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To determine the correlation between frontal intermittent rhythmic delta activity (FIRDA) and the clinical and radiological correlates in children.
Retrospective review of the EEG and imaging studies of 37 children with documented FIRDA.
FIRDA was associated with multiple neurological conditions and not necessarily with midline lesions. Patients with abnormal neurological exam had a longer FIRDA duration (average 9.5 seconds) compared to children with no reported abnormal examination (average of 6.5 seconds). FIRDA ranged from 2 to 2.5 Hz (n=15), 3 Hz (n=17) and from 1.5 to 3 Hz (n=5) and there was a significant association between the duration of FIRDA and abnormal laboratory tests (p. < 0.05, Student's T test).
FIRDA was not correlated with midline brain lesions in children. FIRDA may be a non specific oscillation of an unhealthy pediatric brain with or without seizures.
This study was designed to determine the prevalence of rhythmic coma patterns in comatose children and to ascertain the prognostic significance of reactive rhythmic coma patterns.
We retrospectively analyzed and classified electroencephalogram (EEGs) in comatose children between two months and 18 years of age during the period 1996 - 2003 according to modified Young's classification. Outcome at one-year was scored according to the Paediatric Cerebral and Overall Performance Category Scale. Outcomes were compared using Fisher's exact test and Mann-Whitney test.
Analysis of 63 electroencephalogram (EEG) records in 38 patients showed rhythmic patterns in 19 records (30.2%; 9 alpha, 4 spindle, 4 theta and 2 beta coma patterns, total number of children = 14). Aetiology and outcome of alpha coma patterns and other rhythmic coma patterns were similar. In five children, one type of rhythmic pattern changed to another. Records with reactive rhythmic coma 66.7% (6/9), were associated with favourable outcome. Sixty percent of the records (6/10 records in seven children) with non-reactive pattern were associated with unfavourable outcome. This clinically significant difference did not reach statistical significance (lower Paediatric Cerebral and Overall Performance Category Scale score p= 0.14; favourable outcome p=0.19).
Rhythmic coma patterns in comatose children are not uncommon. Aetiology, reactivity and outcome of individual patterns are similar and thus make the rhythmic coma patterns distinct EEG signatures in comatose children. There was a clinically significant better outcome with reactive rhythmic coma patterns.