Quantitative EEG enhances early assessment and prognostic stratification of brain dysfunction in infants with abusive head trauma

Valentin Hess, Matthieu Doyen, Rima Nabbout, Thomas Blauwblomme, Benjamin Serrand, Martine Balençon, Claire Bar, Olivier Brissaud, Olivier Klein, Arnaud Wiedemann, Mathieu Kuchenbuch
Neurophysiologie Clinique. 2026-02-01; 56(1): 103132
DOI: 10.1016/j.neucli.2025.103132

PubMed

Lire sur PubMed

https://www.bordeaux-neurocampus.fr/12381

Hess V(1), Doyen M(2), Nabbout R(3), Blauwblomme T(4), Serrand B(5), Balençon M(6), Bar C(7), Brissaud O(8), Klein O(9), Wiedemann A(10), Kuchenbuch M(11).

Author information:
(1)Université de Lorraine, CHRU-Nancy, Service de Pédiatrie, Reference centre
for rare epilepsies, member of EPICARE, F-54000 Nancy, France.
(2)Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France.
(3)Reference centre for rare epilepsies, member of EPICARE, Department of
pediatric Neurology, Necker Enfants Malades University hospital, Paris, France;
INSERM, Institut National de la Santé et de la Recherche Médicale, UMR 1163,
Imagine Institute, Paris Descartes University, Paris, France.
(4)INSERM, Institut National de la Santé et de la Recherche Médicale, UMR 1163,
Imagine Institute, Paris Descartes University, Paris, France; Reference centre
for rare epilepsies, member of EPICARE, Department of pediatric Neurosurgery,
Necker Enfants Malades University hospital, Paris, France.
(5)Université de Rennes, CHRU de Rennes, Service de Pédiatrie, Reference centre
for rare epilepsies, F-35000 Rennes, France.
(6)Unité médico-judiciaire, centre-université Paris Cité, hôpital Hôtel Dieu,
AP-HP, 1, place du parvis Notre Dame, 75004 Paris, France; Université Paris
Cité, 85, boulevard Saint-Germain, 75006 Paris, France.
(7)Université de Bordeaux, CNRS, INCIA, UMR 5287, NRGen Team, CHU de Bordeaux,
Service de neurologie pédiatrique, F-33000 Bordeaux, France.
(8)Neonatal and Paediatric Intensive Care Unit, Pellegrin University Hospital,
Bordeaux University, F-33000 Bordeaux, France.
(9)Université de Lorraine, CHRU-Nancy, Service de neurochirurgie, F-54000 Nancy,
France.
(10)Université de Lorraine, CHRU-Nancy, Service de réanimation pédiatrique,
F-54000 Nancy, France; INSERM UMRS 1256 NGERE, National Center of Inborn Errors
of Metabolism, University of Lorraine, Vandoeuvre-les-Nancy, F-54000, France.
(11)Université de Lorraine, CHRU-Nancy, Service de Pédiatrie, Reference centre
for rare epilepsies, member of EPICARE, F-54000 Nancy, France; Université de
Lorraine, IMoPA, UMR CNRS 7365, F-54000 Nancy, France. Electronic address:
.

AIM: To assess the value of quantitative EEG (qEEG) as a diagnostic and
prognostic biomarker in infants with abusive head trauma (AHT). Despite its
central role in monitoring encephalopathy, EEG remains underused in multimodal
evaluations, and its quantitative analysis may provide objective, real-time
insights into cerebral dysfunction and long-term outcome.
METHODS: This retrospective monocentric case-control study included infants
under two years with confirmed AHT and age- and sex-matched controls. Clinical
and early EEG data were collected. Patients’ outcome was stratified by Pediatric
Overall Performance Category score (POPC1-3 vs. 4-6). Quantitative EEG features
were analyzed, and two neural networks were trained using five-fold
cross-validation for diagnosis and outcome prediction.
RESULTS: 84 EEGs from 75 participants were analyzed (46 EEGs from 40 AHT; 38
EEGs from 35 controls). Compared with controls, AHT EEGs showed significantly
reduced entropy and Hurst exponent values and increased low-frequency power,
reflecting diffuse cortical dysfunction. Within the AHT group, reduced signal
complexity and loss of interhemispheric asymmetry correlated with unfavorable
outcomes (POPC4-6, p< 0.01). Machine learning perfectly classified AHT cases
versus controls and classified patients into POPC1-3 or POPC4-6 groups with
73±14 % accuracy. Combined models distinguished control, POPC1-3, and POPC4-6
groups with 90±5 % accuracy.
DISCUSSION: Early qEEG provides functional information that complements imaging
and clinical findings. qEEG-derived biomarkers may enable early risk
stratification, guide neuroprotective strategies, and improve prognostic
counseling in infants with AHT. Larger multicenter prospective studies are
warranted to validate these exploratory findings and define their clinical
applicability.