J Pediatr Intensive Care 2017; 06(02): 136-141
DOI: 10.1055/s-0036-1587328
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Guiding Antiepileptic Therapy in a Pediatric Patient with Severe Meningoencephalitis and Decompressive Craniectomy with the Use of Amplitude-Integrated Electroencephalography

Karl F. Schettler
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
Beatrice Heineking
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
Silvia Fernandez-Rodriguez
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
Angelika Pilger
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
Nikolaus Alexander Haas
1   Department of Pediatric Cardiology and Pediatric Intensive Care, Campus Grosshadern of the Ludwig Maximilians University, Munich, Germany
› Author Affiliations
Further Information

Publication History

03 April 2016

01 July 2016

Publication Date:
08 August 2016 (online)


Introduction Amplitude-integrated electroencephalography (aEEG) is one of the most widely used neuromonitoring tools in neonatology today. However, little is known about its clinical indications and potential benefits in pediatric intensive care patients. Based on limited experience, its impact on therapeutic decision-making in this patient population is unclear.

Case Description We report the case of a 16-year-old boy who, after a pansinusitis, developed a severe meningoencephalitis and intracranial empyema with increased intracranial pressure that required drainage and decompressive craniectomy. He subsequently developed status epilepticus despite a combination of various anticonvulsants. Only after the initialization of an aEEG, we were able to adequately diagnose and continuously monitor his seizure activity and titrate the effect of the antiepileptic drugs. During his hospital stay, we were able to clearly monitor and guide our therapy by accurately identifying the termination of status epilepticus and the recurrence of seizures.

Discussion With the help of aEEG, it was easy to identify the nonconvulsive status epilepticus (NCSE) and the ongoing seizure activity in this teenage patient. NCSE is a clinical problem with an effect on the outcome of the patient and is often underdiagnosed. AEEG enabled a rapid detection and management of seizure activity and thereby reduced the overall seizure burden, which was associated with better neurologic outcome.

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