Electroencephalograph and optic nerve sheath diameter: Comparative usefulness in prediction of hepatic encephalopathy outcome in children

Abstract

This study was carried out to compare the usefulness of electroencephalograph (EEG) and optic nerve sheath diameter (ONSD) in the prediction of outcomes in children undergoing management of hepatic encephalopathy (HE) in the intensive care unit (ICU). Twelve children in the age group 8–14 years with HE and raised intracranial pressure (ICP) were reviewed retrospectively for the prognostication value of EEG and ONSD in their management. The study period was from January 2019 to December 2021. The children were selected consecutively as they were admitted to the ICU. Children admitted to the ICU for the management of acute liver failure, HE, and raised ICP were followed up until recovery or death. Serial recordings of EEG and ONSD were done in twelve children during the management of their critical illness period. ONSD is a physical parameter based on cerebrospinal fluid dynamics while EEG is an electrophysiological measure revealing brain activity. Out of 12 children, ONSD normalized in 4, among these four children, three survived and one expired. Nine children had grade 3 and 4 encephalopathy patterns in their EEGs, and no one survived while three children with EEG grade 1 and 2 encephalopathy, all survived. ONSD values and EEG grades most of the time go together; however, EEG predicted more accurately the survival or death. In addition, seizures were seen in three children. EEG and ONSD are sensitive and useful non-invasive techniques in the prognosis and management of HE, EEG may have an edge over ONSD in predicting outcomes.