Periodic and rhythmic patterns in critically ill children: Incidence, interrater agreement, and seizures

Objectives We aimed to determine the incidence of periodic and rhythmic patterns (PRP), assess the interrater agreement between electroencephalographers scoring PRP using standardized terminology, and analyze associations between PRP and electrographic seizures (ES) in critically ill children. Metho...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2021-12, Vol.62 (12), p.2955-2967
Main Authors: Fung, France W., Parikh, Darshana S., Massey, Shavonne L., Fitzgerald, Mark P., Vala, Lisa, Donnelly, Maureen, Jacobwitz, Marin, Kessler, Sudha K., Topjian, Alexis A., Abend, Nicholas S.
Format: Article
Language:English
Subjects:
Child
Children
Convulsions & seizures
Critical Illness - epidemiology
EEG
electroencephalogram
Electroencephalography
Humans
ictal–interictal continuum
Incidence
Monitoring, Physiologic
pediatric
Pediatrics
periodic
rhythmic
Rhythms
seizure
Seizures
Seizures - diagnosis
Seizures - epidemiology
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Summary:Objectives We aimed to determine the incidence of periodic and rhythmic patterns (PRP), assess the interrater agreement between electroencephalographers scoring PRP using standardized terminology, and analyze associations between PRP and electrographic seizures (ES) in critically ill children. Methods This was a prospective observational study of consecutive critically ill children undergoing continuous electroencephalographic monitoring (CEEG). PRP were identified by one electroencephalographer, and then two pediatric electroencephalographers independently scored the first 1‐h epoch that contained PRP using standardized terminology. We determined the incidence of PRPs, evaluated interrater agreement between electroencephalographers scoring PRP, and evaluated associations between PRP and ES. Results One thousand three hundred ninety‐nine patients underwent CEEG. ES occurred in 345 (25%) subjects. PRP, ES + PRP, and ictal–interictal continuum (IIC) patterns occurred in 142 (10%), 81 (6%), and 93 (7%) subjects, respectively. The most common PRP were generalized periodic discharges (GPD; 43, 30%), lateralized periodic discharges (LPD; 34, 24%), generalized rhythmic delta activity (GRDA; 34, 24%), bilateral independent periodic discharges (BIPD; 14, 10%), and lateralized rhythmic delta activity (LRDA; 11, 8%). ES risk varied by PRP type (p 
ISSN:0013-9580
1528-1167
DOI:10.1111/epi.17068