Neuro-cardiology researchers have found that there should be an increase in perioperative electroencephalogram (EEG) monitoring for certain patients. They discovered a high incidence of epilepsy in children who are suffering from congenital heart disease. Also, researchers noticed that there is a higher incidence in children who suffer from perioperative clinical seizures.
The survival rates among children with congenital heart disease is high and the pediatric surgical teams working with these patients have shifted their goals to help improve the overall functional outcomes for the patients. They want to make sure that they have provided patients with a more positive future. Of course, this goal will only be possible when there is collaboration between all of the medical providers who are a part of these patients’ care. These providers include: neurologists, developmental pediatricians, physiotherapists, occupational therapists, as well as others.
A team of these providers and other related disciplines worked together with researchers at the Clinique d’Investigation Neuro-Cardiaque (CINC), Sainte-Justine, Montreal, and Canada. Head investigators of the study were part of the team too. The goal was to launch an investigation of the “incidence and risk factors of perioperative clinical seizures and epilepsy in children who undergo cardiac surgery for complex CHD.”
How Was the Study Conducted?
The investigators were able to locate 128 children with congenital heart disease who had gone through cardiac surgery “with or without cardiopulmonary bypass at a neurocardiac clinic to follow for a period of at least two years.” They defined perioperative clinical seizures as those that occurred “before the first surgery or less than 21 days after any surgery” and defined epilepsy as “seizure recurrence more than 21 days after surgery.”
What Did the Research Find?
Out of the patients that they were watching, four (3.1%) of the 128 developed epilepsy and the median age was 7.75 months with a range from two to 26 months. There were 10 patients who went through perioperative clinical seizures and four (40%) of those patients developed epilepsy.
The research showed that clinical seizures tended to be the most common for patients who had a higher Risk Adjustment for Congenital Heart Surgery score and those who had “delayed sternal closure and use of extra corporeal membrane oxygenation (ECMO).” In addition, these patients needed to have a longer amount of time in the pediatric intensive care unit and tended to be in the hospitals longer overall.
Patients who had “longer cardio-pulmonary bypass aortic pump time and hypothermic circulatory arrest” were at a higher risk for having clinical seizures. Longer hospital stays and the use of extra corporeal membrane oxygenation were also associated with epilepsy.
The researchers say that there was not systematic EEG monitoring during the cohort, but the research had “detected one additional patient with a preoperative EEG-only seizure.” They went on to say that they believe the number of children (7.8%) who are reported as having clinically apparent seizures is an “underrepresentation of the actual incidence of seizures and those at highest risk of epilepsy.”
They said that there were zero patients without perioperative clinical seizures who went on to develop epilepsy and they believe that “both clinical and EEG-only seizures are equally involved with epileptogenesis.” Researchers also believe that those who are undiagnosed and those who have untreated EEG-only seizures will often “persist longer and eventually manifest clinically.”
Researchers think this shows just how important it is to provide perioperative EEG monitoring to patients, since this is a critical period and can be a good indicator of later epilepsy in a patient. They advocate for more use of EEG monitoring, particularly in infants who may be vulnerable to suffering seizures and potentially developing epilepsy.