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014 May;137(Pt 5):1429–38.Google Scholar
Kharoshankaya, L, Stevenson, NJ, Livingstone, V, et al. Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy. Dev Med Child Neurol. 2016 Dec;58(12):1242–8.CrossRefGoogle ScholarPubMed
Treiman, DM, Walton, NY, Kendrick, C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res. 1990 Jan-Feb;5(1):49–60.CrossRefGoogle ScholarPubMed
Novotny, EJ, Jr., Tharp, BR, Coen, RW, et al. Positive Rolandic sharp waves in the EEG of the premature infant. Neurology 1987;37:1481–6.Google Scholar
Oliveira, AJ, Nunes, ML, Haertel, LM, Reis, FM, da Costa, JC. Duration of rhythmic EEG patterns in neonates: new evidence for clinical and prognostic significance of brief rhythmic discharges. Clin Neurophysiol. 2000 Sep;111(9):1646–53.Google Scholar
van Rooij, LG, de Vries, LS, van Huffelen, AC, Toet, MC. Additional value of two-channel amplitude integrated EEG recording in full-term infants with unilateral brain injury. Arch Dis Child Fetal Neonatal Ed. 2010 May;95(3):F160–8.Google Scholar
Hellström-Westas, L. Comparison between tape-recorded and amplitude-integrated EEG monitoring in sick newborn infants. Acta Paediatr. 1992 Oct;81(10):812–19.Google Scholar
al Naqeeb, N, Edwards, AD, Cowan, FM, Azzopardi, D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics. 1999 Jun;103(6 Pt 1):1263–71.Google Scholar
Toet, MC, van der Meij, W, de Vries, LS, Uiterwaal, CS, van Huffelen, KC. Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates. Pediatrics. 2002 May;109(5):772–9.Google Scholar
Clancy, RR, Dicker, L, Cho, S, et al. Agreement between long-term neonatal background classification by conventional and amplitude-integrated EEG. J Clin Neurophysiol. 2011 Feb;28(1):1–9.Google Scholar
Hallberg, B, Grossmann, K, Bartocci, M, Blennow, M. The prognostic value of early aEEG in asphyxiated infants undergoing systemic hypothermia treatment. Acta Paediatr. 2010 Apr;99(4):531–6.Google Scholar
Thoresen, M, Hellström-Westas, L, Liu, X, de Vries, LS. Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics. 2010 Jul;126(1):e131–9.Google Scholar
Burdjalov, VF, Baumgart, S, Spitzer, AR. Cerebral function monitoring: a new scoring system for the evaluation of brain maturation in neonates. Pediatrics. 2003 Oct;112(4):855–61.Google Scholar
Olischar, M, Klebermass, K, Kuhle, S, et al. Reference values for amplitude-integrated electroencephalographic activity in preterm infants younger than 30 weeks’ gestational age. Pediatrics. 2004 Jan;113(1 Pt 1):e61–6.CrossRefGoogle ScholarPubMed
Hellström-Westas, L. Continuous electroencephalography monitoring of the preterm infant. Clin Perinatol. 2006 Sep;33(3):633–47, vi.Google Scholar
Shah, DK, Mackay, MT, Lavery, S, et al. Accuracy of bedside electroencephalographic monitoring in comparison with simultaneous continuous conventional electroencephalography for seizure detection in term infants. Pediatrics. 2008 Jun;121(6):1146–54.Google Scholar
Rennie, JM, Chorley, G, Boylan, GB, et al. Pressler, R, Nguyen, Y, Hooper, R. Non-expert use of the cerebral function monitor for neonatal seizure detection. Arch Dis Child Fetal Neonatal Ed. 2004 Jan;89(1):F37–40.Google Scholar
Wusthoff, CJ, Shellhaas, RA, Clancy, RR. Limitations of single-channel EEG on the forehead for neonatal seizure detection. J Perinatol. 2009 Mar;29(3):237–42.Google Scholar
de Vries, NK, Ter Horst, HJ, Bos, AF. The added value of simultaneous EEG and amplitude-integrated EEG recordings in three newborn infants. Neonatology. 2007;91(3):212–16.Google Scholar
Evans, E, Koh, S, Lerner, J, Sankar, R, Garg, M. Accuracy of amplitude integrated EEG in a neonatal cohort. Arch Dis Child Fetal Neonatal Ed. 2010 May;95(3):F169–73.CrossRefGoogle Scholar
Suk, D, Krauss, AN, Engel, M, Perlman, JM. Amplitude-integrated electroencephalography in the NICU: frequent artifacts in premature infants may limit its utility as a monitoring device. Pediatrics. 2009 Feb;123(2):e328–32.CrossRefGoogle ScholarPubMed
Stewart, CP, Otsubo, H, Ochi, A, et al. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010 Oct 26;75(17):1501–8.Google Scholar
Akman, CI, Micic, V, Thompson, A, Riviello, JJ, Jr. Seizure detection using digital trend analysis: factors affecting utility. Epilepsy Res. 2011 Jan;93(1):66–72.Google Scholar
Pensirikul, AD, Beslow, LA, Kessler, SK, et al. Density spectral array for seizure identification in critically ill children. J Clin Neurophysiol. 2013 Aug;30(4):371–5.CrossRefGoogle ScholarPubMed
Topjian, AA, Fry, M, Jawad, AF, et al. Detection of electrographic seizures by critical care providers using color density spectral array after cardiac arrest is feasible. Pediatr Crit Care Med. 2015 Jun;16(5):461–7.Google Scholar
Dericioglu, N, Yetim, E, Bas, DF, et al. Non-expert use of quantitative EEG displays for seizure identification in the adult neuro-intensive care unit. Epilepsy Res. 2015 Jan;109:48–56.Google Scholar
Swisher, CB, White, CR, Mace, BE, et al. Diagnostic accuracy of electrographic seizure detection by neurophysiologists and non-neurophysiologists in the adult ICU using a panel of quantitative EEG trends. J Clin Neurophysiol. 2015 Aug;32(4):324–30.Google Scholar
Haider, HA, Esteller, R, Hahn, CD, et al.; Critical Care EEG Monitoring Research Consortium. Sensitivity of quantitative EEG for seizure identification in the intensive care unit. Neurology. 2016 Aug 30;87(9):935–44.Google Scholar

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