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Neuropediatrics 2024; 55(06): 395-409
DOI: 10.1055/a-2380-6743
Original Article

The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study

Daniela Chiarello
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
2   Department of Neuroscience, Neurology of Epilepsy and Movement Disorder Unit, Bambino Gesù Children's Hospital - Member of the European Reference Network EpiCARE, Roma, Italy
,
Annalisa Perrone
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
3   IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
,
Emilia Ricci 
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
4   Department of Health Sciences, Child Neuropsychiatry Unit, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy
,
Giulia Ferrera
4   Department of Health Sciences, Child Neuropsychiatry Unit, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy
,
Francesca Duranti
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
5   Child and Adolescent Neuropsychiatry Unit, AUSL Romagna – Infermi Hospital, Rimini, Italy
,
Silvia Bonetti
3   IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
,
Valentina Marchiani
3   IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
,
Anna Fetta
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
3   IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
,
Marcello Lanari
6   Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Bologna, Italy
,
Duccio Maria Cordelli
1   Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
3   IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
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Abstract

Introduction Acute altered mental status (AAMS) is often a challenge for clinicians, since the underlying etiologies cannot always easily be inferred based on the patient's clinical presentation, medical history, or early examinations. The aim of this study is to evaluate the role of electroencephalogram (EEG) as a diagnostic tool in AAMS of unknown etiology in children.

Materials and Methods We conducted a prospective study involving EEG assessments on children presenting with AAMS between May 2017 and October 2019. Inclusion criteria were age 1 month to 18 years and acute (<1 week) and persistent (>5 minutes) altered mental status. Patients with a known etiology of AAMS were excluded. A literature review was also performed.

Results Twenty patients (median age: 7.7 years, range: 0.5–15.4) were enrolled. EEG contributed to the diagnosis in 14/20 cases, and was classified as diagnostic in 9/20 and informative in 5/20. Specifically, EEG was able to identify nonconvulsive status epilepticus (NCSE) in five children and psychogenic events in four. EEG proved to be a poorly informative diagnostic tool at AAMS onset in six children; however, in five of them, it proved useful during follow-up.

Conclusions Limited data exist regarding the role of EEG in children with AAMS of unknown etiology. In our population, EEG proved to be valuable tool, and was especially useful in the prompt identification of NCSE and psychogenic events.

Keywords

acute altered mental status - electroencephalogram - unknown etiology - children - diagnostic assessment


Publication History

Received: 06 June 2024

Accepted: 04 August 2024

Accepted Manuscript online:
06 August 2024

Article published online:
04 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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