**8. Common clinical applications of EEG in children**

Although the diagnosis of epilepsy is primarily made by clinical history, EEG remains an essential investigational tool to differentiate between epileptic and non-epileptic events, it's also important in the classification of different types of epilepsy and epilepsy syndromes [44–46]. Frequent classical epileptiform abnormalities seen in Pediatric population are hypsarrhythmia associated with infantile spasm, 3 Hz spike and wave discharges in absence epilepsy and burst suppression (**Figures 7** and **8**) [46].

According to the American Academy of Neurology and Child Neurology Society, EEG is recommended in children presented with their first attack of unprovoked seizure [49]. EEG is indicated in children with atypical febrile convulsion or prolonged febrile seizure and it is an essential investigational study in patients with newly diagnosed epilepsy and in classification of common childhood epilepsy syndromes such as centrotemporal spikes associated with benign rolandic epilepsy and Panayiotopoulos syndrome (idiopathic childhood epilepsy). EEG is also important in recording continuous spike-waves during slow-wave sleep (CSWS) in epileptic encephalopathies (**Figures 9** and **10**) [50].

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epilepsy [50].

**Figure 9.**

*epilepsy [51].*

**Figure 8.**

*EEG with burst suppression [48].*

have seizure post-surgery [53].

*Basic Electroencephalogram and Its Common Clinical Applications in Children*

Pediatric patients diagnosed with autistic spectrum disorder (ASD) with positive history of epilepsy and abnormal findings in the neurological examination, EEG study is indicated as a part of their screening tests. EEG is also recommended in monitoring antiepileptic medication in patients with confirmed diagnosis of

*EEG showing left centrotemporal epileptiform spike and wave discharges in patients with benign rolandic* 

The background EEG monitoring has been also used in children with traumatic brain injury which is helpful in evaluating prognosis in these patients [50, 53]. EEG study with poor reactivity, prolonged discontinuity and burst suppression associated with poor prognosis, whereas EEG with good reactivity and normal sleep rhythm favor a good prognosis [53]. A prolonged EEG recording is also essential in children admitted to the PICU (Pediatric Intensive Care Unit) with suspected non-convulsive seizures (NCS). It has been also important in monitoring Pediatric patients underwent surgery for congenital cardiac anomalies as they are at risk to

*DOI: http://dx.doi.org/10.5772/intechopen.94247*

### *Basic Electroencephalogram and Its Common Clinical Applications in Children DOI: http://dx.doi.org/10.5772/intechopen.94247*

#### **Figure 8.** *EEG with burst suppression [48].*

*Electroencephalography - From Basic Research to Clinical Applications*

**8. Common clinical applications of EEG in children**

benign variations of normal EEG study [40, 41].

mended by all epileptologists [38].

(**Figures 7** and **8**) [46].

encephalopathies (**Figures 9** and **10**) [50].

It is vitally important to ensure proper education and gain enough experience to read and interpret EEG recording in order to avoid misdiagnosis of epilepsy and to provide better care to the patient. It is also essential to appreciate the common

A common normal patterns seen in EEG study which can be falsely interpreted as abnormal epileptiform discharges include multifocal sharp waves and spikes, generalized slowing with hyperventilation, hypnagogic hypersynchrony and most commonly is the background alteration at the temporal area (**Figures 5** and **6**) [38]. Over interpretation of normal EEG tracing is the main factor for misdiagnosis of

epilepsy and seizure disorders. Improper neurophysiological training and inadequate experience is the major reason for over interpretation of normal EEG study. Conservative EEG interpretation and avoiding biased history are strongly recom-

Although the diagnosis of epilepsy is primarily made by clinical history, EEG remains an essential investigational tool to differentiate between epileptic and non-epileptic events, it's also important in the classification of different types of epilepsy and epilepsy syndromes [44–46]. Frequent classical epileptiform abnormalities seen in Pediatric population are hypsarrhythmia associated with infantile spasm, 3 Hz spike and wave discharges in absence epilepsy and burst suppression

According to the American Academy of Neurology and Child Neurology Society, EEG is recommended in children presented with their first attack of unprovoked seizure [49]. EEG is indicated in children with atypical febrile convulsion or prolonged febrile seizure and it is an essential investigational study in patients with newly diagnosed epilepsy and in classification of common childhood epilepsy syndromes such as centrotemporal spikes associated with benign rolandic epilepsy and Panayiotopoulos syndrome (idiopathic childhood epilepsy). EEG is also important in recording continuous spike-waves during slow-wave sleep (CSWS) in epileptic

**142**

**Figure 7.**

*EEG tracing showing bilateral, diffuse, high amplitude slow waves seen in hypsarrhythmia [47].*

#### **Figure 9.**

*EEG showing left centrotemporal epileptiform spike and wave discharges in patients with benign rolandic epilepsy [51].*

Pediatric patients diagnosed with autistic spectrum disorder (ASD) with positive history of epilepsy and abnormal findings in the neurological examination, EEG study is indicated as a part of their screening tests. EEG is also recommended in monitoring antiepileptic medication in patients with confirmed diagnosis of epilepsy [50].

The background EEG monitoring has been also used in children with traumatic brain injury which is helpful in evaluating prognosis in these patients [50, 53]. EEG study with poor reactivity, prolonged discontinuity and burst suppression associated with poor prognosis, whereas EEG with good reactivity and normal sleep rhythm favor a good prognosis [53]. A prolonged EEG recording is also essential in children admitted to the PICU (Pediatric Intensive Care Unit) with suspected non-convulsive seizures (NCS). It has been also important in monitoring Pediatric patients underwent surgery for congenital cardiac anomalies as they are at risk to have seizure post-surgery [53].

Viral encephalitis is an inflammatory infectious neurological disease that affects the central nervous system (CNS) which triggers an immune response by the viral antigen causing damage to the brain parenchyma and associated with electrical disturbance of the brain activity [54]. Viral encephalitis is common in children with Herpes Simplex Virus (HSV) being the commonest agent for encephalitis in Pediatric population [54, 55]. EEG study is considered to be a part in the investigational work up in patients with viral encephalitis [56]. Patients with Herpes Simplex Encephalitis (HSE) found to have significant EEG changes in the early stage of the diagnosis. Unilateral Periodic Lateralized Epileptiform Discharges (PLED) is considered to be the most typical EEG finding which correlate with diagnosis of HSE [57] and found to have a good outcome as compared to bilateral periodic lateralized epileptiform discharges which associated with unfavorable prognosis (**Figure 11**) [58].

**Figure 10.**

*Occipital spike and wave discharges seen in panayiotopoulos syndrome [52].*

#### **Figure 11.**

*Periodic lateralized epileptiform discharges (PLED) over the right central-temporal head regions seen in HSE [59].*

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**9. Conclusion**

**Figure 12.**

**Conflict of interest**

The author declares no conflict of interest.

*Basic Electroencephalogram and Its Common Clinical Applications in Children*

EEG study can be also used as an ancillary test to support the diagnosis of brain death. Although positive diagnosis of brain death can be made by two separate settings of clinical examination, The American Neurological Association strongly suggest the use of EEG study to confirm the diagnosis of brain death. Hypothermia and hypotension should be avoided when applying EEG for brain death assessment [60]. Isoelectric encephalogram is confirmed when 30 minutes of EEG recording reveals complete absence of cerebral activity with sensitivity over 2 μV/mm in the absence of electrolyte disturbance and sedative medications (**Figure 12**) [61].

*Isoelectric EEG. No cerebral brain activity with sensitivity over 2* μ*V/mm [62].*

EEG is considered to be save non-invasive procedure since its first application early in the 20th century. This procedure is done by trained EEG technicians and it should be interpreted by Neurologist or expert Neurophysiologists in order to obtain a high quality report to reach a proper diagnosis and provide optimal management to the patient. Performing EEG study in children can be a difficult task because of the great fear and anxiety in this age group patients, so its vitally important to properly prepare these patients to minimize EEG artifacts for better interpretation of the EEG report. EEG is an essential neurophysiological study especially in Pediatric patients to differentiate epileptic form and non-epileptic events as the differential diagnosis for paroxysmal episodes in children is wide and varies according to certain age group. Although the diagnosis of brain death is primarily made on clinical basis, EEG remains an important ancillary test for diagnostic confirmation of brain death.

*DOI: http://dx.doi.org/10.5772/intechopen.94247*

*Basic Electroencephalogram and Its Common Clinical Applications in Children DOI: http://dx.doi.org/10.5772/intechopen.94247*

**Figure 12.** *Isoelectric EEG. No cerebral brain activity with sensitivity over 2* μ*V/mm [62].*

EEG study can be also used as an ancillary test to support the diagnosis of brain death. Although positive diagnosis of brain death can be made by two separate settings of clinical examination, The American Neurological Association strongly suggest the use of EEG study to confirm the diagnosis of brain death. Hypothermia and hypotension should be avoided when applying EEG for brain death assessment [60]. Isoelectric encephalogram is confirmed when 30 minutes of EEG recording reveals complete absence of cerebral activity with sensitivity over 2 μV/mm in the absence of electrolyte disturbance and sedative medications (**Figure 12**) [61].
