Hemispheric Cerebral Oximetry Monitoring During Pediatric Seizure Activity in a Pediatric Emergency Department

Sustained neuronal activity during seizures causes cellular perturbations, alterations in cerebral physiology, and potentially neurological injury, a neurological emergency. With variable clinical manifestations of seizures, frequent failure of seizure recognition by providers in pediatric and developmentally challenged patients can increase seizure complications. Neuroresuscitation should include rapid cerebral physiology assessment for increased seizure recognition and optimal neurological outcomes. In neurological emergencies, cerebral oximetry has demonstrated its utility in altered cerebral physiology and a standard combat neurological assessment tool. During adult seizures, cerebral oximetry (regional cerebral oxygen saturation [r(c)SO(2)]) has been shown as a useful neurological assessment tool, but research is lacking in pediatric emergency department (PED) seizure patients. OBJECTIVE: The aim of this study was to identify trends in r(c)SO(2) readings for patients presenting to the PED with seizure activity and in the postseizure state in order to evaluate usefulness of r(c)SO(2) as a neurological assessment tool in pediatric seizure patients. METHODS: This was a PED observational case series comparing hemispheric r(c)SO(2) readings in first-time clinically evident generalized and focal seizure patients to first-time postseizure patients with no PED seizures. RESULTS: Generalized or focal seizure (n = 185) hemispheric r(c)SO(2) revealed significant differences compared with nonseizure and controls' r(c)SO(2) readings (n = 115) (P < 0.0001). Generalized and focal seizure r(c)SO(2)'s were either less than 60% or greater than 80% compared with nonseizure r(c)SO(2) (P < 0.0001). Ipsilateral focal seizure r(c)SO(2) correlated to seizure side (P < 0.0001) and was less than the contralateral r(c)SO(2) (P < 0.0001), with interhemispheric r(c)SO(2) discordance greater than 16 (P < 0.0001). Seizure to preseizure r(c)SO(2) discordance was as follows: generalized 15.2, focal: left 19.8, right 20.3 (P < 0.0001). CONCLUSIONS: Hemispheric during-seizure r(c)SO(2) readings significantly correlated with generalized and focal seizures and reflected altered cerebral physiology. Ipsilateral focal seizure r(c)SO(2) readings correlated to the focal side with wide interhemispheric r(c)SO(2) discordance. All postseizure r(c)SO(2) readings returned to preseizure readings, showing altered cerebral physiology resolution. Overall, in generalized or focal seizure, r(c)SO(2) readings were less than 60% or greater than 80%, and in focal seizure, interhemispheric r(c)SO(2) discordance was greater than 10. During seizures, hemispheric r(c)SO(2) readings demonstrated its potential pediatric seizure utility. Utilizing r(c)SO(2) readings related to seizure activity could expedite pediatric and developmentally challenged patients' seizure recognition, cerebral assessment, and interventions especially in pharmacoresistant seizures.