Nonconvulsive Status Epilepticus: The Encephalopathic Pediatric Patient

Abstract

A high prevalence of NCSE was observed, comparable to adult studies, but within a wider range of inpatient settings. Children with acute encephalopathy should undergo continuous EEG. This evaluation is more urgent if certain clinical risk factors are present. Optimal duration of monitoring and the effect of NCSE on prognosis should be studied.

Electrographic seizures in pediatric ICU patients

“…15,27 A number of single-center studies have demonstrated an association between electrographic seizures or electrographic status epilepticus and worse outcome in critically ill children. 11,12,14,16,17,28 Our data also indicate that electrographic status epilepticus was associated with higher mortality, even after adjusting for the neurologic diagnosis category and initial EEG background category. However, the current data cannot establish whether electrographic status epilepticus is a modifiable risk factor for mortality or is a nonmodifiable biomarker of severe brain injury leading to mortality.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] The majority of electrographic seizures were not accompanied by any clinical signs, 1,3,8,[10][11][12][13][14] even in nonparalyzed patients. 1,14 Therefore, accurate seizure identification requires CEEG.…”

“…Data obtained from CEEG reportedly affect clinical management in 59% of monitored children, most often by affecting anticonvulsant utilization. 15 Several studies have reported an association between electrographic seizures or status epilepticus and worse outcome, 11,12,16,17 occurring independently of potential confounders related to acute etiology and critical illness severity.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] This variability is likely due to the smaller size of these cohorts, variability in case mix across institutions, and interinstitution variability in CEEG indications. Furthermore, previous studies were performed over nearly a decade, during which CEEG indications and other components of critical care have evolved.…”

“…These are consistent with risk factors identified in smaller singlecenter studies, although the associated risk can be better quantified in this larger cohort. Reported clinical risk factors for electrographic seizures in children include younger age, 1,10 preceding convulsive status epilepticus 10 or clinically overt seizures, 11,13 and structural brain injury, 11,13 including traumatic brain injury 10 and hypoxic-ischemic brain injury after cardiac arrest. 9 Reported electrographic risk factors include epileptiform discharges, 10,13 periodic epileptiform discharges, 3 and lack of background reactivity.…”