EEG and ONSD in management of hepatic encephalopathy: additional role of EEG in prognosis

EEG and ONSD in management of hepatic encephalopathy: additional role of EEG in prognosis Objective: To compare usefulness of EEG and optic nerve sheath diameter in management of hepatic encephalopathy in children. Methods: Eight children in age group 7 to 14 years age group with hepatic encephalopathy were reviewed retrospectively for prognostication value of EEG and ONSD in their management. Children admitted to the intensive care unit for management of hepatic encephalopathy were followed up till recovery or death. Serial recordings of EEG and optic nerve sheath diameter (ONSD) were done during the management of critical illness period Results: EEG revealed grades of severe encephalopathy to mild slowing in recovered children. EEG also picked up seizure discharges in four children. Antiepileptic medications were added in their management. ONSD normalized in most children at the end of the critical illness. Four children had isoelectric EEG in the end even if ONSD had normalized, denoting the brain death state and no recovery. Only one out of four survivors had full neurological recovery till last follow up. Conclusions: EEG is more sensitive and useful prognostic tool of investigation in day to day management of hepatic encephalopathy.
Keywords: Hepatic Encephalopathy, brain edema,EEG,ONSD, management