The prevalence of seizures in comatose children in the pediatric intensive care unit: A prospective video‐EEG study

Abstract

Summary Purpose: Studies in adult and neonatal intensive care units (ICUs) report a high prevalence of epileptic seizures in comatose patients. The prevalence of seizures in pediatric ICUs is variably reported in a few retrospective studies using different electroencephalography (EEG) methods. We aimed to determine prospectively the prevalence of epileptic seizures (clinical and subclinical) in comatose children in the pediatric ICU using continuous video‐EEG (v‐EEG) monitoring. Methods: We performed v‐EEG in consecutive children aged 2 months to 17 years admitted to the pediatric ICU with sustained depressed consciousness over a period of 15 months. Results: We monitored 100 comatose children, 69% within 24 h of ICU admission. Median length of ICU stay was 5 days. Median duration of v‐EEG was 20 h. Epileptic seizures were identified in only seven patients, of whom six had a history of epilepsy with witnessed seizures immediately prior to v‐EEG. All epileptic seizures were recorded in the first 3 h of v‐EEG. Seizures were suspected by ICU staff in 18 monitored patients, only four of whom had confirmed epileptic seizures. Discussion: The lower prevalence of epileptic seizures and the shorter length of ICU stay in children compared to adults and neonates suggest a different spectrum of disease and neurologic response. Short‐duration v‐EEG in patients with a history of prior seizures, epilepsy, or clinical events suspected to be seizures seems more appropriate than routine v‐EEG in all comatose children in the pediatric ICU.

Nonconvulsive seizures are common in critically ill children

“…7 However, our data differ from a recent prospective study that reported only 7 of 100 comatose children who underwent cEEG had electrographic seizures. 12 Several issues may underlie this difference. First, the subjects enrolled had different primary medical problems.…”

“…4 -11 One prospective study reported that only 7% of 100 comatose children had seizures detected by cEEG. 12 In this prospective observational study of critically ill children who underwent clinically indicated EEG monitoring, we aimed to 1) determine the incidence of NCS and NCSE in critically ill children using predefined institutional practice criteria for cEEG, 2) identify clinical features predictive of seizure occurrence, and 3) determine the duration of cEEG required to identify the majority of patients with seizures.…”

Electrographic seizures in pediatric ICU patients

“…[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.…”

“…[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.…”

Pediatric Neurocritical Care

“…The majority of patients with NCS had NCS exclusively. In contrast, using strict enrollment criteria (consecutively admitted patients with a Glasgow Coma Scale of <8 and not rapidly improving, as after anesthesia) Shahwan et al [155] diagnosed NCS in only 7 of 100 pediatric patients, and 6 of these had witnessed clinical seizure activity prior to initiating the monitoring. Although patient characteristics may partially explain these discrepancies, they also suggest that without rigorous enrollment criteria it may be very difficult to circumvent the introduction of ascertainment bias into such studies [147].…”