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Nonconvulsive status epilepticus: the encephalopathic pediatric patient
Hansel M Greiner1, Katherine Holland, James L Leach
1Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. hansel.greiner@cchmc.org
Nonconvulsive status epilepticus (NCSE) is common in children across various hospital settings. Urgent continuous electroencephalography (EEG) is recommended for pediatric patients with acute encephalopathy, especially if clinical seizures or neuroimaging abnormalities are present.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
- Critical Care Medicine
Background:
- Nonconvulsive status epilepticus (NCSE) prevalence varies in critically ill children.
- Previous studies primarily focused on intensive care unit (ICU) populations.
- Understanding NCSE prevalence in broader pediatric inpatient settings is needed.
Purpose of the Study:
- To determine the prevalence of pediatric NCSE across all inpatient settings.
- To identify clinical risk factors associated with NCSE in children.
- To inform the urgency of continuous electroencephalography (EEG) monitoring.
Main Methods:
- Retrospective chart review of patients aged 3 months to 21 years.
- Inclusion criteria: clinical EEG database search (n=18) and consecutive inpatient NCSE referrals (n=57).
- Analysis of medical records for NCSE diagnosis and associated clinical factors.
Main Results:
- NCSE was identified in 35% (26/75) of the studied pediatric patients.
- A witnessed clinical seizure (92%) and acute neuroimaging abnormalities were frequent in NCSE patients.
- Clinical seizures plus neuroimaging abnormalities predicted NCSE with 82% probability.
Conclusions:
- Pediatric NCSE prevalence is high, similar to adults, and occurs beyond the ICU.
- Continuous EEG is crucial for children with acute encephalopathy.
- Urgency for EEG increases with specific clinical risk factors like seizures and neuroimaging findings.
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