Background: Fast ripples (FR, 250-500 Hz) detected with chronic intracranial electrodes are

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.

Objective: Epilepsy neurosurgery is a treatment option for children with refractory epilepsy. Our aim was to determine if outcomes improved over time. Methods:Pediatric epilepsy surgery patients operated in the first 11 years (1986 -1997; pre-1997) were compared with the second 11 years (1998 -2008; post-1997) for differences in presurgical and postsurgical variables.Results: Despite similarities in seizure frequency, age at seizure onset, and age at surgery, the post-1997 series had more lobar/focal and fewer multilobar resections, and more patients with tuberous sclerosis complex and fewer cases of nonspecific gliosis compared with the pre-1997 group. Fewer cases had intracranial EEG studies in the post-1997 (0.8%) compared with the pre-1997 group (9%). Compared with the pre-1997 group, the post-1997 series had more seizure-free patients at 0.5 (83%, ϩ16%), 1 (81%, ϩ18%), 2 (77%, ϩ19%), and 5 (74%, ϩ29%) years, and more seizure-free patients were on medications at 0.5 (97%, ϩ6%), 1 (88%, ϩ9%), and 2 (76%, ϩ29%), but not 5 (64%, ϩ8%) years after surgery. There were fewer complications and reoperations in the post-1997 series compared with the pre-1997 group. Logistic regression identified post-1997 series and less aggressive medication withdrawal as the main predictors of becoming seizure-free 2 years after surgery. Conclusions: Improved technology and surgical procedures along with changes in clinical practicewere likely factors linked with enhanced and sustained seizure-free outcomes in the post-1997 series. These findings support the general concept that clearer identification of lesions and complete resection are linked with better outcomes in pediatric epilepsy surgery patients. Neurology Surgery for children with refractory epilepsy has become an important treatment option over the past 30 years. Initially, most patients were adolescents with focal lesions involving the temporal lobe similar to adult epilepsy surgery.1,2 With modern neuroimaging (e.g., MRI SPECT and fluorodeoxyglucose [FDG]-PET), the number of surgical centers expanded, as did etiologies and types of operations. Today, pediatric epilepsy surgery has evolved to include extratemporal operations and cerebral hemispherectomy for children of all ages. Etiologies range from cortical dysplasia, tumors, and perinatal strokes to rarer syndromes such as hemimegalencephaly, tuberous sclerosis complex (TSC), Rasmussen encephalitis, Sturge-Weber syndrome, and hypothalamic hamartomas.3 Many children are treated because they are at risk for epileptic encephalopathies. e-Pub ahead of print on April 28, 2010, at www.neurology.org. From the Departments of Neurosurgery (M.H., T.R.V., G.W.M.) and Neurology (H

Summary Purpose Traumatic brain injury (TBI) is an important cause of morbidity and mortality in children and early post-traumatic seizures (EPTS) are a contributing factor to ongoing acute damage. Continuous video EEG monitoring (cEEG) was utilized to assess the burden of clinical and electrographic EPTS. Methods Eighty-seven consecutive, unselected (mild – severe), acute TBI patients requiring pediatric intensive care unit (PICU) admission at 2 academic centers were prospectively monitored with cEEG per established clinical TBI protocols. Clinical and subclinical seizures and status epilepticus (SE, clinical and subclinical) were assessed for their relation to clinical risk factors and short-term outcome measures. Key findings Of all patients, 42.5% (37/87) had seizures. Younger age (p=0.002) and mechanism (abusive head trauma - AHT, p<0.001) were significant risk factors. Subclinical seizures occurred in 16.1% (14/87), 6 of whom had only subclinical seizures. Risk factors for subclinical seizures included: younger age (p<0.001), AHT (p<0.001) and intraaxial bleed (p<0.001). Status Epilepticus (SE) occurred in 18.4% (16/87) with risk factors including: younger age (p<0.001), AHT (p<0.001), and intraaxial bleed (p=0.002). Subclinical SE was detected in 13.8% (12/87) with significant risk factors including: younger age (p<0.001), AHT (p=0.001), and intraaxial bleed (p=0.004). Subclinical seizures were associated with lower discharge KOSCHI score (p=0.002). SE and subclinical SE were associated with increased hospital length of stay (p=0.017 and p=0.041 respectively) and lower hospital discharge KOSCHI (p=0.007 and p=0.040 respectively). Significance cEEG monitoring significantly improves detection of seizures/SE and is the only way to detect subclinical seizures/SE. cEEG may be indicated after pediatric TBI, particularly in younger children, AHT cases, and those with intraaxial blood on CT.

We conclude that the rate of clinically apparent new onset diabetes after distal pancreatectomy is minimal. Alternative pancreatic resections aimed at preserving pancreatic mass are likely to be unwarranted.