Epileptiform Discharge and Electrographic Seizures during the Hypothermia Phase as Predictors of Rewarming Seizures in Children after Resuscitation

Abstract

<jats:p>The aim of this study was to determine the frequency, timing, and predictors of rewarming seizures in a cohort of children undergoing therapeutic hypothermia after resuscitation. We retrospectively reviewed consecutive pediatric patients undergoing therapeutic hypothermia after resuscitation admitted to our pediatric intensive care unit between January 2000 and December 2019. Continuous electroencephalographic monitoring was performed during hypothermia (24 h for cardiac aetiologies and 72 h for asphyxial aetiologies), rewarming (72 h), and then an additional 12 h of normothermia. Thirty comatose children undergoing therapeutic hypothermia after resuscitation were enrolled, of whom 10 (33.3%) had rewarming seizures. Two (20%) of these patients had their first seizure during the rewarming phase. Four (40%) patients had electroclinical seizures, and six (60%) had nonconvulsive seizures. The median time from starting rewarming to the onset of rewarming seizures was 37.3 h (range 6 to 65 h). The patients with interictal epileptiform activity and electrographic seizures during the hypothermia phase were more likely to have rewarming seizures compared to those without interictal epileptiform activity or electrographic seizures (p = 0.019 and 0.019, respectively). Therefore, in high-risk patients, continuous electroencephalographic monitoring for a longer duration may help to detect rewarming seizures and guide clinical management.</jats:p>

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

“…Twelve studies reported the relationship between absence or presence of seizures in children after cardiac arrest and good neurological outcomes at PICU/hospital discharge, 6 months, and 12 months. 175,188,189,191,198,199,[205][206][207][208][209][210] These studies included 1165 children, and 4 of the 12 studies reported using the ACNS criteria. 189,205,208,210 Absence of seizures up to 24 hours after ROC had a sensitivity of 50% to 100% with an FPR of 63% to 98% for predicting good neurological outcome at various time points.…”

“…189,205,208,210 Absence of seizures up to 24 hours after ROC had a sensitivity of 50% to 100% with an FPR of 63% to 98% for predicting good neurological outcome at various time points. 191,205,208,209 Absence of seizure after 24 hours had a sensitivity of 50% to 100% with an FPR of 42% to 100% for predicting good neurological outcome. 175,188,189,191,198,199,202,208,210 Absence of Status Epilepticus Absence of status epilepticus was reported in 3 studies.…”

“…The predictive ability of presence of pupil reactivity to classify good neurological outcome was evaluated in 8 studies [186][187][188][189][190][191][192][193] in 402 patients within 1, 6 to 12, 24, and 72 hours after resuscitation. Most studies had a sensitivity >82% at all assessment times, and the corresponding FPR ranged from 3.2% to 67%.…”

“…191,205,208,209 Absence of seizure after 24 hours had a sensitivity of 50% to 100% with an FPR of 42% to 100% for predicting good neurological outcome. 175,188,189,191,198,199,202,208,210 Absence of Status Epilepticus Absence of status epilepticus was reported in 3 studies. 205,209,210 Two of these studies used ACNS criteria to define status epilepticus.…”

“…The relationship between coma assessment using the GCS motor score alone or total GCS and good neurological outcome at ICU discharge, hospital discharge, and 6 months was evaluated in 3 studies 191 , 193 , 194 including 296 patients. In 1 study, GCS motor score of ≥4 within 1 hour and at 4 to 6 hours after ROC had a sensitivity of 17% and 50% for predicting good neurological outcome at 6 months, with a corresponding FPR of 6% and 7%, respectively.…”