Electroencephalographic Monitoring in the Pediatric Intensive Care Unit

Abend, Nicholas S.; Chapman, Kevin; Gallentine, William B.; Goldstein, Joshua; Hyslop, Ann; Loddenkemper, Tobias; Nash, Kendall; Riviello, James J.; Hahn, Cecil D.

doi:10.1007/s11910-012-0330-3

Cited by 36 publications

(37 citation statements)

References 90 publications

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“…ES with a clinical correlate were designated as clinical seizures, whereas those without any clinical correlate were designated as NCS. Electrographic status epilepticus (ESE) was defined as a single seizure lasting more than 30 minutes or repetitive seizures totaling more than 30 minutes of any 1 hour epoch (50% seizure burden) (18). …”

Section: Methodsmentioning

confidence: 99%

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Nonconvulsive Electrographic Seizures are Common in Children With Abusive Head Trauma*

Hasbani

Topjian

Friess

et al. 2013

Pediatric Critical Care Medicine

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Objective To determine the prevalence of nonconvulsive seizures in children with abusive head trauma. Design Retrospective study of children with abusive head trauma undergoing clinically indicated continuous electroencephalographic monitoring. Setting PICU of a tertiary care hospital. Subjects Children less than or equal to 2 years old with evidence of abusive head trauma determined by neuroimaging, physical examination, and determination of abuse by the Child Protection Team. Interventions None. Measurements and Main Results Thirty-two children with abusive head trauma were identified with a median age of 4 months (interquartile range 3, 5.5 months). Twenty-one of 32 children (66%) underwent electroencephalographic monitoring. Those monitored were more likely to have a lower admission Glasgow Coma Scale (8 vs 15, p = 0.05) and be intubated (16 vs 2, p = 0.002). Electrographic seizures occurred in 12 of 21 children (57%) and constituted electrographic status epilepticus in 8 of 12 children (67%). Electrographic seizures were entirely nonconvulsive in 8 of 12 children (67%). Electroencephalographic background category (discontinuous and slow-disorganized) (p = 0.02) and neuroimaging evidence of ischemia were associated with the presence of electrographic seizures (p = 0.05). Subjects who had electrographic seizures were no more likely to have clinical seizures at admission (67% electrographic seizures vs 33% none, p = 0.6), parenchymal imaging abnormalities (61% electrographic seizures vs 39% none, p = 0.40), or extra-axial imaging abnormalities (56% electrographic seizures vs 44% none, p = 0.72). Four of 21 (19%) children died prior to discharge; none had electrographic seizures, but all had attenuated-featureless electroencephalographic backgrounds. Follow-up outcome data were available for 16 of 17 survivors at a median duration of 9.5 months following PICU admission, and the presence of electrographic seizures or electrographic status epilepticus was not associated with the Glasgow Outcome Scale score (p = 0.10). Conclusions Electrographic seizures and electrographic status epilepticus are common in children with abusive head trauma. Most seizures have no clinical correlate. Further study is needed to determine whether seizure identification and management improves outcome.

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Section: Methodsmentioning

confidence: 99%

“…The majority of ES have no clinical correlate (3, 8, 10–12, 14, 16, 17) and are therefore referred to as nonconvulsive seizures (NCS) (18). Importantly, these NCS would not be identified without continuous electroencephalographic (EEG) monitoring.…”

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confidence: 99%

Nonconvulsive Electrographic Seizures are Common in Children With Abusive Head Trauma*

Hasbani

Topjian

Friess

et al. 2013

Pediatric Critical Care Medicine

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“…Since electrographic seizures are common and may be associated with worse outcome, 18 an increasing number of children in the PICU are undergoing CEEG. A recent survey of 61 large pediatric hospitals in the United States and Canada reported a 30% increase in the number of monitored PICU patients from 2010 to 2011.…”

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Electrographic seizures in pediatric ICU patients

et al. 2013

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Objectives: We aimed to determine the incidence of electrographic seizures in children in the pediatric intensive care unit who underwent EEG monitoring, risk factors for electrographic seizures, and whether electrographic seizures were associated with increased odds of mortality.Methods: Eleven sites in North America retrospectively reviewed a total of 550 consecutive children in pediatric intensive care units who underwent EEG monitoring. We collected data on demographics, diagnoses, clinical seizures, mental status at EEG onset, EEG background, interictal epileptiform discharges, electrographic seizures, intensive care unit length of stay, and in-hospital mortality.Results: Electrographic seizures occurred in 162 of 550 subjects (30%), of which 61 subjects (38%) had electrographic status epilepticus. Electrographic seizures were exclusively subclinical in 59 of 162 subjects (36%). A multivariable logistic regression model showed that independent risk factors for electrographic seizures included younger age, clinical seizures prior to EEG monitoring, an abnormal initial EEG background, interictal epileptiform discharges, and a diagnosis of epilepsy. Subjects with electrographic status epilepticus had greater odds of in-hospital death, even after adjusting for EEG background and neurologic diagnosis category.Conclusions: Electrographic seizures are common among children in the pediatric intensive care unit, particularly those with specific risk factors. Electrographic status epilepticus occurs in more than one-third of children with electrographic seizures and is associated with higher in-hospital mortality. Neurology â 2013;81:383-391 GLOSSARY CEEG 5 continuous EEG; CI 5 confidence interval; IQR 5 interquartile range; OR 5 odds ratio; PICU 5 pediatric intensive care unit.

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“…4 Several observational studies in children have reported that levetiracetam may be safe and effective for managing SE and acute symptomatic seizures in children at doses of 20–60mg/kg. 69–73 Levetiracetam has no hepatic metabolism, which may be beneficial in complex patients with liver dysfunction, metabolic disorders, or in those at risk for major drug interactions. In comparison to other intravenous anticonvulsants, levetiracetam has a low risk of sedation, cardio-respiratory depression, or coagulopathy.…”

Section: Status Epilepticus Managementmentioning

confidence: 99%

Status Epilepticus and Refractory Status Epilepticus Management

Abend¹,

Bearden²,

Helbig³

et al. 2014

Seminars in Pediatric Neurology

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Status epilepticus (SE) describes persistent or recurring seizures without a return to baseline mental status, and is a common neurologic emergency. SE can occur in the context of epilepsy or may be symptomatic of a wide range of underlying etiologies. The clinician’s aim is to rapidly institute care that simultaneously stabilizes the patient medically, identifies and manages any precipitant conditions, and terminates seizures. Seizure management involves “emergent” treatment with benzodiazepines followed by “urgent” therapy with other anti-seizure medications. If seizures persist then refractory SE is diagnosed and management options include additional anti-seizure medications or infusions of midazolam or pentobarbital. This paper reviews the management of pediatric SE and RSE.

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Electroencephalographic Monitoring in the Pediatric Intensive Care Unit

Cited by 36 publications

References 90 publications

Nonconvulsive Electrographic Seizures are Common in Children With Abusive Head Trauma*

Nonconvulsive Electrographic Seizures are Common in Children With Abusive Head Trauma*

Electrographic seizures in pediatric ICU patients

Status Epilepticus and Refractory Status Epilepticus Management

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