Summary Purpose:  Several studies indicate a higher occurrence than might be expected of seizures in intensive care unit patients, many of which are not clinically apparent. Few of these studies are devoted exclusively to pediatric patients. The purpose of this study is to determine the occurrence of seizures in a cohort of pediatric and neonatal intensive care unit patients. Methods:  Long‐term video electroencephalography (EEG) monitoring studies performed in the pediatric and neonatal intensive care units were reviewed. Age, gender, diagnosis, EEG background, epileptiform activity, time of onset and duration of seizures, presence of electroclinical or electrographic seizures, and survival were collected. Key Findings:  One hundred thirty‐eight recordings encompassing 122 patients were identified. Thirty‐four percent of the sessions identified seizures in the first 24 h (38% of the cohort experienced a seizure at some time during monitoring, which ranged from 1–22 days): 17% captured only electroclinical seizures, 49% were electrographic only, and 34% had both electroclinical and electrographic seizures. Seventy percent of those patients experiencing seizures had their first seizure within the first hour of EEG recording. Younger age and epileptiform activity (including periodic) were associated with the occurrence of seizures. Diagnoses of head trauma and status epilepticus/recent prior seizure were more likely than other at‐risk diagnoses to be associated with seizures; cardiac arrest managed with hypothermia was less likely to be associated with seizures. One‐fourth of the recordings identified nonepileptic events. Significance:  Seizures occurred in one‐third of critically ill pediatric patients at risk for seizures who underwent video‐EEG monitoring, and many of these seizures did not have a clinical correlate. In those at risk for seizures in intensive care units, there should be a low threshold for obtaining long‐term monitoring.

Most patients achieved resolution of status epilepticus on KD therapy, suggesting it could be an effective therapy that can be utilized early in the treatment of children with super refractory status epilepticus.

Objective: The purpose of this study is to investigate the outcomes of epilepsy surgery targeting the subcentimeter-sized resting state functional magnetic resonance imaging (rs-fMRI) epileptogenic onset zone (EZ) in hypothalamic hamartoma (HH). Methods: Fifty-one children with HH-related intractable epilepsy received anatomical MRI-guided stereotactic laser ablation (SLA) procedures. Fifteen of these children were control subjects (CS) not guided by rs-fMRI. Thirty-six had been preoperatively guided by rs-fMRI (RS) to determine EZs, which were subsequently targeted by SLA. The primary outcome measure for the study was a predetermined goal of 30% reduction in seizure frequency and improvement in class I Engel outcomes 1 year postoperatively. Quantitative and qualitative volumetric analyses of total HH and ablated tissue were also assessed. Results: In the RS group, the EZ target within the HH was ablated with high accuracy (>87.5% of target ablated in 83% of subjects). There was no difference between the groups in percentage of ablated hamartoma volume (P = 0.137). Overall seizure reduction was higher in the rs-fMRI group: 85% RS versus 49% CS (P = 0.0006, adjusted). The Engel Epilepsy Surgery Outcome Scale demonstrated significant differences in those with freedom from disabling seizures (class I), 92% RS versus 47% CS, a 45% improvement (P = 0.001). Compared to prior studies, there was improvement in class I outcomes (92% vs 76%-81%). No postoperative morbidity or mortality occurred. Significance: For the first time, surgical SLA targeting of subcentimeter-sized EZs, located by rs-fMRI, guided surgery for intractable epilepsy. Our outcomes demonstrated the highest seizure freedom rate without surgical complications and are a significant improvement over prior reports. The approach improved freedom ---