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Continuous EEG monitoring in Kenyan children with non-traumatic coma

Continuous EEG monitoring in Kenyan children with non-traumatic coma
Continuous EEG monitoring in Kenyan children with non-traumatic coma

Background: The aim of this study was to describe the EEG and clinical profi le of seizures in children with non-traumatic coma, compare seizure detection by clinical observations with that by continuous EEG, and relate EEG features to outcome. Methods: This prospective observational study was conducted at the paediatric high dependency unit of Kilifi District Hospital, Kenya. Children aged 9 months to 13 years presenting with acute coma were monitored by EEG for 72 h or until they regained consciousness or died. Poor outcome was defi ned as death or gross motor defi cits at discharge. Results: 82 children (median age 2.8 (IQR 2.0-3.9) years) were recruited. An initial medium EEG amplitude (100-300 mV) was associated with less risk of poor outcome compared to low amplitude (≤100 mV) (OR 0.2, 95% CI 0.1 to 0.7; p<0.01). 363 seizures in 28 (34%) children were observed: 240 (66%) were electrographic and 112 (31%) electroclinical. In 16 (20%) children, electrographic seizures were the only seizure types detected. The majority (63%) of electroclinical seizures had focal clinical features but appeared as generalised (79%) or focal with secondary generalisation (14%) on EEG. Occurrence of any seizure or status epilepticus during monitoring was associated with poor outcome (OR 3.2, 95% CI 1.2 to 8.7; p=0.02 and OR 4.5, 95% CI 1.3 to 15.3; p<0.01, respectively). Conclusion: Initial EEG background amplitude is prognostic in paediatric non-traumatic coma. Clinical observations do not detect two out of three seizures. Seizures and status epilepticus after admission are associated with poor outcome.

0003-9888
343-349
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Fegan, Gregory
665c804f-5687-40f3-b40c-ccd88540f7aa
Chengo, Edwin
da6a4108-a2e0-4d76-aca2-f0ee7966ea5d
Garrashi, Harrun
b5b9638c-0eaa-461d-bd1d-e7d127754f27
White, Steve
9cef0fdf-45ac-4e31-b8ae-da060d865ca6
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Fegan, Gregory
665c804f-5687-40f3-b40c-ccd88540f7aa
Chengo, Edwin
da6a4108-a2e0-4d76-aca2-f0ee7966ea5d
Garrashi, Harrun
b5b9638c-0eaa-461d-bd1d-e7d127754f27
White, Steve
9cef0fdf-45ac-4e31-b8ae-da060d865ca6
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Newton, Charles R.
ea661613-9a2d-4e14-8d04-2d1c0804a321

Gwer, Samson, Idro, Richard, Fegan, Gregory, Chengo, Edwin, Garrashi, Harrun, White, Steve, Kirkham, Fenella J. and Newton, Charles R. (2012) Continuous EEG monitoring in Kenyan children with non-traumatic coma. Archives of Disease in Childhood, 97 (4), 343-349. (doi:10.1136/archdischild-2011-300935).

Record type: Article

Abstract

Background: The aim of this study was to describe the EEG and clinical profi le of seizures in children with non-traumatic coma, compare seizure detection by clinical observations with that by continuous EEG, and relate EEG features to outcome. Methods: This prospective observational study was conducted at the paediatric high dependency unit of Kilifi District Hospital, Kenya. Children aged 9 months to 13 years presenting with acute coma were monitored by EEG for 72 h or until they regained consciousness or died. Poor outcome was defi ned as death or gross motor defi cits at discharge. Results: 82 children (median age 2.8 (IQR 2.0-3.9) years) were recruited. An initial medium EEG amplitude (100-300 mV) was associated with less risk of poor outcome compared to low amplitude (≤100 mV) (OR 0.2, 95% CI 0.1 to 0.7; p<0.01). 363 seizures in 28 (34%) children were observed: 240 (66%) were electrographic and 112 (31%) electroclinical. In 16 (20%) children, electrographic seizures were the only seizure types detected. The majority (63%) of electroclinical seizures had focal clinical features but appeared as generalised (79%) or focal with secondary generalisation (14%) on EEG. Occurrence of any seizure or status epilepticus during monitoring was associated with poor outcome (OR 3.2, 95% CI 1.2 to 8.7; p=0.02 and OR 4.5, 95% CI 1.3 to 15.3; p<0.01, respectively). Conclusion: Initial EEG background amplitude is prognostic in paediatric non-traumatic coma. Clinical observations do not detect two out of three seizures. Seizures and status epilepticus after admission are associated with poor outcome.

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Published date: April 2012

Identifiers

Local EPrints ID: 429119
URI: http://eprints.soton.ac.uk/id/eprint/429119
ISSN: 0003-9888
PURE UUID: 2b88aeb8-ccbe-4676-afd4-d5fef119f021
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 21 Mar 2019 17:30
Last modified: 13 Aug 2022 01:39

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Contributors

Author: Samson Gwer
Author: Richard Idro
Author: Gregory Fegan
Author: Edwin Chengo
Author: Harrun Garrashi
Author: Steve White
Author: Charles R. Newton

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