Division of Pediatric Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
Medical Scientist Training Program, Washington University School of Medicine, Washington University School of Medicine, St. Louis, Missouri, U.S.A.
J Clin Neurophysiol. 2022 Nov 1;39(7):602-609. doi: 10.1097/WNP.0000000000000828. Epub 2021 Feb 9.
Seizures occur in 10% to 40% of critically ill children. We describe a phenomenon seen on color density spectral array but not raw EEG associated with seizures and acquired brain injury in pediatric patients.
We reviewed EEGs of 541 children admitted to an intensive care unit between October 2015 and August 2018. We identified 38 children (7%) with a periodic pattern on color density spectral array that oscillates every 2 to 5 minutes and was not apparent on the raw EEG tracing, termed macroperiodic oscillations (MOs). Internal validity measures and interrater agreement were assessed. We compared demographic and clinical data between those with and without MOs.
Interrater reliability yielded a strong agreement for MOs identification (kappa: 0.778 [0.542-1.000]; P < 0.0001). There was a 76% overlap in the start and stop times of MOs among reviewers. All patients with MOs had seizures as opposed to 22.5% of the general intensive care unit monitoring population ( P < 0.0001). Macroperiodic oscillations occurred before or in the midst of recurrent seizures. Patients with MOs were younger (median of 8 vs. 208 days; P < 0.001), with indications for EEG monitoring more likely to be clinical seizures (42 vs. 16%; P < 0.001) or traumatic brain injury (16 vs. 5%, P < 0.01) and had fewer premorbid neurologic conditions (10.5 vs. 33%; P < 0.01).
Macroperiodic oscillations are a slow periodic pattern occurring over a longer time scale than periodic discharges in pediatric intensive care unit patients. This pattern is associated with seizures in young patients with acquired brain injuries.
在 10%至 40%的危重病儿童中会出现癫痫发作。我们描述了一种在彩色密度频谱图上观察到的现象，但在原始脑电图上没有发现，与儿科患者的癫痫发作和获得性脑损伤有关。
我们回顾了 2015 年 10 月至 2018 年 8 月期间入住重症监护病房的 541 名儿童的脑电图。我们确定了 38 名儿童（7%）在彩色密度频谱图上出现周期性模式，每隔 2 到 5 分钟出现一次，在原始脑电图描记上不明显，称为宏观周期性振荡（MOs）。评估了内部有效性测量和组间一致性。我们比较了有和没有 MOs 的儿童的人口统计学和临床数据。
MOs 识别的组间可靠性产生了强烈的一致性（kappa：0.778 [0.542-1.000]；P<0.0001）。两位审阅者在 MOs 的开始和停止时间上有 76%的重叠。所有有 MOs 的患者都有癫痫发作，而普通重症监护病房监测人群中只有 22.5%（P<0.0001）。MOs 出现在反复癫痫发作之前或之中。有 MOs 的患者年龄较小（中位数为 8 天与 208 天；P<0.001），进行脑电图监测的指征更可能是临床癫痫发作（42%与 16%；P<0.001）或创伤性脑损伤（16%与 5%，P<0.01），且更少存在先前的神经系统疾病（10.5%与 33%；P<0.01）。
宏观周期性振荡是一种在儿科重症监护病房患者中出现的较慢的周期性模式，比周期性放电出现的时间更长。这种模式与年轻获得性脑损伤患者的癫痫发作有关。
