Seizure Characteristics and EEG Features in Intoxication Type and Energy Deficiency Neurometabolic Disorders in the Pediatric Intensive Care Unit: Single-Center Experience Over 10 Years.

Acute metabolic crisis Hyperammonemia Inborn errors of metabolism Maple syrup urine disease Mitochondrial disorders Organic acidemias Urea cycle disorders

Journal

Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086

Informations de publication

Date de publication:
13 Aug 2024
Historique:
received: 21 02 2024
accepted: 09 07 2024
medline: 14 8 2024
pubmed: 14 8 2024
entrez: 14 8 2024
Statut: aheadofprint

Résumé

Acute metabolic crises in inborn errors of metabolism (such as urea cycle disorders, organic acidemia, maple syrup urine disease, and mitochondrial disorders) are neurological emergencies requiring management in the pediatric intensive care unit (PICU). There is a paucity of data pertaining to electroencephalograms (EEG) characteristics in this cohort. We hypothesized that the incidence of background abnormalities and seizures in this cohort would be high. Neuromonitoring data from our center's PICU over 10 years are presented in this article. Data were collected by retrospective chart review for patients with the aforementioned disorders who were admitted to the PICU at our institution because of metabolic/neurologic symptoms from 2008 to 2018. Descriptive statistics (χ Our cohort included 40 unique patients (8 with urea cycle disorder, 7 with organic acidemia, 3 with maple syrup urine disease, and 22 with mitochondrial disease) with 153 admissions. Presenting symptoms included altered mentation (36%), seizures (41%), focal weakness (5%), and emesis (28%). Continuous EEG was ordered in 34% (n = 52) of admissions. Twenty-three admissions were complicated by seizures, including eight manifesting as status epilepticus (seven nonconvulsive and one convulsive). Asymmetry and focal slowing on EEG were associated with seizures. Moderate background slowing or worse was noted in 75% of EEGs. Among those patients monitored on EEG, 4 (8%) died, 3 (6%) experienced a worsening of their Pediatric Cerebral Performance Category (PCPC) score as compared to admission, and 44 (86%) had no change (or improvement) in their PCPC score during admission. This study shows a high incidence of clinical and subclinical seizures during metabolic crisis in patients with inborn errors of metabolism. EEG background features were associated with risk of seizures as well as discharge outcomes. This is the largest study to date to investigate EEG features and risk of seizures in patients with neurometabolic disorders admitted to the PICU. These data may be used to inform neuromonitoring protocols to improve mortality and morbidity in inborn errors of metabolism.

Sections du résumé

BACKGROUND BACKGROUND
Acute metabolic crises in inborn errors of metabolism (such as urea cycle disorders, organic acidemia, maple syrup urine disease, and mitochondrial disorders) are neurological emergencies requiring management in the pediatric intensive care unit (PICU). There is a paucity of data pertaining to electroencephalograms (EEG) characteristics in this cohort. We hypothesized that the incidence of background abnormalities and seizures in this cohort would be high. Neuromonitoring data from our center's PICU over 10 years are presented in this article.
METHODS METHODS
Data were collected by retrospective chart review for patients with the aforementioned disorders who were admitted to the PICU at our institution because of metabolic/neurologic symptoms from 2008 to 2018. Descriptive statistics (χ
RESULTS RESULTS
Our cohort included 40 unique patients (8 with urea cycle disorder, 7 with organic acidemia, 3 with maple syrup urine disease, and 22 with mitochondrial disease) with 153 admissions. Presenting symptoms included altered mentation (36%), seizures (41%), focal weakness (5%), and emesis (28%). Continuous EEG was ordered in 34% (n = 52) of admissions. Twenty-three admissions were complicated by seizures, including eight manifesting as status epilepticus (seven nonconvulsive and one convulsive). Asymmetry and focal slowing on EEG were associated with seizures. Moderate background slowing or worse was noted in 75% of EEGs. Among those patients monitored on EEG, 4 (8%) died, 3 (6%) experienced a worsening of their Pediatric Cerebral Performance Category (PCPC) score as compared to admission, and 44 (86%) had no change (or improvement) in their PCPC score during admission.
CONCLUSIONS CONCLUSIONS
This study shows a high incidence of clinical and subclinical seizures during metabolic crisis in patients with inborn errors of metabolism. EEG background features were associated with risk of seizures as well as discharge outcomes. This is the largest study to date to investigate EEG features and risk of seizures in patients with neurometabolic disorders admitted to the PICU. These data may be used to inform neuromonitoring protocols to improve mortality and morbidity in inborn errors of metabolism.

Identifiants

DOI: 10.1007/s12028-024-02073-4 PMID: 39138714
pubmed: 39138714
doi: 10.1007/s12028-024-02073-4
pii: 10.1007/s12028-024-02073-4
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Children's National Board of Visitors/ Founders Auxiliary Board Grant
ID : FY 2021 CHB Award 9 6005920

Informations de copyright

© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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Auteurs

Kuntal Sen (K)

Division of Neurogenetics and Neurodevelopmental Pediatrics, Center for Neuroscience and Behavioral Medicine, GWU School of Medicine and Health Sciences, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA. ksen2@childrensnational.org.

Dana Harrar (D)

Division of Child Neurology, Children's National Hospital, Washington, DC, USA.

Nicole Pariseau (N)

Division of Child Neurology, Children's National Hospital, Washington, DC, USA.
Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, USA.

Karis Tucker (K)

Division of Neurogenetics and Neurodevelopmental Pediatrics, Center for Neuroscience and Behavioral Medicine, GWU School of Medicine and Health Sciences, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA.

Julia Keenan (J)

Division of Child Neurology, Children's National Hospital, Washington, DC, USA.

Anqing Zhang (A)

Department of Biostatistics, Children's National Hospital, Washington, DC, USA.

Andrea Gropman (A)

Division of Neurogenetics and Neurodevelopmental Pediatrics, Center for Neuroscience and Behavioral Medicine, GWU School of Medicine and Health Sciences, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA.

Classifications MeSH