“Children are not Small Adults.”
This common saying is true in many ways and EEG is no exception.
Those of us that have primarily worked with this patient population know that if you can work in pediatrics - you can work anywhere.
Not only is the procedure set up more challenging due to the unique developmental ages of children but the variation in the EEG interpretation is evident as well.
Let’s take a look at some of these differences:
Posterior Slow Waves of Youth:
This delta/alpha combination in the Posterior Dominant Rhythm would surely result in an MRI being ordered for you or I…but for children - no reason for concern.
This posterior slowing pattern where the alpha rides on top of the delta like a roller coaster is going to be read as normal for the right age population.
Hypnagogic Hypersynchrony
This pattern termed Hypnagogic Hypersynchrony is described as a normal burst of delta as children transition from wakefulness to sleep.
In adults drowsiness is often accompanied by slow rolling eye movements and a waxing and waning of the Posterior Dominant Rhythm; however, for children particularly young children this classic burst of delta occurs as a marker followed by sleep.
Another prominent feature of pediatric tracings is the variation in the amplitude and frequency. Pediatric tracings tend to be a much higher amplitude than adults.
This can take getting used to if your primary experience is recording only adult tracings.
Frequency ranges for the posterior rhythm are varied as well with delta and theta frequencies allowed for the toddler and infant age populations.
Not only are the normal patterns different but the abnormal patterns can be as well.
Certain epilepsy’s are seen only in pediatrics since often these patterns are outgrown by adulthood:
Self-limiting Epilepsy with Central Temporal Spikes (previously known as BCECTS or Benign Rolandic Epilepsy)
Self-limiting Epilepsy with Autonomic Seizures (SeLEAS; previously known as Panayiotopoulous)
and Typical Absence Epilepsy (also known as Childhood Absence Epilepsy)
As late adolescence develops into adulthood; the EEG transitions as well, with a PDR solidly in the alpha frequency, and a mixture of anterior beta.
The lower amplitude and faster frequencies becoming more apparent.
Since childhood is when epilepsy most commonly develops there are also many types that are not as often outgrown; however, with medications many patients can have their seizures well-controlled.
For more information on pediatric epilepsy syndromes please reference this comprehensive site: epilepsydiagnosis.org
Knowing the unique EEG differences for children and adjusting our procedural approach is essential in ensuring that all of our patient’s unique needs are met.
Roya Tompkins, MS, REEG/EP T, RPSGT
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