Cerebral oximetry monitoring in pediatric seizure patients in the emergency department

Introduction

During ictal/post-ictal events, altered cerebral physiology occurs: increased neuronal activity causes significant increase in cerebral metabolism with changes in ipsilateral cerebral blood flow. Standard PED seizure monitoring is by O₂SAT and ETCO₂ which yield no direct data about regional cerebral oxygenation/physiology (rSO₂). Significant abnormal hemispheric cerebral physiology resulting in neurological injury can occur without knowing because the current monitoring system could not detect the abnormal hemispheric abnormality. Cerebral oximetry can provide a rapid, non-invasive detection of each hemisphere's cerebral physiologic changes during ictal/post-ictal phases. The aim was to study left and right rSO₂ values in patients in the pre and post seizure periods and in nonseizing controls.

Methods

An observational study of seizing and nonseizing patient's left and right rSO₂ readings compared with nonseizure patients.

Results

No difference for ictal left and right rSO₂ readings across ages. See Figure 1.

Figure 1

Conclusion

We have demonstrated abnormal hemispheric cerebral physiology during focal or generalized ictal activity. In patients with generalized seizures, the left and right rSO₂ values were significantly decreased. In patients with focal seizures, the ipsilateral rSO₂ values were significantly different from the contralateral rSO₂ readings and correlated to the hemisphere experiencing the focal seizure. In certain patients, during the ictal phase their rSO₂ readings rose and stayed or rose then dropped. Overall, cerebral oximetry has shown great monitoring potential for actively seizing patients in the emergency department.