Description of Patterns in Reduced-Lead Electroencephalography Performed for Suspected Electrographic Seizures in Pediatric Patients With Altered Mental Status Using Standardized Terminology.

BACKGROUND

This study aimed to analyze and describe reduced-lead electroencephalographic (EEG) data for suspected electrographic seizure (ESz) in pediatric patients presenting with altered mental status (AMS) in the emergency department (ED) according to standardized EEG terminology. The secondary aim was to compare the characteristics of these EEG patterns across febrile seizure (FS), acute encephalopathy/encephalitis (AE/AES), and epilepsy.

METHODS

Epileptologists retrospectively analyzed the medical records and findings of reduced-lead EEG performed for suspected ESz in pediatric patients with AMS in ED between March 1, 2019, and February 28, 2023. Fifty-one EEG results with few artifacts were extracted; these patterns were described according to the American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology 2021. The obtained clinical diagnoses were categorized into three groups: FS, AE/AES, and epilepsy, and the characteristics of EEG patterns were compared.

RESULTS

Clinical seizure types were not significantly different between FS, AE/AES, and epilepsy. In terms of EEG, there was no difference in Main term 1 (localization) among the groups. With regard to Main term 2 (morphology), patients with FS and AE/AES had commonly rhythmic delta activity, whereas patients with epilepsy had significantly more spikes and waves. ESz was observed in 25 patients; their incidence was significantly higher in the epilepsy group.

CONCLUSIONS

This is the first study to describe patterns in reduced-lead EEG performed for suspected ESz in pediatric patients with AMS due to disorders commonly encountered in the ED by using standardized EEG terminology and to compare EEG patterns among these disorders.