Continuous Video EEG Monitoring in Acute Paediatric Ischaemic Stroke

The cEEG will commence within 48 hours of study enrolment and within 10 days of stroke onset. The cEEG will be set-up by trained hospital neuroscientists, as per standard hospital procedure. Duration of video EEG monitoring will be a minimum of 24hrs. Acute neuroimaging will be reported as per current clinical practice. For study purposes, a second paediatric radiologist will review the original imaging (MRI, CT or ultrasound). This radiologist will be blinded to the occurrence of clinical or sub-clinical seizures. Neuroimaging analysis by the study radiologist will include infarct laterality (right, left, bilateral), location (anterior, middle, or posterior cerebral artery territories), tissue involved (cortex, white matter, basal ganglia), presence or absence of haemorrhage and vascular imaging analysis. Arterial occlusion will be defined as a hyperdense MCA sign on the initial CT scan or as an arterial “cutoff ” of on magnetic resonance angiography or computerized tomographic angiography. All electronically available scans will be further scored with the modified pediatric version of the Alberta Stroke Program Early Computed Tomography Score (modified PedASPECTS, range 0 to 30), a validated method for estimating infarct volume. Evidence of mass effect including sulcal effacement, ventricular compression, cistern effacement, midline shift, and herniation will also be documented. Acute stroke severity will be assessed based the pedNIHSS (Pediatric National Institute of Health Stroke Scale) in accordance with the Australian Paediatric Stroke Guidelines (clinical practice recommendations). Other clinical scores will include the Functional status score and/or Modified Glascow outcome scale to assess function on discharge from PICU and/or hospital. Demographic (age, gender, ethnicity), anthropometric data (height, weight, head circumference) and standard clinical data will also be collected, “Standard” clinical data includes medical history (including past medical history, history of presentation and family medical history), physical examination findings (including observations such as Glascow coma scale score, blood pressure, heart rate, pulse oximetry), investigation results (laboratory data, echocardiography and electrocardiography) and treatment provided. Clinical data will be obtained from the hospital electronic medical records. Investigations other than cEEG will be performed solely on a clinical basis. Follow-up Clinic visit assessments at 3, 6, 12, 18 and 24 months post stroke may include (some assessments will be age dependent): - Standard clinical assessment (review of history, treatment, physical examination) - Paediatric Stroke Outcome Measure (PSOM).10 This a validated tool to measure neurological outcome following stroke. It is based on a physical assessment performed by a clinician. - Functional Status Score (FSS) - Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) - Epilepsy/seizure questionnaire A Neuropsychological assessment and parent questionnaires will be performed at 12 and 24 months post-stroke. The type of assessment or questionnaire will be made by the neuropsychologist (OL) as this will vary depending on the age of the patient and clinical symptoms. Neuropsychological assessments may include: - Wechsler Intelligence Scale for Children (WISC-V) – 7-16:11; Wechsler Primary and Preschool Scale of Intelligence (WPPSI-IV) 2.6-7; or Bayley scales of Infant Development (<4 years of age), dependent on age, to assess general intelligence - Boston Naming Test (second Edition) – word finding - NEPSY-II subtests - Design Memory (memory), Animal Sorting (EF), and Verbal Fluency (language) - Rey Complex figure test (memory, EF) - Children’s Memory Scale (CMS) – word pairs, story memory subtests (all memory) - Continuous Performance Test (CPT3; attention) – Test of Everyday Attention for Children (TEA-Ch) - Screening tests from the Wechsler Individual Achievement Test (WIAT-III) – reading, spelling, maths - Clinical Evaluation of Language (CELF-5) to assess language Parent Questionnaires may include: - Behaviour Rating Inventory of Executive Functioning (BRIEF; covers EF) - Conners Parent Rating Scale (Attention) - Adaptive Behaviour Assessment System (ABAS-3) - CBCL (Child behaviour checklist) or Strengths and Difficulties Questionnaire – mental health (CBCL is probably stronger here; a bit broader, but SDQ is popular at present). - WeeFIM (interview) - Background questionnaire (including but not limited to re pre-injury diagnoses, therapy inputs), and socioeconomic screen (based on occupation of primary caregiver or income) - The family assessment Device (FAD) – general functioning scale re family functioning - Family Burden or Injury Inventory – family burden