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Continuous video EEG for patients with acute encephalopathy in a pediatric intensive care unit
John M Schreiber1, Tesfaye Zelleke, William D Gaillard
1Department of Epilepsy, Neurophysiology, and Critical Care Neurology, George Washington University School of Medicine and Health Sciences and the Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
Insights
Electrographic seizures are common in pediatric acute encephalopathy, occurring in 30% of patients. Continuous video electroencephalogram (cVEEG) monitoring for at least 24 hours is recommended, especially for young children or those with prior clinical seizures.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Epileptology
Background:
- Acute encephalopathy in children admitted to the pediatric intensive care unit (PICU) can be associated with electrographic seizures.
- Identifying these seizures is crucial for appropriate management and prognostication.
Purpose of the Study:
- To determine the incidence of electrographic seizures in pediatric patients with acute encephalopathy.
- To identify risk factors for electrographic seizures.
- To assess the optimal duration of continuous electroencephalogram (EEG) monitoring.
Main Methods:
- A prospective database was used to extract data from 94 consecutive pediatric patients with acute encephalopathy monitored with continuous video EEG (cVEEG) for up to 48 hours.
- Data included patient demographics, clinical information, and electrographic seizure occurrence (non-convulsive seizures [NCS] and non-convulsive status epilepticus [NCSE]).
Main Results:
- Electrographic seizures were detected in 30% (28/94) of patients, including 18% with NCSE.
- Younger age (<24 months) and prior clinical seizures were associated with a higher incidence of electrographic seizures.
- The majority of seizures (97%) were captured within the first 24 hours of cVEEG monitoring.
- Acute brain injury and electrographic seizures correlated with poorer outcomes.
Conclusions:
- Electrographic seizures are a frequent complication in pediatric acute encephalopathy.
- Continuous video EEG monitoring for a minimum of 24 hours is supported for these patients.
- Monitoring should be prioritized for children under 24 months and those with preceding clinical seizure events.
Objectives:
In this study, we aimed to determine the incidence of electrographic seizures among patients in a pediatric intensive care unit (PICU) presenting with acute encephalopathy. Risk factors and duration of continuous EEG monitoring needed to capture electrographic seizures were also assessed.
Study Design:
Based on a NeuroICU clinical care pathway, all patients with acute encephalopathy admitted to the PICU are monitored with continuous video electroencephalogram (cVEEG) for 48 h or until the encephalopathy improves. Ninety-four consecutive patients included on the pathway over a year were identified. Mean age was 6.7 years (range 32 days-17.9 years). Data pertaining to patient clinical information and electrographic seizures, including non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE), were extracted from a prospective database.
Results:
Thirty percent (28/94) had seizures captured on cVEEG including 17 patients (18%) with NCSE. Variables associated with electrographic seizures were age <24 months and clinical seizure(s) prior to EEG placement. The first seizure captured on cVEEG occurred in the first 24 h for the majority of patients (97%). Acute brain injury and electrographic seizures were associated with worse outcome.
Conclusions:
Electrographic seizures are common in pediatric patients with acute encephalopathy. This study supports the practice of cVEEG monitoring for at least 24 h in pediatric patients with acute encephalopathy, particularly if they are less then 24 months of age and/or if a clinical event suspicious for seizure precedes the encephalopathy.
