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Continuous EEG monitoring in Kenyan children with non-traumatic coma
  1. Samson Gwer1,2,
  2. Richard Idro1,3,
  3. Gregory Fegan1,4,
  4. Edwin Chengo1,
  5. Harrun Garrashi2,
  6. Steve White5,
  7. Fenella J Kirkham6,7,
  8. Charles R Newton1,7,8
  1. 1Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya
  2. 2Department of Clinical Research, Afya Research Africa, Nairobi, Kenya
  3. 3Department of Paediatrics and Child Health, Mulago Hospital/Makerere University, Kampala, Uganda
  4. 4Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  5. 5Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK
  6. 6Department of Child Health, Southampton General Hospital, Southampton, UK
  7. 7Neurosciences Unit, University College London Institute of Child Health, London, UK
  8. 8Department of Psychiatry, University of Oxford, Oxford, UK
  1. Correspondence to Dr Samson Gwer, Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute–Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya; samgwer{at}gmail.com

Abstract

Background The aim of this study was to describe the EEG and clinical profile 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 defined as death or gross motor deficits 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.

This paper is freely available online under the BMJ Journals unlocked scheme, see http://adc.bmj.com/info/unlocked.dtl

https://doi.org/10.1136/archdischild-2011-300935

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    Footnotes

    • Funding This research was supported by the Wellcome Trust, UK, through a senior research fellowship awarded to CN (070114). SG was supported by a Wellcome Trust strategic award for training to the Kenya Medical Research Institute.

      This manuscript is published with the permission of the Director of the Kenya Medical Research Institute.

    • Competing interests None.

    • Ethics approval This study was approved by the Kenya Medical Research Institute Ethics Committee (SSC No 1249).

    • Provenance and peer review Not commissioned; externally peer reviewed.