Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Abend, Nicholas S.; Wagenman, Katherine L.; Blake, Taylor; Schultheis, Maria T.; Radcliffe, Jerilynn; Berg, Robert A.; Topjian, Alexis; Dlugos, Dennis J.

doi:10.1016/j.yebeh.2015.03.013

Cited by 36 publications

(45 citation statements)

References 39 publications

(49 reference statements)

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“…Accumulating evidence indicates that high ES exposure is associated with unfavorable short‐ and long‐term neurobehavioral outcomes independent of acute encephalopathy etiology and critical illness severity. Children with acute encephalopathy and ESE (and sometimes also ES) have a higher mortality, worse functional outcome scores on discharge, worse functional outcome at follow‐up, and a higher risk developing subsequent epilepsy . Presumably, more rapid ES identification results in earlier treatment and reduction of seizure burden.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic seizures in critically ill children: Management and adverse events

et al. 2019

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Objective Guidelines recommend that encephalopathic critically ill children undergo continuous electroencephalographic (CEEG) monitoring for electrographic seizure (ES) identification and management. However, limited data exist on antiseizure medication (ASM) safety for ES treatment in critically ill children. Methods We performed a single‐center prospective observational study of encephalopathic critically ill children undergoing CEEG. Clinical and EEG features and ASM utilization patterns were evaluated. We determined the incidence, types, and risk factors for adverse events associated with ASM administration. Results A total of 472 consecutive critically ill children undergoing CEEG were enrolled. ES occurred in 131 children (28%). Clinicians administered ASM to 108 children with ES (82%). ES terminated after the initial ASM in 38% of patients who received one ASM, after the second ASM in 35% of patients who received two ASMs, after the third ASM in 50% of patients who received three ASMs, and after the fourth ASM in 53% of patients who received four ASMs. Thirty patients (28%) received anesthetic infusions for ES management. Adverse events occurred in 18 patients (17%). Adverse effects were expected and resolved in all patients, and they were generally serious (in 15 patients) and definitely related (in 12 patients). Adverse events were rare in patients with acute symptomatic seizures requiring only one to two ASMs for treatment, but were more common in children with epilepsy, ictal‐interictal continuum EEG patterns, or patients requiring more extensive ASM management. Significance ES ceased after one ASM in only 38% of critically ill children but ceased after two ASMs in 73% of critically ill children. Thus, ES management was often accomplished with readily available medications, but optimization of multistep ES management strategies might be beneficial. Adverse events were rare and manageable in children with acute symptomatic seizures requiring only one to two ASMs for treatment. Future studies are needed to determine whether management of acute symptomatic ES improves neurobehavioral outcomes.

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Section: Discussionmentioning

confidence: 99%

Electroencephalographic seizures in critically ill children: Management and adverse events

et al. 2019

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“…A previous study of 200 critically ill children managed in our PICU showed that both short-term and long-term outcomes were worse in the presence of electrographic status epilepticus but not electrographic seizures (16, 17, 35). A study by Payne et al indicated that increasing seizure burden was associated with worse short-term neurologic outcomes (19).…”

Section: Discussionmentioning

confidence: 72%

Early Electroencephalographic Background Features Predict Outcomes in Children Resuscitated From Cardiac Arrest*

Topjian

Sánchez

Shults

et al. 2016

Pediatric Critical Care Medicine

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Objective To determine a) whether early electroencephalographic (EEG) background features were associated with survival and neurologic outcomes among children resuscitated from cardiac arrest and not treated with therapeutic hypothermia and b) if addition of EEG background to commonly used clinical criteria is more predictive of outcome than clinical criteria alone. Design Retrospective study. Setting Pediatric intensive care unit and Cardiac Intensive Care Units of a tertiary children’s hospital. Patients Patients resuscitated from in-hospital or out-of-hospital cardiac arrest who underwent clinically indicated EEG monitoring and were not treated with therapeutic hypothermia. Interventions None Measurements and Main Results One-hundred twenty-eight patients underwent EEG monitoring within one day of return of spontaneous circulation (ROSC). Background category was normal in 4 subjects (3%), slow-disorganized in 58 subjects (45%), discontinuous - burst-suppression in 24 subjects (19%) and attenuated-flat in 42 subjects (33%). Forty-six subjects (36%) had a reactive EEG. Twenty subjects (15%) had a seizure during EEG monitoring. Absence of reactivity (p<0.001) and seizures (p=0.04) were associated with worse EEG background category. After controlling for covariates, for each incrementally worse background score, the odds of death was 3.63 (95% CI: 2.18, 6.0, p<0.001) and the odds of unfavorable neurologic outcome was 4.38 (95% CI: 2.51, 7.17, p=0.001). Conclusions Worse EEG background early after resuscitation from both in-hospital and out-of-hospital cardiac arrest is associated with increased odds of death and unfavorable neurologic outcomes at hospital discharge. These EEG background patterns may be used in addition to clinical criteria to support prognostic decision making.

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“…1; 9; 10; 12; 15–20 Thus, if rapid identification and management of electrographic seizures actually reduced electrographic seizure exposure, this might be a useful neuroprotective strategy. Our initial data suggest that a multi-disciplinary pathway can lead to more rapid management initiation.…”

Section: Discussionmentioning

confidence: 99%

Impact of an ICU EEG monitoring pathway on timeliness of therapeutic intervention and electrographic seizure termination

et al. 2016

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Summary Objectives We aimed to determine whether implementation of a structured multi-disciplinary EEG monitoring pathway improved the timeliness of anti-seizure medication administration in response to electrographic seizures in encephalopathic critically ill children. Methods A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizure onset to anti-seizure medication administration. Data was collected to inform the team of improvement opportunities which were then provided by an institutional pathway, staff education, and streamlined communication. Measurements were obtained prior to and after pathway implementation to assess for improvement. Results We collected data on 41 patients before and 21 after pathway implementation. There were no differences between the baseline and pathway groups in demographic characteristics, acute encephalopathy etiologies, or anti-seizure medications utilized. The median duration from seizure onset to anti-seizure medication administration was shorter for patients treated with the pathway (64 minutes [50, 101]) compared to patients treated prior to pathway implementation (139 minutes [71, 189]) (p=0.0006). The interval from seizure onset to anti-seizure medication order was shorter for the pathway group (31 minutes [20, 49]) than the baseline group (71 minutes [33, 131]) (p=0.003). The interval from anti-seizure medication order to administration was shorter for the pathway group (30 minutes [19, 40]) than the baseline group (40 minutes [17, 68]) (p=0.047). Seizure termination was more likely to occur following initial anti-seizure medication administration in the pathway than baseline group (67% vs. 27%, p=0.002). Significance Implementation of the pathway resulted in a significant reduction in the duration between electrographic seizure onset and anti-seizure medication administration, and a significant increase in the rate of electrographic seizure termination following an initial anti-seizure medication. Further study is needed to determine whether these changes are associated with improved outcomes.

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Electrographic status epilepticus and neurobehavioral outcomes in critically ill children

Cited by 36 publications

References 39 publications

Electroencephalographic seizures in critically ill children: Management and adverse events

Electroencephalographic seizures in critically ill children: Management and adverse events

Early Electroencephalographic Background Features Predict Outcomes in Children Resuscitated From Cardiac Arrest*

Impact of an ICU EEG monitoring pathway on timeliness of therapeutic intervention and electrographic seizure termination

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