Elucidation of the Neurological Damage Mechanism in Non-Convulsive Seizures Utilizing Continuous EEG Data from Emergency Departments

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K17894
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Kobe University
• Principal Investigator: Yamaguchi Hiroshi 神戸大学, 医学研究科, 特命助教 (80851849)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 非けいれん性てんかん重積 / 非けいれん性発作 / 熱性けいれん / 意識障害 / 救急外来 / 脳波 / 急性脳症 / てんかん

Outline of Final Research Achievements

We conducted a reduced-lead electroencephalogram (EEG) analysis for pediatric patients with altered mental status in the emergency department (ED). We classified 51 cases into three groups: febrile seizures (FS), acute encephalopathy/encephalitis (AE/AES), and epilepsy, and described the EEG patterns using the ACNS Standardized Critical Care EEG Terminology 2021. The results showed that the EEG patterns of the FS and AE/AES groups were similar. However, intermittent rhythmic theta activity was observed in only about one-fourth of the FS group. Furthermore, we compared the levels of NSE, S100B, GFAP, Tau protein, and GDF-15 in the cerebrospinal fluid within 24 hours of onset in three cases of the FS group and five cases of the AE/AES group. S100B, GFAP, and GDF-15 were higher in the AE/AES group compared to the FS group. Combining EEG in ED with markers of neurological injury may offer the potential to differentiate between FS and AE/AES at an early stage.

Free Research Field

小児神経

Academic Significance and Societal Importance of the Research Achievements

救急外来（ED）で意識障害を呈する小児患者では、熱性けいれん（FS）、急性脳症/脳炎（AE/AES）およびてんかんが原因として多い。FSは後遺症を残すことは稀だが、AE/AESは後遺症を残す可能性が高く、遅れて診断されることがある。しかしEDではこれらを早期に鑑別することは難しい。EDの脳波(EEG)解析は，EDでEEGを実施できる施設が限られており報告は少ない。本研究はEDでの小児の意識障害患者において，詳細な簡易EEGの非けいれん性発作のEEGパターンを記述し、神経傷害バイオマーカーと組み合わせて評価した初めての研究である。